Facial Dermal Fillers

• What can dermal fillers do to enhance facial contours?
• How can dermal fillers help treat these conditions?
• Are there different types of dermal filler?
• How safe are dermal fillers?
• What happens before the treatment?
• What happens during the treatment?
• What happens after the treatment?
• Juvéderm® ULTRA Facial Dermal Filler
• Restylane Dermal Fillers
• Sculptra Dermal Filler
• Frequently asked questions

Dermal fillers are injected into your skin to fill lines, enhancing your facial contours and lips for natural-looking results. They are injected into the deeper layers of skin at the site of sunken areas, creases, or scars to smooth out and 'plump up' the area for a firmer, more youthful appearance. Depending on your particular needs, your Consultant Plastic Surgeon may recommend using combinations of different types of fillers for the best results. The two most popular materials used are HA and collagen: these are both temporary fillers. Aesthetic Surgery Ireland do not use permanent fillers owing to potential safety concerns.

What can dermal fillers do to enhance facial contours?

1. reduce lines in the forehead and the eye area
2. enhance the size and shape of your lips
3. help disguise nasolabial folds
4. reduce laugh lines
5. fill hollow cheeks and sunken scars

It is important to note that dermal fillers generally cannot help dynamic wrinkles including lines caused by muscle action (e.g. crow's feet), very deep lines from sagging skin, neck lines and eye lines caused by eye bags.

The most appropriate lines to treat with fillers are those that are described as 'static': this means lines you can see when your face is still. Also they are used to enhance, or 'plump up', your lips, for soft, subtle results.

How can dermal fillers help treat these conditions?
Lips reach their fullness in our late teenage years or early twenties. Aging causes the lips to lose volume and become thin and flat.The appearance of lips is also affected by a multitude of other structures including skin, fat, muscle, teeth and bones. Aging changes affect all these components and contribute to the less attractive lip appearance. With advancing age, skin becomes less elastic and the sun damage contributes to the loss of lip edge definition, wrinkles and irregular pigmentation. The facial fat changes with respect to its amount and its distribution and combined with changes in muscle, loss of jawbone and teeth height result in loss of lip support. These support structures frequently need addressing to prevent or correct the down turning of lip corners.

In addition to lines, lost facial and cheek volume may also be a concern. Many women want to restore the lost volume from their cheeks that can leave them looking flat or hollow. Some women start to use make-up as a means of overcoming this loss of volume in their lips and cheeks.

Are there different types of dermal filler?
Depending on your particular needs, your Consultant Plastic Surgeon may recommend using combinations of different types of fillers for the best results. The two most popular materials used are:

(i) Hyaluronic acid (HA), and
(ii) Collagen.

(i) What is hyaluronic acid?
Hyaluronic acid (HA) is a polysaccharide that keeps your skin moisturised and gives it its elasticity. HA is present throughout our bodies, with 50% of it located in the skin. It occurs naturally in the deeper layers of our skin (the dermis), where it helps to keep skin smooth and 'plump' through its amazing ability to hold up to 1,000 times its weight in water. A way to think of HA is as our skin's own natural and internal moisturiser.

HA is plentiful in our bodies when we are born, but its levels gradually decrease over time. In fact, 50-year-olds are estimated to have less than half the amount of HA they had in their youth. The drop in HA starts at around the age of 18 to 20 years and, by the age of 40, signs start to show—skin starts to lose its elasticity and volume as lines and wrinkles appear.

Injectable HA gel is a modified form of the HA that occurs naturally in your body. Injections help fill in and smooth away facial lines, acne scars, or other skin contour deficiencies.

(ii) What is collagen?
Collagen is a protein chemical substance that is the main support of skin, giving it underlying strength. As you age, it's normal for your skin's natural collagen to become depleted. Collagen replacement therapy adds support to your skin's natural collagen to restore its resilience and strength and recapture its youthful appearance. This treatment swiftly erases lines, softens scarring, and solves the problem of lack of lip definition or fullness. By supporting the skin's natural collagen, filler made from collagen helps minimise lines and scars, improves texture, and gives the skin a softer and more even tone.

What is the difference between HA and collagen?
HA and collagen are different substances but both are found naturally in your skin. Collagen helps provide your skin its structure and elasticity whereas HA serves to provide volume and internal moisturisation for your skin. HA filler smoothes your skin, helping to correct skin defi ciencies and improving facial lines typically found between the eyes and around the mouth area. Collagen filler helps support the collagen network within your skin. By supporting the skin's natural collagen, collagen filler helps minimise lines, improves texture, and gives the skin a softer and more even tone.

Because they play different roles in restoring your skin's natural vitality, collagen and HA may be used together for the soft, subtle results you want. However, HA is now far more widely used in clinics because it can be administered at your very first appointment, whereas in order to be treated with collagen you will need to undergo an allergy test first.

How safe are dermal fillers?
As a naturally based biological material, HA is similar to your body's natural HA and so does not require a skin test prior to treatment to test for allergic reactions. Collagen fillers support the natural collagen found throughout your body, in skin, muscle, tendon, and bone. To help ensure the safe administration of collagen fillers, a skin test is performed before treatment to help minimise the risk of allergic reaction.

Treatment is usually relatively painless or just slightly uncomfortable, and your surgeon may use a local anaesthetic for increased comfort. Immediately after treatment it's perfectly normal to experience temporary minor:

• stinging
• discolouration
• bruising
• to moderate redness and
• swelling

Typically, these responses are temporary and, if they do occur, will usually go away within a couple of days. It's also normal to experience temporary puffiness of the treated areas, especially with injectable collagen.

If any of these symptoms last more than a day or two, be sure to tell your Consultant Plastic Surgeon. There's a small risk of allergic reaction to the filler. If you have a history of cold sores, you may experience an outbreak of cold sores after treatment. This can be minimised by the use of anti-viral medicines before treatment.

What happens before the treatment?
Before the treatment, your Consultant Plastic Surgeon will evaluate your skin type, discuss your health history, answer your questions and discuss your goals and expectations for the treatment.

Because HA is so similar to the HA that occurs naturally in your body, you won't need a skin test prior to treatment. If you're planning to undergo collagen injection, you'll need to have a skin test one month before treatment to reduce the risk of allergic reaction.

What happens during the treatment?
The surgeon shall prepare the area for injection by administering a topical anaesthetic cream unless the dermal filler being used contains an anaesthetic ingredient. A fine needle is then inserted just under the skin and the filler injected as the surgeon slowly withdraws the needle. Typically HA and collagen procedures will last 30-45 minutes depending on the number of areas for injection and assuming you have been given the all clear for the collagen allergy test.

You should recover almost immediately and be ready to return to work or home. Some bruising may occur and possibly last up to 7 days. Swelling may also occur for up to 3 or 4 days especially with lip treatments, or 2 days with nasolabial lines. In general, the effects of treatment with temporary fillers last from three to 5 months.

What happens after the Treatment?
After treatment with dermal fillers, the lines on your face should appear minimised and smoothed out. If your treatment plan included lip enhancement, you will notice that your lips appear fuller and more defined. If your plan included adding volume to your cheeks, you will notice that your cheeks look plumper and your face looks younger.

After your initial treatment your Consultant Plastic Surgeon may ask you to come back after about two weeks for a checkup to ensure you are happy with the results. Occasionally a little top-up is needed to ensure you are getting the look you desire.

Recovery may take few hours to a few days, depending on the area treated and the type of filler used. Most people find that they can return to work or go about their normal daily activities immediately after treatment.

After your initial dermal filler or collagen treatment, you should notice visible results immediately. You should notice a smoothing of lines. Also, if your treatment plan included it, you'll notice fuller, more defined lips.

You may experience temporary swelling and some reddening: any swelling can be reduced by using ice soaks over a 10 minute period every 4 hours. If swelling does not reduce after a few days you should contact your surgeon immediately.

Please note: that with all procedures there is a possibility of patient dissatisfaction with the outcome.

Allergic reaction to anaesthetic
In very rare cases anaesthetics can cause allergic reactions. The best current estimate is that a life-threatening allergic reaction (also known as anaphylaxis) happens during one in 10,000 to one in 20,000 anaesthetics. Your anaesthetist will choose the drugs for your anaesthetic by taking into account many different factors, in particular, the type of operation, your physical condition, and whether you are allergic to anything.

Most people make a full recovery from anaphylaxis. It isn’t known how many anaphylactic reactions during anaesthesia lead to death or permanent disability. One review article suggests that one in 20 serious reactions can lead to death. This in effect implies that the chance of dying as a result of an anaphylactic reaction during anaesthesia is between one in 200,000 and one in 400,000 anaesthetic procedures.

For additional information regarding this procedure please consult with your Consultant Plastic Surgeon.

Juvéderm® ULTRA Facial Dermal Filler
Juvéderm® ULTRA is a range of smooth consistency gels made of hyaluronic acid (HA) – a naturally occurring substance in your skin that helps to hydrate and add volume. Juvéderm® ULTRA is injected under the skin to instantly restore your skin’s volume, smooth away facial wrinkles and folds and redefine lips.

Because of its smooth consistency Juvéderm® ULTRA gel flows easily into the skin for a smooth, natural look and feel. Juvéderm® ULTRA gel is unique in that it contains 0.3% Lidocaine to reduce injection pain for a more comfortable experience.

The range of Juvéderm® ULTRA fillers includes 3 formulations of viscosity allowing for a choice of volume for fine, standard and deep wrinkles and folds.

Restylane Dermal Fillers
Restylane enhances your natural looks by restoring your skin’s volume, creating softness and revitalizing your appearance.

Youthful skin is rich in hyaluronic acid. As we age, the distribution and function of hyaluronic acid in our skin gradually change, leading to the characteristic signs of aging. Restylane gels work by enhancing your skin’s own stocks of hyaluronic acid, directly adding volume to either soften the signs of aging or enhance your features.

With tissue-tailored solutions for a wide range of aesthetic indications the Restylane range of dermal fillers offers unparalleled versatility. The ‘tissue tailoring’ enables the Restylane gel to match the density of the target tissue, resulting in optimal lift and a more durable outcome. Included in the Restylane range are:
(i) Restylane for the mid dermis area
(ii) Restylane Lido, which incorporates an anaesthetic, and
(iii) Restylane Perlane™ which is designed for deeper wrinkles and folds.

Restylane is supported by an extensive body of clinical evidence.

Frequently Asked Questions

1. How long do the effects of Evolence® last? Evolence® is clinically proven to last up to 12 months: this should be seen as a general indication and not as a guarantee for your particular case.
2. How long does the procedure take? Injections of Evolence® should normally take approximately 15 minutes and you can return to normal activities shortly afterwards.
3. Is Evolence® suitable for all areas of the face? Evolence® is suitable for the nose, ears, cheeks, nasolabial and chin while Evolence® Breeze™, which has a more finely textured consistency, is more suitable for the lips(both fullness and outline) mouth corners and smile wrinkles.

Sculptra®

Natural Collagen Stimulation
Sculptra® is a long lasting, clinically-proven treatment than can smooth deep lines and wrinkles and restore facial volume lost to the body's natural ageing process.

The improvement is gradual, long-lasting and gives you an entirely natural-looking fuller face. Clinical studies have shown that the results last for two years after the final treatment has been completed, significantly longer than other injectable treatment.

Sculptra® is an injectable volumising treatment that stimulates the build-up of the body’s own collagen to smooth out lines and wrinkles and restore lost facial volume to give you a fuller, younger-looking face.

With Sculptra®, you can restore facial contour and eliminate lines, wrinkles and sunken cheeks without resorting to face lifts or cosmetic surgery.

Sculptra® is a an injectable synthetic material that contains skin-smoothing microparticles to help lift and smooth sagging skin, wrinkles, creases, dark circles, and scars.

A proven treatment
The main ingredient of Sculptra® is poly-l-lactic acid, which has been successfully used in surgical operations for more than 25 years. Sculptra® was specially developed to repair facial scars and contour defects. Sculptra® is long lasting, biocompatible, and biodegradable.

Which parts of the face is it suitable for?
Sculptra® is a non-surgical cosmetic treatment that can help to correct:

• Deep folds between the nose and the mouth (nasolabial folds)
• Folds around the corners of the mouth (marionette lines)
• Sunken cheeks
• Wrinkles and lines in the cheeks or chin
• Deep scars

Why Sculptra®?
The effect of Sculptra® cosmetic treatment is gradual and exceptionally natural looking. Two or three treatments are usually required, and the benefits may become noticeable after about six weeks. Clinical studies have shown that the results of Sculptra® can last for up to two years, which is considerably longer than many other injectable aesthetic treatments. Sculptra® is well tolerated. The main ingredient is biocompatible and biodegradable.

No allergy testing is needed before treatment.

Frequently Asked Questions

How often would I require treatment?
Follow-up treatments are usually required to maintain the effect. Collagen treatment effects last three to five months. Keep in mind that everyone's skin is different; the timing of any additional wrinkle treatment will vary from person to person. When repeat treatments occur over time, either the interval between appointments becomes longer, or less product is required to achieve the same results, or more areas can be treated with the same amount of product.

What type of qualified clinician should administer my treatments?
To help ensure that you get the best results possible, you should choose an experienced Consultant Plastic Surgeon or Dermatologist who understands your goals for treatment and who has the necessary training to optimise your treatment outcomes.

Are there any reactions to treatment?
Reactions can include temporary discomfort, discolouration, or mild to moderate redness and swelling at the injection site. Typically these responses are temporary and, if they do occur, will usually go away within a couple of days. It's important to tell your consultant about redness, visible swelling, or other questionable symptoms that persist for more than a few days.

Treatment with collagen is not for everyone. A small number of patients develop an allergic reaction after one or more treatments. Patients who develop an allergic reaction can be treated with hyaluronic products. An experienced Consultant Plastic Surgeon can help reduce these risks.

Do I need to take an allergy test?
For collagen, yes. For HA, no. If you're planning to undergo collagen injection, one month before treatment you'll need to have a skin test to reduce the risk of allergic reaction. Once the test demonstrates that you aren't allergic, you're free to proceed with your treatment. Because HA gel is so similar to the HA that occurs naturally in your body, you won't need a skin test prior to treatment.

Is dermal filler treatment painful?
You may feel an initial sting but only for a moment. Your qualified consultant may apply a local anaesthetic to numb the area prior to the procedure. This should help dull the sensation of being pricked during the injection. Dermal filler treatments are relatively painless due to the use of local anaesthesia. These may be applied topically or injected at the treatment site to numb the area prior to the procedure.

For additional information regarding this procedure please consult with your Consultant Plastic Surgeon.