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| NAVIGATOR: Home: Treatment FAQs: Non Surgical: Dermal Fillers | 03 September 2010 | ||
Dermal Fillersor simply scroll down.
Background InformationDermal fillers are made of various kinds of natural and man-made or synthetic materials that have been developed over the years for injection into the skin.
This is not a new treatment. As early as the 1890s, doctors could take fat from patients’ arms and inject it into their faces. In fact, fat is still a popular substance used by some practitioners today who can move fatty tissue from an area of the body where it is not required and inject it somewhere else. If you would like to find out more about this treatment, please go to our fat transfer section. In the mid 1900s, doctors were using paraffin and then silicone as a filler in the skin, with some reported problems regarding safety that prevented them being used widely. In the U.S.A. in the 1980s, scientists discovered a type of collagen (a filler material) which occurs naturally in cows’ skin that proved to be safe in humans. At this point, the use of fat as a filler material was overtaken by this new collagen. According to Statistics from the American Society for Aesthetic Plastic Surgery, (ASAPS), collagen injections were the 13th commonest aesthetic procedure in the U.S. with more than 59,000 treatments in 2009 alone, (42.7% of these procedures used bovine-derived collagen products and 57.3% used human-derived collagen products). Although we previously noted that when comparing 2006 to 2005, 2007 to 2006 and 2008 to 2007 figures, the results showed a decrease in the use of collagen products, the 2009 figures actually show an increase of 1.4% over 2008 results. Previous years' drops had been attributed to rises in the use of hyaluronic acid based dermal fillers and others (i.e. calcium hydroxlapatite, poly-l-lactic acid and polymethyl methacrylate dermal fillers), however some of the non-HA products have shown a decline in use in 2009, perhaps with some clients returning to collagen. The hyaluronic acid based dermal fillers (Hylaform®, Restylane® & Juvederm®) are now the 2nd commonest aesthetic procedure in the U.S. (up from 3rd in 2008) with over 1.31 million treatments in 2009, (an increase of 4% on 2008 figures). With calcium hydroxlapatite (Radiesse™) accounting for just over 118,000 dermal filler procedures, (a fall of 3.7% in its use since 2008), poly-l-lactic acid (Sculptra™) nearly 40,000, (a dramatic increase of 23.8% on 2008), and polymethyl methacrylate (Artecoll®) showing as a new entry in 2007 since US FDA approval with just over 7,000 procedures in 2009, a fall of 35% on 2008. Although similar statistics are not yet available in the U.K., there has been tremendous growth in the use of collagen and other dermal fillers in this country. More people than ever are having this treatment because it works, it is not as expensive as a face lift and it doesn’t involve any surgery. As the use of these products has grown, so has the choice of different filler substances. Since the late 1990s, some manufacturers have been claiming that their products last longer than older fillers, and even that their effects can be permanent. If you are considering a dermal filler procedure, the following information will give you a basic understanding of what's involved. It can't answer all your questions, since a lot depends on the individual patient and the practitioner. Please ask a practitioner about anything you don't understand.
What are Dermal fillers and how do they work?As the skin ages, it gradually loses some of its collagen and fat. These are the materials that prevent the skin from becoming saggy. Thus, as we age, our skin can become thinner and more wrinkled and lined.
Background image provided courtesy of Q-med Limited. What are the different types of Dermal fillers used?Dermal fillers tend to be broadly classified as being either non-permanent or permanent in their effect by both manufacturers and practitioners using these products. Collagen treatment has been widely used to increase the size and volume of lips in women for a number of years, and this is still the most popular use for most dermal fillers. What happens during Dermal Filler treatment and how long does it take to recovery?During your first visit to a clinic, you should explain what you expect from a dermal filler treatment and how you would like to look afterwards. Your practitioner should discuss any potential problems connected with the treatment, such as allergies. You must discuss which filler is best for you and how much it will cost.
For instance, if bovine collagen is recommended, you will be advised to have a skin test where a small amount of collagen is injected into your forearm to see if you have an allergic response. This skin test is only currently recommended for products containing bovine collagen. Other dermal fillers can be used without a skin test. The area injected will be checked after 2 - 3 days and again after 4 weeks to see if there is any swelling or tenderness. Around 3% of people will have a positive skin test preventing them from having treatment with bovine collagen. The practitioner should take a medical history to make sure that there are no reasons why you shouldn’t have the treatment. Then you will usually be asked to read detailed information and sign a consent form which means that you have understood what the treatment may do, along with any potential side effects from the filler(s) being used. Photographs may also be taken by the practitioner for a “before and after” comparison of the treatment. The consultation, skin test (if appropriate), or maybe even an initial treatment might happen in your first visit, if your skin suits the filler recommended and you are comfortable in going ahead with the treatment. If not, you will simply be given a second appointment to begin your procedure.
Animations provided by MEDiVision
Do dermal fillers hurt and what are the side effects?Depending on the area injected and the type of filler or pain control used, patients may find the procedure relatively painless to mildly uncomfortable. Treatments around the nose or lip areas are usually more painful. It is important that you follow the advice of your practitioner carefully after dermal filler treatment. This will help you to gain maximum effect from the procedure and reduce the risk of complications.
Post-treatment advice may include:
 Additionally, when you leave a clinic after a dermal filler treatment you are likely to suffer from varying degrees of redness depending on the areas treated, which may not be the most attractive face that you wish to present to the public as you walk down the street. There is however a solution.Lycogel® are the first truly breathable, completely safe camouflage and concealer products that oxygenate skin at the cellular level, and are suitable for immediate use after cosmetic procedures such as dermal fillers. Doctors, skin specialists, aestheticians and beauty therapists use Lycogel® Camouflage & Concealer, because it is the only foundation that has the ability to promote the healing of damaged or postprocedural skin and can be used on the skin immediately following treatment, allowing you to face the world without a red face.
Few clinics currently offer this product, or any camouflage make-up, as part of the treatment service, so be prepared and take it with you. Lycogel® is available in a variety of shades to suit all skin colours.
For more information and to buy Lycogel® Camouflage and Concealer, please click here. Who should not have a dermal filler treatment?As in any treatment to the skin, injections should be avoided in areas where the skin is swollen or where infections are present – e.g. active acne. This will reduce the risk of infection at the injection site after the treatment.
Photographs provided courtesy of Q-med Limited.
Photographs provided courtesy of Euromedical Systems Limited.
Photographs provided courtesy of Cloverleaf Products Limited
Photographs provided courtesy of Q-med Limited.
Photographs provided courtesy of Q-med Limited.
Images provided courtesy of Dr David Eccleston at MediZen
Images provided courtesy of Marea Brennan Thorns RGN at MBNS Clinic.
Images provided courtesy of Dr.Geoff Fairris, Dermatologist at the Wessex Skin Clinic.
Images provided courtesy of MediZen Clinics Ltd
(All before and after photographs are real patients, your results may differ).
Dermal fillers are categorised by the UK medical authorities as medical devices. This means that practitioners do not need to write a prescription to use these treatments. Manufacturers recommend that only medically qualified practitioners should use collagen and hyaluronic acid or other dermal filler treatments. Thus you will find many nurses, as well as general practitioners, cosmetic doctors, dermatologists, plastic surgeons, ophthalmologists (eye specialists) and even some private dentists offering one or a range of dermal filler options. Manufacturers do not recommend that beauticians or any other person outside the medical profession use these treatments. As there are many different fillers on the market that can be used to treat a variety of problems, please ensure that your practitioner has undergone proper certificated training for both the use of the specific filler, and the area that they are treating. Please go to our Find a Clinic section to find a clinic or practitioner specialising in this treatment.
We do not know exactly how many treatments using dermal fillers, or indeed what type of fillers, are currently being used in this country. We do know, however, that they are an increasingly popular cosmetic procedure. As fillers are technically regarded as “medical devices” in the U.K., there are few restrictions to prevent them being used. Some members of the medical profession are concerned about the recent growth in new fillers available in the U.K. and feel that more studies should be performed on them to see how safe they are and how long their effects can last. The two most widely used products in the U.K. are collagen and hyaluronic acid. Both these fillers are used by thousands of practitioners on millions of patients across the world. Their results are generally safe and very effective. The final result, however, is dependent upon the type of filler which the practitioner uses, the problems you want treated, and the skill of the practitioner. Make sure that they are experienced with the filler that they are using, and ensure that your idea of a pleasing aesthetic result, particularly when these products are used for lip enhancement, is the same as yours!
Costs vary depending mostly on the type of dermal filler used and the degree of filling to the skin required. Generally prices for fillers are based upon the estimated number of syringes needed to obtain the required result. Deeper lines and wrinkles tend to require more filler than shallow lines. In addition, fillers used more for facial sculpting, contouring and addition of volume will tend to me more expensive than those just used for treating single lines. A combination of fillers may also be recommended, and for certain areas additional treatments with other agents such as botulinum toxin (Botox®) may also be suggested, (especially for lines in the upper part of the face).
In addition, collagen based filler brands such as Evolence and Zyderm or Zyplast and hyaluronic acid brands such as Restylane, Perlane, Puragen, Hydrafill and Juvederm differ in price to clinics and practioners who purchase them from the respective manufacturers. Hence, overall prices may vary from £150 to over £750 per treatment session.
Remember, using less filler than is actually required to fill out a line or improve the contour of the face properly will generally produce a less pleasing and less long lasting effect than opting for a proper (and more expensive) treatment.
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