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Understanding the science behind dermal fillers: A comprehensive guide for aesthetic practitioners

Understanding the science behind dermal fillers: A comprehensive guide for aesthetic practitioners

Medically Reviewed by Mohsen Talani, MD on November 27, 2023 | Written by CBAM Author

Fillers are used to create a smooth appearance and fill wrinkles and folds, lip volumizing, cheek and face shaping, correcting deformities such as the nose and other parts of the body. It is important to learn more about hyaluronic acid and non-hyaluronic acid fillers, filler injection methods in different areas, lip filler injection techniques, facial contouring method using filler, ischemia management in filler injection before starting your practice in this field.

What is dermal filler?

Dermal filler is actually a filling material that is placed under the skin of an area of the body through surgery or injection. Among the fillers, Hyaluronic acid is a synthetic material that is the most popular and widely used rejuvenation and beauty technique as a minimally invasive, low-complication, cheap and immediate-result method. In most cases, filler injection is used to enhance the appearance of the skin and rejuvenation. The material used as a filler may be fat, HA or artificial prosthesis.

What are the indications for facial fillers?

In general, the use of fillers can be divided into the following 4 categories.

  • One of the uses of filler is to remove wrinkles and rejuvenate the face. Filler is used to eliminate deep lines such as frown line, laugh line and forehead.
  • Another use is injecting fillers for boils and removing atrophic and sunken facial scars. In this condition, filler injection complements other treatment techniques. You can always consider combination therapy during your patient assessment sessions.
  • One of the most important applications of filler injection is in removing defects and dissimilarity of facial components. In some people, the cheeks, lips or jaw are not symmetrical for various reasons. For this reason, fillers are used for facial contouring, which has a unique effect on the beauty of the face, because contouring is one of the most important principles of beauty.
  • The most important application of filler is to give volume and shape to the facial parts. For genetic reasons or as a result of aging, a part of the face may not have enough volume. This may also happen due to lifestyle or improper weight loss. In this case, filler injection is used to give volume to the lips, cheeks, jaw angle, etc. These are the patients that you will treat using fillers most of the time.

Are there different types of filler?

Many materials are used for filler injection, which we will mention below.

Hyaluronic acid (HA) filler

One of the most widely used substances used for filler injections is hyaluronic acid, which is a natural sugar. This substance is normally present in the human body and therefore the possibility of allergic reactions to it is low. The function of this substance in an acute state is to collect different parts of the skin when needed. This substance is considered one of the most popular types of filler because it is very low-risk and safe.

But since this substance is natural and normally exists in the body, it is easily absorbed by the body. As a result, hyaluronic type fillers last from 6 to 12 months, and after that, the patient has to inject and renew the filler. Therefore, before injecting hyaluronic acid, remind your patients that the effect of this injection is temporary and they need to be injected again after some time. Of course, hyaluronic acid also has long-term effects, and that is the increase in the amount of collagen production at the injection site, which can be seen well after repeated injections in the long term.

The injection of this substance is one of the solutions with the least side effects due to its naturalness and the presence of this sugar in the body in general. With a little practice and experience, you can safely inject this substance to your patient.

This type of filler is designed for the specific purpose of replacing lost volume or enhancing the structure of the face. The majority of the ones currently on the market contain a bit of local anesthetic so that the procedure is more comfortable when they are injected. One of the main advantages of this type of filler is that if required, it can be reversed by injecting a concentrated hyaluronidase into the area treated.

Calcium Hydroxyl Apatite (CaHA)

Calcium hydroxyl apatite is another substance has a higher viscosity than hyaluronic acid. This filler consists of very fine and microscopic components. Due to the greater viscosity of this filler, its durability is longer than hyaluronic acid, and its effects can be seen for more than one year. You should also pay attention to the fact that this substance is not used for all parts of the face and is generally used in areas that have deep fat.

Polylactic acid (PLLA)

Polylactic acid is a synthetic material that was used to produce suture thread in the past years. Polylactic acid filler is not a type of direct filler, but its effect appears after a certain period of time and by stimulating collagen production at the injection site.

This filler is usually used in the lower half of the face and in the place of the laugh line and smile lines, lip volume and cheek filling. Polylactic acid injection is performed in three or four periods of one month and usually has a semi-permanent and multi-year effect. Note that the only polylactic acid filler approved by the FDA is the Sculptra Aesthetic filler.

Fat cells

This method is more aggressive than other products. In fat injection, using techniques such as liposuction, body fat is removed and used as a filler product. This procedure requires anesthesia and may also cause complications at the site of extraction and injection. With all the mentioned cases, it is considered one of the safest products for filler injection. One of the advantages of this method is that the fat is obtained from the patient’s body and does not cause allergic reactions. Also, the durability of this method is much longer than other materials.

Are dermal fillers permanent?

In terms of durability, fillers are divided into three groups.

Permanent fillers

As it is clear from the name of these fillers, the body does not have the ability to break down these types of fillers, and as a result, they remain in the body permanently and for life. Polyacrylamide can be mentioned among these fillers. Fat is also included in this category, if it is injected with the right technique and by a skilled injector, it can remain in the body for many years without side effects.

Semi-permanent fillers

This category of fillers has more variety than the previous category and includes calcium hydroxyl apatite, polycaprolactone, poly-L-lactic acid, which last between 2 and 4 years. Injections of this type of fillers require special experience and skill because the points and considerations of injecting these types of fillers must be taken into account.

Temporary fillers

There are different types of temporary fillers available. One of the most widely used is hyaluronic acid filler, which, as we said, has less complications than other fillers and is very widely used. The durability of these fillers is several months, and according to the brand used and the body of each person, they have a durability of 6 to 18 months in the body, and after that, re-injection and repair are required.

What are the benefits of face fillers?

This method has many advantages over other treatment and beauty methods. The most important thing is that this method is less invasive. Filler injection is done without leaving any scars or stitches. It also has very few side effects. There is no need for recovery or rest, and the patient can continue his daily activities after the injection.

Another advantage of filler injection is seeing the result objectively, and if you see a defect, you can fix it. However, it should be noted that filler injection is associated with swelling in the desired area and the exact result can be seen after the swelling disappears. Some fillers also help to regenerate the skin and prevent it from sagging.

What are the risks of filler injection?

Like any other cosmetic and therapeutic method, filler injection may have side effects or disadvantages. The common side effects of fillers are completely temporary and local, which include swelling, redness and slight burning sensation in the area after the injection, which will go away over time and within a few days. Some more serious complications include:

  • Infection at the injection site
  • Damage to blood vessels
  • Hematoma and tissue damage

If you want to do the filler injection in the best way and get the best results, you need to increase your skills and knowledge. In CBAM we try to make it easier for you to start your practice in aesthetic medicine. Try our CBAM Board certified package if you want to have your own successful aesthetic medicine practice. This package is the ultimate bundle to enhance your skills in the field of Aesthetic Medicine. With access to all courses offered under this package and having multiple repeats within 6 months (starting from the first in-class course date of your choice), this package will allow all certified practitioners and professionals become familiar with the different streams available in the industry.

Learn more about CBAM Board certified and CAMP certified packages here.

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