So what exactly are fillers and how can they improve one’s appearance?
To understand this one must understand a little bit about how the face ages. Aging is a complex process involving both internal and external factors. External aging occurs due to environmental stressors like UV radiation and pollution while internal aging occurs on account of the internal programming that each cell of the body has. These lead to the breakdown of structural proteins in the skin, of which the most important is collagen. The same factors also lead to the depletion of something known as hyaluronic acid (HA) from the skin. HA belongs to a class of skin proteins called mucopolysaccharides or glycosaminoglycans and it is these proteins that fill in the deeper layers of the skin producing healthy firm skin structure. Think of these as gels that insert between the structural proteins of the skin (viz. collagen) and thereby support the skin. Facial fat, unlike fat in other parts of the body, is organized into well defined fat pads that are strategically located to produce outward facial appearance. Now when the supporting structures of the skin deplete with age (called volume loss), this leads to the sagging of these fat pads under the effect of gravity, and this produces problems like lines along the sides of the nose (nasolabial lines) and mouth (mentolabial lines), hollowing of the mid face producing grooves under the eye as well as dark circles, and excess skin hanging over the sides of the jawbone (jowls).
Anything which is injected into the skin to correct this volume loss is called a Filler, or more appropriately, a Dermal Filler. In the past this included temporary fillers like collagen (e.g zyplast, zyderm) as well as permanent fillers like silicone. These days the most popular fillers are those containing Hyaluronic Acid (HA). As we saw earlier, this is a key structural support and volumizing agent in the skin. Popular brands include Restylane, Perlane, Juvederm and Fortalis. All of these contain the same molecule (HA) but in differing concentration and viscosity (thickness). Thicker fillers last longer and need to be injected deeper, producing volume correction, while thin fillers are injected more superficially and can smoothen out superficial wrinkles. They each have their role and can even be combined if required. There are other fillers like Radiesse (a calcium salt), Sculptra (poly-L-Lactate) and Aquamid (polyacrylamide) and they can all give great results when used appropriately but the one advantage that HA fillers have that others don’t, is reversibility. What this means is that given the unlikely situation of you not liking your look after the filler, it can be dissolved and removed in a matter of days restoring your previous appearance. This is done with an enzyme called Hyaluronidase. The availability of this enzyme makes HA fillers the safest fillers on the market and enable doctors to tailor results to just how the patient likes it.
So, do you need filler?
Well that can only really be assessed through an in-person consult but here are some broad guidelines. Fillers can be used to enhance or correct. For the former usually a small amount of filler is sufficient – something like Juvederm Ultra/Ultra Plus or Restylane can be injected into strategic points in the face to enhance a person’s appearance. Indications include augmenting the cheekbone, defining and shaping the lips, correcting nose droop and filling in temple hollows. For these indications even a little filler can produce amazing results. For correcting signs of skin aging more filler is required and this is injected deeper to both fill depleted areas as well as act as a scaffold for correcting structural changes that have happened with age (e.g lifting the jowels, filling in lines along the nose and/or mouth). Juvederm Voluma, Perlane and Modalis are fillers that do a great job at this.
How long do fillers last?
The perennial question. The answer to this is that there is no one time frame that will work for everyone because how fast a filler is used up depends on factors like how mobile that part of the face is, what other procedures the patient got done after filler, how much filler was injected relative to patient need and how fast the person’s body breaks down the filler material. That said thinner fillers (e.g Juvederm Ultra, Restylane) usually last about a year while thicker fillers (e.g Juvederm Voluma) last two years or more.
Are there any side effects?
The newer HA based fillers are very safe and have virtually eliminated problems which sometimes occurred with older fillers like allergic reactions, bumpiness and skin nodule formation. So apart from occasional, temporary, bruising (lasting 7-10 days or less) the procedure carries no real risk. There have been rare cases reported in the literature in which inadvertent injection of filler material into a blood vessel produced skin necrosis, however this is not a real problem for the common areas that are injected and even in the cases reported patients recovered with adequate management.
What if I don’t repeat a filler again after this one wears off, will my face become worse than before?
No it will not. You will just lose the benefits of the filler and your face will gradually go back to how it used to be. Repeated filler injection can also stimulate collagen synthesis, according to new data which is emerging, and in patients who have taken fillers for 5 years or more there may be long term benefits of this collagen even if they stop taking fillers.
How long does the procedure take, and is it painful?
Patient’s may complain of some discomfort during the procedure but this can be minimized by injecting very slowly and applying a numbing cream on the area to be treated for 30-60 minutes before the procedure. Alternatively fillers with built in anaesthetic (e.g Juvederm Ultra XC, Restylane-L) can be used to make the procedure painless. The procedure typically takes between 30-60 minutes. There may be mild redness and swelling for a few hours thereafter but you can go right back to work the next day.
Will the filler make my face look artificial?
This is where the skill of the person injecting the filler comes into the picture. A good injector will produce results that are completely natural and apart from compliments about how good you look, no one will notice that you had something done. A novice injector will not produce the same results and hence it is well worth the time spent researching your doctor before taking the plunge.
What is the difference between Botox and Fillers?
Botox is a protein that works by temporarily paralysing or relaxing some muscle groups while fillers have no such action and work by producing a volumizing effect. Botox cannot do what fillers do and vice versa. Broadly speaking Botox has more of a role in treating the upper face (above the eyes) while fillers have more of a role in the mid and lower face (below the eyes). For this reason they are often used together to enhance both parts of the face simultaneously. Fillers give immediate results while Botox takes about 7-10 days.