Dermal fillers are one of the most important and useful advances in cosmetic medicine for the past 20 years, and can be put to good use in nearly every client seeking cosmetic rejuvenation - surgical or non-surgical. But what are they exactly?
The word "dermal" refers to the dermis, which is the lower layer of the skin containing all of the skin's collagen, elastic fibres, blood vessels, nerve endings, sweat and oil glands. (The upper layer, called the epidermis, consists mainly of cells which are constantly sloughed off and replaced from underneath - it functions as a protective barrier against sunlight, temperature and weather.)
As we age, our dermis tends to get thinner, while the epidermis gets thicker. We lose collagen and elastic fibres, and the skin becomes less resistant to deformation, starts to droop, and forms wrinkles. Loss of dermal thickness also leads to a "thin-skinned" look which can make our faces look pinched. This process is accelerated by the cumulative effects of sun damage.
Dermal fillers are designed to replace the missing collagen underneath wrinkles and in facial hollows, thereby reversing the visible signs of ageing. Modern dermal fillers are made via synthetic processes in the laboratory, and allergic or hypersensitivity reactions are very rare. Let's have a look at some of the best-known products currently on the market:
Restylane has largely replaced Collagen. It is the trade name for cross-linked hyaluronic acid, a complex sugar molecule lattice which can hold many times its own volume in water. Hyaluronic acid occurs naturally in the body - hence it is very safe, but also tends to be reabsorbed within a few months. Restylane comes in various "thicknesses" and is hence very versatile, being used both for fine wrinkles around the eyes and mouth, and deeper wrinkles such as the nasolabial and marionette lines. Perlane is a thicker version or Restylane which is useful for lip augmentation and deeper contour defects. The thickest version, Sub-Q, is useful for volumising cheeks which have become hollow and saggy. The results from Restylane are very natural and tend to last for around 6 months, although there is variation between individuals. Some clients maintain their improvement for over a year!
Surgiderm, Hylaform, Esthélis and Juvéderm are all made from hyaluronic acid, and the results tend to be similar to those from Restylane. Some surgeons prefer a particular brand - there are slight variations in the consistency and "feel", as well as the duration, from product to product.
Sculptra is the trade name for L-polylactic acid, which acts partially as a filler and partially as a "dermal thickener" - this is because it stimulates collagen formation by dermal fibroblast cells. Much of the filling/thickening effect of Sculptra in fact comes from new collagen made by the body, rather than from the product per se. Sculptra is especially useful for correcting cheek hollowness. Its effects take a few weeks to appear, but can last for up to 18 months.
Radiesse is a relatively new, long-acting filler from the USA. Consisting of tiny crystals of calcium hydroxylapatite (which is also the main constituent of bone) embedded in little spherules of hyaluronic acid, this filler can be used for deep wrinkles, cheek volumisation, and even as an implant to enhance jawlines, chins, noses and cheekbones. Radiesse lasts for 18-24 months, has a very low risk of side-effects, and due to its versatility, it is a powerful tool for overall non-surgical rejuvenation of the ageing face.
Aquamid is the only truly permanent filler on the market. This is wonderful, unless something goes wrong! The risk of an adverse reaction is said to be around 1 in 100, and can be further reduced by ensuring that the injection is given using strict sterile technique, and that the product is never used close to the surface of the skin. Aquamid has its main use as a deep filler, hence it is sometimes referred to as "an implant delivered through the tip of a needle".
Copyright ©2007 Dr Tony Prochazka
