The approach to the aging face takes into account the various changes, and different treatment strategies to target the multiple components of the aging process. Fillers treatment are not just effective at filling lines, they also have an important role for facial restoration and volumization. Many studies have shown that fillers treatment together with botulinum toxin wrinkle treatments gives longer lasting results.
Our face undergoes many changes as we age. The changes in facial anatomy occurs in many layers; affecting our skin, fat, muscle and bone. As we progress through time, our body breaks down collagen, as well as a reduction in new collagen synthesis and hyaluronic acid. Ageing is determined by genetic, hormonal changes, metabolic processes, environmental and lifestyle factors. Early, and chronic exposure to the sun will lead to the skin losing its elasticity and pigmentation more prominent. Smoking up to 20 cigarettes a day accelerates the effects of skin aging by up to 10 years!
So many brands! Which one to choose?
Fat was the first filler substance used. In the late 19th century, Dr. Neuber, a German surgeon transplanted fat from the arm of a man to fill a facial defect. Today fat grafting is a common procedure to volumize the face and many body areas, but the average fat survival rate is only about 25% to 30%, and the procedure is associated with surgical risks. Collagen fillers entered the market in the early 1980s, but were associated with allergic reactions, did not last very long (3-4 months on average), and were derived from animals thereby raising concerns of cross infection.
Today, with the advancement of biocompatible fillers and a greater understanding of age related changes, there is an ever increasing number of fillers treatment entering the market. It can be indeed be overwhelming for a consumer to decide which works best for you.
What is the Ideal Filler Treatment?
To understand which fillers treatment to go for, you need to know the individual properties of the fillers. A consultation with your doctor to discuss the benefits, suitability and level of expected improvement is needed before any filler procedure. Individuals vary, and so does the treatment response.
The ‘ideal’ filler would have properties of being consistent, and having sustained results over time. It is bio-compatible, non-allergenic, free of complications, feel and look completely natural. The filler has to biodegrade naturally overtime because a permanent filler that remains when the rest of the face changes due to aging will lead to an undesirable result.
The ideal filler would be able to stimulate collagen and provide a greater lifting effect. In addition, there has to be an element of reversibility in case the results are not desirable, and the option to handle filler related complications.
Although there is no ‘ideal’ filler at present, with modern day science we are getting close.
Hyaluronic Acid Fillers
(Restylane, Juvederm, Belotero)
Hyaluronic acid (HA) fillers are gel based injectable fillers. Hyaluronic acid forms an integral part of human tissue; it provides a supporting framework for collagen and elastin to bind. It hydrates the skin due to its water binding ability, volumizing the treatment areas and reducing lines, wrinkles and folds.
Although abundant in youth, the passage of time and environmental factors such as UV exposure depletes the presence of hyaluronic acid within the skin. The arrival of Hyaluronic Acid (HA) fillers in the USA in the 2003 disrupted the way we look at fillers and has since become the dominant filler type used today.
Modern day HA fillers treatment are non-animal sourced derived, have low allergic potential, lasts much longer (up to 2 years), and has a greater element of safety. HA fillers are reversible with the enzyme, Hyaluronidase, in cases of filler related complications, giving this an important edge over other fillers.
Calcium Hydroxylapatite Fillers
Radiesse is a calcium hydroxyapatite (CaHA) filler. The CaHA particles act as a scaffold for new tissue formation and collagen deposition. These CaHA microspheres slowly degrade over time by the body’s metabolic pathway.
Radiesse is well suited for soft tissue enhancement. It is well-tolerated, safe and last at least 12 months. Radiesse cannot be used on the lips because it would cause the lips to look and feel lumpy. Another disadvantage is the lack of reversibility in cases where the filler produces lumps or require correction.
Poly-L-lactic acid Fillers
Sculptra consists of micro particles of poly-L-lactic acid (PLLA). Following injection of PLLA into the skin, an inflammatory response leads to fibrous tissue formation and subsequently volumization.
While results can last more than 2 years, multiple treatments are needed for a desirable result. Typically, 3 injections over several months are required to improve wrinkles, lines and volumize the face. There is also a higher risk of causing lumps beneath the skin, and there is currently no reversing agent to correct this.
Ellanse is one of the newer fillers recently launched in the aesthetic market. Ellanse consists of polycaprolactone smooth microspheres suspended in an aqueous carboxymethylcellulose gel vehicle.
It works by not only filling up your lines and wrinkles, but also by stimulating your body’s own collagen for longer lasting natural results.
Although it can lasts 1-4 years, and only one fillers treatment is needed, there is a lack of reversibility for this particular agent.
Face Fillers Treatment Areas
Who is not a good candidate for Fillers treatment?
- Breastfeeding or Pregnancy
- Active skin infection or inflammation
- Autoimmune diseases
- Multiple severe allergies and hypersensitivities
- Recent plastic surgery e.g. rhinoplasty
- On blood thinners or pre-existing blood clotting disorder
Holistic Approach to Aging
While fillers treatment provide volume restoration, and reduced the appearance of lines and wrinkles, a comprehensive approach is require to tackle the various aspects of aging. Fillers can be safely combined with the following:
What are the side effects of Fillers treatment?
The most common side effects are temporary injection side swelling, discomfort and bruising, which typically fade in 7 days.
Some individuals may develop lumps under the site of injection. This is more common under the lower eyelids where the skin is thinner and on the lips.
Quite uncommonly, fillers may lead to skin infections and may trigger an allergic reaction in susceptible individuals.
A serious but fortunately rare complication of fillers treatment is the accidental injection of filler into the blood vessel. This can cause the skin that is being supplied to the blood vessel to die if steps are not taken to salvage it on time. There have been cases of individuals going blind following filler injection, especially to the nose and forehead filler injections, as the blood vessels supplying these areas share the same path to the eyes. The use of Hyaluronidase, an enzyme to dissolve the Hyaluronic acid filler has been invaluable to avert many filler related complications.
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- Kontis TC. Contemporary review of injectable facial fillers. JAMA Facial Plast Surg. 2013 Jan. 15(1):58-64.
- Lacombe V. Sculptra: a stimulatory filler. Facial Plast Surg. 2009 May. 25(2):95-9.
- Pavlovic M, Adamic M, Schuller Petrovic S. The actual role of hyaluronic acid-based and calcium hydroxylapatite soft tissue fillers: a guide for a practicing dermatologist. G Ital Dermatol Venereol. 2012 Jun. 147(3):295-314.