Top 7 Fears with Dermal Fillers

Dermal fillers are prescription-only products. Before they are allowed to be prescribed, fillers need to be studied for their risks.

Fillers need to be injected by licensed medical professionals.

These services are medical procedures and carry risks, which your injector will discuss with you before going ahead with treatment.

Patients commonly think that dermal filler will change their appearance dramatically after one treatment, however, the amount of filler injected will depend on the area that the injector is going to treat. The amount and placement  varies from person to person.

Patients prior to treatment often think 1 ml filler is a lot. Actually, 1 ml of dermal filler is equal to 1/5 th of a teaspoon- not much at all! When placed correctly it is just enough to give patients a very subtle look.

Patients can get more than 1 syringe of dermal filler in one treatment but injectors can tailor the amount to the subtletly requested by the patient.  It is ideal for a patient to have a series of appointments to achieve their expectations.

Therefore,  in general, patients will not look fake /frozen after the treatment unless they choose to do too much too quickly OR they love the overfilled look and want other people know they have done something on their faces.

Most patients prefer the natural look and will walk out of clinic with a natural but subtly improved face.

There is a common misconception that the skin will go more saggy/ look older after filler fully absorbed by the body. First, as we age, facial bone changes (bone loss), muscles fall due to gravity, fat pads get thinner and descend, and skin sags and droops downwards due to collagen and elastin loss.

Fillers are made of a substance which naturally exists in the skin and helps retain water, enhances facial volume, restores natural facial contour, and smooths away facial lines.

An experienced and careful injector will add a subtle amount of volume to the skin and subtly restore structure and soften permanent fine lines, any skin stretching will be minimal.

Even you require to have a large amount of fillers to your face, fillers should not be injected in a way that they overstretch skin.

Fillers are metabolised over time, and results will fade without making any dramatic changes to your facial appearance.

Adverse effects can be classified into 3 types – mild, moderate and severe. The mild side effects include redness, swelling, bruising, pain, tenderness, rash,itching. Most of the common side effects are minor and will disappear on their own.

The moderate side effects can be infection, granulomas (a type of inflammatory reaction to the filler), late-onset inflammatory response. Moderate side effects required treatment which is usually conservative, e.g. oral antibiotics, oral steroid, hyaluronidase, or corticosteroid injections.

The severe side effects are vascular. Vascular occlusions can lead to necrosis, scarring and even more seriously, blindness and or stroke. A vascular occlusion occurs when blood is no longer able to pass through a blood vessel. It may be caused by an internal obstruction, such as filler material, or occurs as a result of external compression, such as too much filler around blood vessels. The signs of VA include severe pain, blanching, dusky/purple discoloration, coolness, delayed capillary refill time, blue/grey appearance. In some cases, it might be possible to resolve the occlusion with conservative methods, like massaging, tapping or heat applied to the area. However, if conservative methods fail, hyaluronidase (hyalase) should be administered without delay. Hyalase is an enzyme which breaks down dermal fillers. Vascular compromise and blindness are reported but rare complications. Stroke is an even rarer complications resulting from intraarterial injection of fillers.

In our clinic, all the injectors have a detailed knowledge of the three-dimensional anatomy of the area being treated. They also understand the distribution and depth of vessels of the treated area and possible variations of these. Experienced cosmetic injectors will minimise the risks of adverse effects, but these complications are still a risk even with the best education and experienced injectors.

After the filler is dissolved by hyaluronidase (hyalase), the treated area should return to the patient’s natural appearance over time. Hyalase should not permanently affect your natural tissues. It will not destroy natural tissues such as collagen, but it can break down your body’s product that is similar to the filler but your body will reproduce this product.

If patients have a significant amount of filler and they dissolve this, then their naturally aged face will look different to the filled version they are used to after they dissolve the filler. They may not be used to this look and think they look worse, but this is just their face with a reduced amount of tiller

Our experienced injectors will choose the dosage of hyalase according to which filler was originally used and how much product is there. Often dissolving might require more than one session to dissolve the filler to achieve patients’ expectations.

Dermal filler injections are not very painful but may cause some discomfort as they go under the skin. The pain will subside. After injections, you may

experience mild pain/soreness at injections sites. The pain should go away after 12-48 hours. The lips tend to be the most sensitive area to inject. However, patients generally find the treatment tolerable and that the results are worth it.

It is always important to follow up with your injector to address your concerns.

At the Manse Clinic, we offer multiple methods to make treatments as close to pain-free as possible.

First, we may apply topical numbing cream to numb the injections area before treatment. The one we are using currently is very effective. We normally leave the numbing cream to injection area for 10-15 mins before injection. It makes a

big difference in the comfort level, especially for lip filler.

Second, we may recommend to apply the ice pack to the injection area for a few seconds before each injection, which will decrease the pain and constrict the blood vessels to minimise the bruising.

Third, we may offer stress/squeeze ball to patients. When you squeeze a stress ball, your nerves and muscles stimulate and contract which makes them stronger. The strength improve the overall nervous system, which minimise essential hormones, control your stress level, improve your concentration and therefore distract you from treatment.

Fourth, we may offer nitrous oxide, which is a gas and is commonly known as happy gas. Happy gas is a colourless, odourless gas which

can provide temporary and reversible sedation and comfort, help reduce the pain and anxiety during the procedure. Patients may feel like they have had a few glasses of wine, but it will wear off reasonably quickly.

In addition to these methods, all the fillers also contain lidocaine, a local anaesthetic. This local anaesthetic helps numb the injection area to reduce the

associated pain during the procedure.

Generally speaking, dermal filler can more expensive than anti wrinkle treatment. However, it may last about 2-4 times longer than anti wrinkle treatment. Fillers, depending on their specific chemical makeup, can last from six months to 2 years before being gradually absorbed by the body. After their filler building treatments are complete and they come back for maintenance treatment, the amount required may be less and therefore maybe not as expensive as during the building phase.

The most commonly used dermal fillers  can last for 6-12 months, while other dermal fillers can last up to 2 years or more. Also, many things can affect dermal filler longevity. If patients have a high metabolic rate or often exercise regularly, they may metabolise the filler more quicker than others. If patients have fillers done in more mobile areas like lips and peri-oral area, the longevity of the filler may get affected as well.

Also, small dose injections will dissipate more quickly than larger doses.

Generally, we prefer to review/reassess the filler result every six months.

Patients notice that after several treatments it appears that filler has increased longevity,