Everything You Need to Know about Dermal Fillers

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Everything You Need to Know about Dermal Fillers


Thinking about getting dermal fillers? From anti-wrinkle injections to lip plumping and jawline sculpting, dermal fillers have boomed in popularity over the past 5 years. These nonsurgical, seemingly ‘non-invasive’ procedures can have instant cosmetic outcomes and limited recovery time.

But, there is still a lot to weigh up before you decide to go under the needle. From knowing exactly what to ask for to checking if your practitioner’s legit, WH spoke to cosmetic physician Dr Bibi Ghalaie to find out everything you need to know. Interested in filler? You have to read this first…

What is dermal filler?

‘Dermal fillers are gel-like substances that are injected beneath the skin to restore lost volume, smooth lines and soften creases, or enhance facial contours,’ Dr Ghalaie explains. ‘They are made from a variety of substances and are generally categorised by what they are made of.’

What are the different types of dermal filler?

Interestingly, there is not ‘one filler fits all.’ The type of filler you have injected can depend on a few things: where you’re having filler placed, your practitioner’s preference and cost. It’s super important to know which filler you’re having injected – as this could impact aftercare, or what you need to know, should something go wrong.

‘HA fillers are made of hyaluronic acid, a naturally occurring substance already found in our skin and is a major contributor to skin hydration and plumpness,’ explains Dr Ghalaie. ‘They are soft and gel-like, and last 6-22 months, after which the body absorbs the particles. Most HA fillers are infused with lidocaine (an anaesthetic) to help minimise discomfort during treatment.’

‘Examples of HA fillers include Teoxane’s RHA range and this is the range I use in my clinic. I do a lot of under eye rejuvenation and Teoxane’s Redensity 2 product is the only filler licensed for treatment of the tear troughs in the UK. Other HA fillers are Juvederm products, Restylane products and the Belotero range.’

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‘Calcium Hydroxylapatite (CaHA) is another substance, found naturally in our bones, that is used to make dermal fillers. CaHA fillers are thicker and last longer than hyaluronic acid filers and they help stimulate collagen production. They are best used for deeper lines and wrinkles and an example is Radiesse.’

‘Poly-L-Lactic Acid (PLLA) is a biocompatible (safe to use in the body), biodegradable synthetic substance. It has been used for many years in medical devices, such as dissolvable stitches. Poly-L-lactic acid products are technically classified as “collagen stimulators,” as their main mechanism to smooth fine lines is by helping your skin rebuild natural collagen—the filler gel itself dissipates a few days after treatment. PLLA is typically used to treat deeper facial wrinkles, and results can last more than 2 years. An example of a PLLA filler is Sculptra®.’

What are some of the risks involved?

Dermal fillers are injectables and as with any injectable procedure, there are risks involved.

For starters, there’s the possibility of infection pre and post-treatment. ‘The skin is punctured, often repeatedly, meaning there is vulnerability to infection by way of bacteria entering through the needle punctures,’ Dr Ghalaie explains, who stresses that following post-procedure advice is equally important to prevent infection.

Another major concern is that fillers can also migrate from the site of infection, particularly if the wrong type of filler is used in the wrong area of the face or injected in the wrong plane. ‘They can cause lumps (again due to poor choice of product or poor injection technique) and if a filler is injected inappropriately it can become visible externally and can cause a blueish tinge to the skin, called the Tyndal Effect,’ he adds.

There are also some severe cases in which the immune system can react to dermal fillers or when fillers are inadvertently injected into a blood vessel in the face, which could block blood flow and lead to death of the skin (necrosis), blindness or even a stroke.

Why is it so important to visit a qualified expert?

Put simply, it’s essential to visit a qualified expert because of the aforementioned risks involved in dermal filler treatments which, in severe circumstances, can have life threatening consequences. These are not beauty treatments, says Dr Ghalaie, but medical treatments that carry serious risks and experts will know whether the patient should consider an alternative avenue or treatment instead.

‘[I believe that] Dermal fillers should be classified by the government as a drug and should be treated with the same regulations, restrictions and caution as other drugs,’ explains Dr Ghalaie. ‘They require extensive training for safe injection and medical qualifications are necessary for the safe management of their risks and complications.’

A trained medical clinician will also understand not only how best to avoid complications but will also have in depth training of how to manage any complications if they do arise. ‘They should also have prescribing rights to be able to prescribe antibiotics, hyalase (the dissolving enzyme), steroids, and various other medications needed in managing filler complications [if you should need them],’ says Dr Ghalaie.

Training aside, qualified medical practitioners are part of larger organisations, so patients can feel confident that they can escalate higher up if something happens during or after the procedure. ‘Beauticians and non medics are not accountable in this way and may not even need insurance to practice aesthetics.


7 things you should know before getting dermal filler

Dr Ghalaie outlines the 7 things you must know (and ask) before getting any kind of dermal filler treatment. Consider this your injectable checklist…

1. Know the risks

‘You should know the risks involved in the procedure you are seeking, and this should be an extensive in-person conversation between the injecting clinical and the individual.’

‘I have lost count of the number of times I have consented a patient who has had numerous dermal fillers in the past and they tell me they were never before given the information I discussed with them. The potential complications must be discussed and how these would be managed should form part of the conversation.’

2. Have realistic expectations

‘You should have a realistic understanding of the expected outcome and what is achievable and what is not. The patient and their practitioner must be on the same page and a treatment plan should be agreed by both.’

3. Look for qualifications

‘Ask for the qualifications of your practitioner and your practitioner’s level of experience. Any practising doctor in the UK should be registered with the GMC and their GMC registration number can be verified by anyone online. Similarly any dentist must be registered with the GDC and nurses with the NMC.’

‘I would encourage patients to ask their practitioner how many relevant procedures they have carried out in the past and how often they perform the said procedure. For example, if someone wants to have their tear troughs injected, they should not be going to a doctor who mainly injects lips and does a few tear troughs every month, rather they should be seeing a clinician who injects the under eyes daily and can present a portfolio of their results along with their complication rates.’

4. Know complication rates

‘You should ask about the practitioner’s complication rates and adverse events. A reputable medical professional will conduct yearly or biyearly audits of their work and will be able to present the patient with how many cases of infection, migration, nodules, granulomas, Tyndall etc they have had.’

5. Ask about complaints

‘You should also ask what the clinic’s formal complaints procedure is and how the practitioner will manage them if you are dissatisfied or if a complication occurs.’

6. Check insurance

‘You should ask about the clinician’s insurance/indemnity and what level of cover the clinic has.’

7. Ask for the specifics

‘Finally I feel it is very important for the individual being treated to know exactly what product is being used in their face. I find it astonishing how frequently patients have no clue what they have been injected with, and, similarly, how frequently it can be seen that practitioners are using poor quality fillers. I make a point of informing my patients that I use Teoxane fillers and explaining why they are safe and why they can rest assured that they are high quality products. This conversation is so important.’

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