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Dermal Fillers for Scarring

Author: Dr Naomi / 27 Oct 2015

Before and after 2 treatments of dermal filler and 3 treatments of fractional laser

Before and after 2 treatments of dermal filler and 3 treatments of fractional laser

Before and after multiple treatments for acne scarring including fractional laser, dermal filler and skinbooster

Before and after multiple treatments for acne scarring including fractional laser, dermal filler and skinbooster

Before and after multiple treatments of dermal filler for scarring and volume, and fractional laser

Before and after multiple treatments of dermal filler for scarring and volume, and fractional laser

Image 1: Scar Before Image 2: Immediately after injections of dermal filler to scar Image 3: 2 weeks after treatment

Image 1: Scar Before Image 2: Immediately after injections of dermal filler to scar Image 3: 2 weeks after treatment

Dermal Fillers can lift depressions in the skin, so for an atrophic scar, where there is a depression in the skin, dermal filler can be injected under that depression to lift it and flatten the skin’s surface making typically the most obvious feature of the scar (the depression) disappear. This can be performed on all suitable scars on the face and body. he scars may have any cause from wounds to previous surgery

If the scar is tethered to the underlying structures then the lesion will have to be subcised (released from the tethering) which is a very simple procedure.

The dermal filler will give a great result immediately and also over the next few months, collagen will be stimulated due to the stretching of the fibroblasts with the dermal filler. This is useful as the skin is thin in the scarred areas.

See acne scarring page

Aging and scarring;

Dermal fillers are used to fill the scars in patients of all ages. A problem which occurs over time with patients with scarring is: as the normal volume loss associated with aging occurs, the bone and soft tissue including fat dissolves, causing the scarring to appear worse over time. This means that to adequately treat patients with scarring, the doctor should be constantly alert to any volume loss and replace this.

The other thing which occurs with aging and scarring is that wrinkles and folds will form in the scars. Dermal fillers should be injected beneath the scars to support these scars to prevent this from happening and if wrinkles have already etched in, then in addition, dermal filler should be injected to lift the wrinkle.

TREATMENT OF SCARS WITH DERMAL FILLERS 

Choosing the type of dermal filler for the scarring

We use several different types of dermal fillers for scarring. We cannot use their names due to Australian regulations, which makes it difficult to talk about how they compare to each other and the pros and cons of each.

Dermal filler reversible : These are safe and well tolerated, with great results to fill the depression associate with  scars. The larger particle size fillers are best for volume loss

Biostimulators are good for structural filling and can be used for volume loss and  scarring

Permanent fillers are not suitable to be used at too superficial a depth in the skin.

Dose of dermal fillers for scarring

The dose required for acne scar filling is variable, it depends on the  patient’s anatomy, the scar and where the patient wants to get to in terms of results.

The doctor will assess the scarring and decide on the best dose after taking a history and examining the patient. If a patient has a history of complications with dermal fillers, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen to start with.

Typically, we would start with 1 mls  of dermal filler. Several treatments may be required

For volume replacement. it would depend on the anatomy how much is required.

Pain relief during treatment

A numbing cream (eg EMLA or LMX ) may be applied to the area prior to the treatment (45 minutes prior is ideal) Glad wrap may be used over the numbing cream to increase its effect.

Local anaesthetic may be injected prior to the procedure in the area

There is local anaesthetic in the dermal filler

Ice is always used to decrease pain and to reduce the risk of bruising.

Very rarely patients will use Penthrox for dermal filler in acne scars

Nitrous oxide (happy gas) is available for patients to use

What happens during the injectables treatment for  scarring itself?

The skin will be cleaned with alcohol/chlorhexidine.

Ice will be applied to the area briefly before treatment The doctor will inject using a very fine needle. Then pressure with gauze will be applied.

If a cannula is used, a small injection of local anaesthetic is injected into the skin and then a fine needle makes a small hole in the skin where the cannula is inserted. This can be used in volume replacement.

How will I look after dermal filler in the  scar?

There will be redness and swelling, and red dots at the injection sites.

Side effects /risks with dermal fillers in the scars:

Bruising occurs in a significant number of cases.

Swelling in the injection area will occur. This will last for aprox 48 hours

Infection is a rare complication, but always a possibility when the needle goes into the skin. Anecdotally, infections are more common in patients with acne scars who have dermal filler than those who don’t have acne scars. It may be due to the blood supply in scarred areas.

Necrosis (blood vessel being blocked, interfering with blood supply to the skin) is very rare. This could lead to scarring. The nose is susceptible to necrosis

Need for further treatment: It may  take several syringes and treatments to get to where the patient wants to be.

Scars will have variable levels of improvement

Instructions for care afterward

No makeup on the injected area for 4 hours

No heavy exercise that day

No spas no saunas, no hot yoga for 1 week post treatment

What to expect after the dermal filler  treatment for scarring?

The effect of the dermal filler will be obvious immediately

Most of the swelling from the dermal filler will have resolved by 2-3 days after the procedure. There may be a small amount of swelling for even 2-4 weeks after the procedure.

When should I have my next treatment?

The answer to this is very individual and depends on the patient’s anatomy, metabolism, the dose, the placement, the product etc. Typically with our most commonly used reversible dermal filler, the protocol is: If the patient is happy with the results at 1 month (ie there has been adequate fill) they should be treated at 6 months, then at 6 months and then once yearly. If the patient is not satisfied with the results at 1 month (ie more dermal filler is required to obtain the results that they desire), then further dermal filler should be injected every 1-3 months until the desired appearance has been reached, and then the patient should have treatment at 6 months, then 6 months, then once yearly

Cost of dermal filler in scars:

Cost is per syringe.

 Dermal fillers are from $620-$1400 per ml. In the first year 1-3 treatments may be required. After that, treatment should be yearly

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