DERMAL FILLERS

Dermal Fillers: Service

With age we become more sure of ourselves, better at our jobs, better able to communicate. We become better at a lot of things, but this comes with a price. The soft, supple skin that we had when we were in our twenties becomes wrinkled. Creases and folds appear on our cheeks and forehead, crow’s feet detract from beautiful eyes, and the face may become thinner as we lose the plumping fat underlying the skin.
With this simple and quick office procedure, injectable fillers can make you look as young as you feel. Once fillers are injected under the skin, they work by restoring volume and softness, easing the wrinkles and filling sunken areas and creases. Some injectables attract water to plump up the skin; other fillers stimulate the formation of the body’s collagen to keep the face younger looking longer. Each filler has unique properties and uses. Some have short term rejuvenating properties, lasting a few months, and others may provide benefits for years.
Dermal fillers come in a variety of materials and by numerous companies. The oldest Dermal Fillers were Collagen based (Cosmoderm, Cosmoplast, Zyderm, Zyplast, Evolence, etc). Cow collagen (bovine), pig collagen (porcine), as well as human collagen were widely used in the 1980s and 1990s. After 2000, Hyaluronic Acid also known as “HA fillers” ( Juvederm,Restylane, Perlane, Belotero,Captique, Hylaform, ) became more popular.
HA fillers are the most commonly used dermal fillers in Canada today. There are other types of fillers as well such as Radiesse (calcium hydroxylapatite or “Bone Cement”), Artefill and Bellafill (Polymethylmethacrylate “PMMA” microspheres in bovine collagen), Silicone, Sculptra (Poly-L-Lactic Acid) and even fat.

Dermal Fillers: FAQ

HYALURONIC ACID FILLERS

Popular temporary dermal fillers, including JUVÉDERM®, Restylane®, Teosyal®, Perlane®, and Belotero are comprised of hyaluronic acid, a non-allergenic substance naturally produced by the skin. Each formula offers unique benefits, though fillers are generally intended to add volume, smooth lines, and reduce the appearance of other bothersome skin conditions, such as acne scars. Furthermore, treatment can take place in as little as 30 minutes, with results often immediately visible. The results usually last 6-12 months.

Hyaluronic acid-based dermal fillers offer rapid rejuvenation with little to no downtime or recovery typically necessary. Additionally, many cosmetic fillers incorporate a local anesthetic to help optimize your comfort. Some of the areas commonly treated with cosmetic injectables include:

Smile lines (nasolabial folds)
Corners of the mouth
Marionette lines (from the mouth to the chin)
Jowls
Cheekbones
Temples
Forehead lines
Frown lines
Smoker’s lines (upper lip wrinkles)
Undereye bags

Some formulas may be able to provide lip enhancement for a fuller, more shapely smile. A customized treatment plan will be developed based on your unique needs and goals.

PROCEDURE, WHAT TO EXPECT?

WHAT ARE RISKS OF HYALURONIC ACID (HA) FILLERS?

On arrival you will fill out the medical intake questionnaire form. After having a consult with the doctor and letting her know what your area of concern is, she will advise you of what product will be best suited for that area. She will also let you know roughly how many syringes are needed to correct the problem area and what each syringe will cost. She will go over the treatment and potential side effect. If you decide to proceed, you will have to sign an informed consent form and agree to pay for the services. Photographs will be taken of you for documentation and comparison.

A topical anesthetic, numbing medicine is used to reduce the discomfort of the injection and left on for twenty minutes. The filler also has an anesthetic medication in it to help make the experience less uncomfortable.

The treatment site is cleaned first with an antiseptic (cleansing) solution.

Dermal fillers are clear transparent gels that are injected under your skin, into the tissue of your face using a thin needle or cannula.

The depth of the injection(s) will depend on the depth of the wrinkle(s) and its location(s)

Multiple injections might be made depending on the site, depth of the wrinkle, and technique used.

·Following each injection, the injector would gently massage the correction site to conform the filler to the contour of the surrounding tissues.

If the treated area is swollen directly after the injection, ice may be applied on the site for a short period of time.

There is a limited amount of filler that can be placed in some areas so for full correction additional treatments of dermal fillers may be necessary.

Most fillers have the same risks and side effects. Bruising and swelling can often occur from small hidden blood vessels that often get in the path of the needle penetrating the skin. Pain and discomfort can occur from the injections. Infection or allergic reactions are extremely rare but possible. Scar tissue, discoloration, lumps or asymmetry can occur. Blood vessel occlusion and skin loss and blindness are extremely rare but possible if the filler is accidentally injected into an artery. But for the vast majority of patients, the only issue is temporary bruising and swelling.
What are alternatives to Restylane, Perlane, Juvederm, Belotero?
Other types of fillers such as Bellafill, Radiesse, or Sculptra are alternatives to HA fillers. These fillers tend to last longer but are not reversible in case of adverse events. Although the idea of a long lasting permanent filler is very attractive, fillers are foreign materials and the body will try to mount immunologic reaction to dissolve them and if is it not successful in dissolving them it can lead to granuloma formation and other adverse events. So although Hyaloronic acid fillers are shorter lasting but they are reversible with use of an injectable enzyme and are ultimately safer as the body is able to get rid of them in a shorter period of time.

FAQ ABOUT DERMAL FILLERS

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HOW LONG DO HA DERMAL FILLERS LAST?

The effect of HA fillers, once the optimal location and pattern of cosmetic use is established, can last 6-12 months . The duration of effects is dependent on many factors including but not limited to: age, sex, tissue conditions, site of administration and movements in the area, general health, life style such as smoking, and sun exposure. The correction is thus very individual, and in most people last 6-12 months and in some cases shorter and some cases longer.

DERMAL FILLER PRE-TREATMENT INSTRUCTIONS

If you have a special event or vacation coming up, please keep in mind that you may want to schedule your treatment at least 2 weeks in advance.
You should not schedule any invasive procedures for 2 weeks before or after treatment with dermal fillers. These include but are not limited to:

Dental cleaning or dental work o Lesion excision or biopsy
Surgery of any kind
Internal device placement
Tattoo or permanent makeup
cosmetic treatments with laser, ultrasound, peels, facials or micro- dermabrasion.

History of surgical face lift and rhinoplasty will lead to denial of treatment of dermal fillers to the face or nose. As prior surgery changes the tissue and blood vessels of the area and will make injections very unsafe. If you have had these procedures done you should see your plastic surgeon.
It is recommended to discontinue the use of Aspirin, Motrin, Gingko Biloba, Garlic, Flax Oil, Cod Liver Oil, Vitamin A, Vitamin E or any other essential fatty acids at least 3 days to 1 week before and after treatment to minimize bruising or bleeding. Please consult with your primary physician prior to discontinuing any medications.
Avoid alcohol, caffeine, Niacin supplement, high-sodium foods, high sugar foods, refined carbohydrates, spicy foods and cigarettes 24-48 hours before and after your treatment. These items may contribute to increased swelling or irritation.
If you have a history of cold sores with outbreaks occurring more than 4 times a year, it is recommended that you are pretreated with medication prior to the injection treatments around or near the lip area. The medication will need to be initiated 2 days prior to your treatment visit and continue for one week after. Please see your primary care physician in obtaining the medication.
If you develop a cold/flu, cold sore, blemish, or rash, etc. in the area to be treated prior to your appointment, we recommend that you please reschedule your appointment until it resolves.
It is recommended to discontinue Retin-A 2-3 days before treatment to avoid any increased redness and irritation.
It is recommended that you wait at least 2 weeks to have dermal filler treatments performed if you had cosmetic treatments with laser, ultrasound, peels, facials or microneedling, etc.

Dermal Fillers: FAQ

DERMAL FILLER POST-TREATMENT INSTRUCTIONS

Do NOT, touch, press, rub, or manipulate the implanted areas for 6 hours after treatment. This can cause irritation, sores or possible scarring. It is best to sleep upright the first night to avoid sleeping on your face.
Avoid vigorous exercise, sun and heat exposure for 3 days after treatment.
Avoid submerging head under water for a full 24 hours after treatment; this includes pools, beach, bathtub, hot tub, etc.
Avoid Aspirin, Motrin, Gingko Biloba, Garlic, Flax Oil, Cod Liver Oil, Vitamin A, Vitamin E or any other essential fatty acids at least 3 days to 1 week after treatment. These items may increase bleeding and bruising.
Avoid alcohol, caffeine, Niacin supplement, high-sodium foods, high sugar foods, refined carbohydrates, spicy foods and cigarettes 24-48 hours after your treatment. These items may contribute to increased swelling or irritation.
Avoid the use of Retin-A or similar products (ex. Kinerase, Tazarac) 2 days after treatment to avoid increased irritation or redness.
Avoid cosmetic treatments such as laser, ultrasound, peels, facials or micro-dermabrasion for 2 weeks after treatment.
Try to avoid wearing makeup or lipstick until the day after treatment. Earlier use may cause pustules. If you must wear makeup, we recommend a good quality mineral makeup for the face or Aquaphor ointment for the lips.
Please report to your provider immediately if you have increased pain, swelling, redness, blisters or itching following your treatment. If you have a painful lump, blanching of the skin (stays white when pressed), or open sores that develop, please call the office immediately. If this occurs after office hours, please go to the nearest Emergency room as immediate intervention may be needed to prevent permanent complications.
Ice the treated areas for the next 24 hours. Place the icepack very gently on the area for 20 minutes and remove the ice pack for 40 minutes. Continue this pattern for 24 hours.
Please remember one side may heal faster than the other side.

DERMAL FILLER FORMS

Before proceeding with getting dermal fillers you would have to sign the consent forms. If you would like to have a smoother time in the clinic please review the following forms before coming in.

Dermal filler medical questionnaire

Dermal Filler informed consent form

Dermal filler pre and post treatment instructions

Photographic consent form

Dermal Fillers Before and After photos Courtesy of Allergan

Dermal Fillers: FAQ