What are dermal fillers?

Facial fillers, also called dermal fillers or injectables, are a nonsurgical way to give your face a lift. They’re used to fill in crevices, soften creases, and add volume to thin lips or shallow areas of the face. Facial fillers can also improve the appearance of scars caused by acne or life’s bumps, nicks and scrapes.

Board certified plastic surgeons at The Ohio State University Wexner Medical Center may combine facial fillers with other cosmetic procedures and nonsurgical skin rejuvenation.

Dermal fillers are among many therapeutic choices you can discuss with Ohio State’s plastic and cosmetic surgeons. Your doctor can consult with you about single or combined procedures. Ohio State offers high-quality skin care and spa therapies and facial treatment options such as Botox, dermaplaning and light therapy.

Why are dermal fillers used?

Age, skin conditions, genetics and lifestyle habits can cause subtle and not-so-subtle changes to your face. Facial skin stretches, thins and changes over time. Your face can also lose some of the fat just beneath the surface of the skin. As a result, lines caused by facial muscles that perform repeated functions — such as frowning or laughing and smiling — become more visible. Smile lines, crow’s feet and furrowed brows appear, and skin can take on a hollowed or sunken appearance.

Injectable fillers can diminish some of these unwelcome effects. The doctor uses fine needles to strategically deliver dermal fillers, which are medical-grade solutions that plump up problem areas. Facial fillers add fullness and volume to give your face a younger, healthier look.

Doctors can use facial fillers to:

  • Add fullness to thin lips
  • Fill in shallow areas of the face
  • Diminish lines, creases and wrinkles
  • Improve the appearance of recessed scars
  • Reduce the shadow effect of lower eyelids
  • Enhance facial contours and jawline
  • Restore damaged tissues and features after illness or injury
  • Treat facial wasting related to HIV treatment

Fillers can enhance your face and offer a temporary fix for minor flaws. If you have larger treatment goals, your doctor may recommend other options. In some instances, eyelid surgery or a brow lift may be needed to achieve the results you want.

Since the effects of dermal fillers eventually fade, your doctor can talk with you about routine touch-up appointments to get and keep your new look. Some people choose Ohio State’s nonsurgical therapies, including medical-grade services and products at Ohio State’s spa services as an alternative. Together, these therapies may delay the need for a facelift.

Medical applications of dermal fillers

Dermal fillers are sometimes part of a larger care plan for cancer reconstructive procedures [link to new cancer reconstructive surgery page in plastic surgery] to restore disease- or treatment-related damage to the nose, eyes, jaw or other areas of the face.

Plastic surgeons may use facial fillers in other types of restorative plastic surgery [link to https://wexnermedical.osu.edu/plastic-surgery/restorative-surgery-and-repair] after illness, trauma or accidental injury to the face or disease-related facial wasting conditions.

Types of dermal fillers

When it comes to facial fillers, there are many types and brands on the menu. Your doctor will help you select a high-quality product that’s best suited to your unique treatment goals. Commonly used fillers include:

Calcium hydroxylapatite (Radiesse and other brands)

This mineral-like compound is found naturally in bone tissue. It’s biosynthetically produced, which means no animals or animal products are used. Since this lowers your risk of an allergic reaction, you won’t need to have pre-treatment skin testing. This compound has a long safety record and stays in place without migrating, and complications are rare.

Calcium hydroxylapatite can give you natural-looking results. It’s used to minimize moderate or deep creases including smile lines, marionette lines (nose to mouth) and frown lines between the brows. It can also help add fullness to cheeks and facial contours.

Hyaluronic acid (HA) or Restylane

Hyaluronic acid is a natural substance found in your body’s soft connective tissues. It’s also used to provide cushioning and pain relief for arthritic joints. In addition to Restylane, brands of HA-based products include Captique, Hylaform, Juvederm, Puragen and many others.

HA can improve contour and reduce skin depressions caused by scars, injury or lines such as crow’s feet, frown lines and laugh lines. HA can be used to redefine lip borders and treat vertical “smoker’s lines” on lips.

Polyalkylimide (Aquamid and other brands)

This semi-permanent filler is biocompatible, which means it has doesn’t cause allergic reactions, so no allergy test is required. It is radio-transparent, which means it won't appear on X-rays and cause potentially confusing medical readings.

After the doctor injects polyalkylimide gel, a thin layer of collagen forms around it. This takes about four weeks. The collagen encircled gel enables the doctor to inject a larger volume of filler where needed. It’s stable over time and can be removed at a later date if desired.

Doctors can use this dermal filler to treat deeper wrinkles, plump up thin lips, and enhance your cheekbones and jawline. It’s a good choice to replace significant loss of facial volume in conditions such as facial wasting.

Polylactic acid (Sculptra)

This nontoxic, biodegradable synthetic filler is a stimulator, which means that it stimulates your body's natural production of collagen. Polylactic acid is widely used to fill in laugh lines, plump thin lips and treat deep folds around your nose and mouth.

Unlike other facial fillers, you won’t see immediate results. Improvements become visible gradually over the next few months as new collagen is produced.

Most people require three monthly treatments to achieve the desired effect. Each treatment re-stimulates your own collagen. It can take four to six weeks to see the full effect. This is semi-permanent, so you’ll still need occasional touch-ups.

Polymethyl-methacrylate microspheres (PMMA or Bellafill)

Doctors use this semi-permanent filler to treat medium-to-deep wrinkles, folds and furrows — particularly nasolabial folds, which extend from your nose to your mouth. It can help fill out pitted scars and give thin lips a boost. For facial wrinkles, PMMA may be an alternative to collagen replacement therapy or hyaluronic therapy. Your surgeon can go back and add more later, if desired, to achieve the results you want.

PMMA requires several injections to create volume. It can take up to three months before you see the full effects of treatment. A drawback of PMMA is that it can sometimes be visible under the skin if not properly applied. That’s why it’s important to choose a skilled plastic surgeon who understands the appropriate technique, which involves injection at the dermal subcutaneous junction using threading or tunneling methods.

Choosing the right dermal filler

Dermal fillers vary in chemical composition, how long they last and their degree of softness. Doctors select softer fillers for areas such as the lips and sturdier fillers for adding contours to cheekbones. Your plastic surgeon will discuss the pros and cons of each approach and other considerations.

Your Ohio State plastic surgeon will help you to choose the most appropriate type of filler for the areas you want to treat. You’re encouraged to ask questions, and you’ll be fully informed so you feel comfortable about your decisions.

How to prepare for treatment with dermal fillers

Before having facial filler treatment, you’ll consult with your Ohio State plastic surgeon in Columbus or at a surrounding outpatient location. The doctor will talk about your goals and evaluate your health, medical condition and skin condition.

Be prepared to provide information about any medications or supplements you’re taking. Your doctor will also ask about any past surgeries or cosmetic procedures you may have had.

The doctor will also look at these considerations and qualifications for dermal filler treatment:

  • Avoidance of smoking and substance abuse
  • Good physical health
  • Healthy skin care habits
  • No medical conditions that could affect healing
  • Positive attitude and lifestyle habits
  • Realistic treatment goals

Your doctor may examine, measure and take photos of facial areas to be treated. You’ll learn more about the treatment, filler types and recommendations, and expected results. Depending on the type of filler, you may have allergy testing. You’ll learn more about procedure steps and other details specific to you and your treatment.

What to expect if you have dermal fillers

During earlier visits, your doctor and practitioners will inform you about what to do and what to expect on the day of your treatment.

  • Your skin will be cleansed and prepared for treatment, including something to help prevent infection. The doctor may do facial mapping, which involves temporary marks on your face in areas to be treated.
  • You may get a topical anesthetic or an injected local anesthetic to ease any discomfort. Most people find facial filler injections to be uncomfortable, but reasonably tolerable.
  • Injections take a few minutes per area treated. The doctor injects, massages and evaluates the site, and may add additional filler if needed.
  • Typical treatment times can range from 15 minutes to an hour. Once treatment is finished, your practitioner will remove any markings and may give you an ice pack to ease swelling and discomfort.

After dermal filler treatment

After your procedure you may experience some tenderness and redness, swelling or bruising in the areas treated. This should go away within one or two days. Other temporary effects can include numbness and lumpy or hard areas that should resolve as the solution settles.

With many fillers, you’ll see immediate results in areas treated. Your face appears fuller and lines and skin flaws are diminished. Certain types of fillers take longer to work so results vary and may be delayed. Your doctor will talk with you about how soon you’ll see results and when you may need a touch-up treatment.

Most people can return to ordinary daily activities after treatment with no downtime. It’s best to avoid intense physical activity for a day or two. Your doctor will advise you about how to protect the treated skin. Topical ice and massage may help ease symptoms, as directed by your doctor.

Risks of dermal fillers

Facial fillers are considered safe for most people when done by qualified doctors like the expert plastic surgeons at Ohio State. However, certain conditions and other factors could increase the risk of complications.

Potential risks of dermal fillers vary depending on individual health, skin condition, the type of filler selected and areas treated. Possible risks include:

  • Acne-like eruptions
  • Bleeding or bruising
  • Infection
  • Lumps
  • Redness and swelling
  • Scarring
  • Skin rash
  • Uneven results
  • Ulceration or skin loss

Although it happens very rarely, facial filler can be unintentionally injected into blood vessels instead of beneath the skin. This can affect circulation and lead to skin loss, wounds or more serious complications in the area affected.

Your Ohio State plastic surgeon will carefully evaluate your health and condition for any individual risk factors. The doctor will be sure you’re fully informed before and after your procedure.

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