By Dr. Tracey Garner, Dr. Marisa Heyns & Dr. Cindy Kerbel
Even though facial wrinkles and loss of volume are a natural part of the ageing process, it remains a concern for many. Therefore, we are fortunate that scientists have developed a range of sophisticated facial injectables to help fight and effectively delay signs of ageing without having to go under the knife. But before you venture into the world of dermal fillers, here is a list of everything you need to know.
Table of contents
- What are Dermal Fillers?
- Where can Dermal Fillers be used?
- What is LipStrobing with Dermal Filler?
- What is the Natural-Lift with Dermal Filler?
- What are the benefits of Dermal Filler?
- How do Dermal Fillers work?
- What can Dermal Fillers achieve?
- What can’t Dermal Fillers achieve?
- Who is the ideal candidate for Dermal Filler injections?
- What is the best age to get Dermal Fillers?
- Dermal Fillers: before and after
- Can Dermal Fillers be reversed?
- Dermal Filler side effects
- Are Dermal Filler injections safe?
- What is the recovery time for Dermal Fillers?
- How to prepare for a Dermal Filler treatment?
- How long do Dermal Fillers last?
- Which Dermal Filler treatment should I get?
What are Dermal Fillers?
Dermal fillers are substances that have been specifically designed to be injected under the surface of the skin at different levels to smooth out creases, enhance lips and facial contours, restore volume loss and provide a subtle ‘lift’ in certain areas. The dermal fillers we use are made of hyaluronic acid (HA). Biostimulators are also injected under the skin, but for the purpose of this article, we are referring to HA fillers.
Hyaluronic acid is a substance that occurs naturally in the skin. It is hydrophilic which means that it attracts water and expands, providing hydration and plumpness for the skin. It is this property that allows for the volumization and lift that we are looking to achieve with its use in injectable form. Most of the hyaluronic acid dermal fillers used are already premixed with lidocaine in order to minimize pain and discomfort during the procedure.
Where can Dermal Fillers be used?
Dermal fillers can be used in most areas of the face. To correct foundational support or the bone loss that occurs with age fillers can be placed deep directly onto the bone, under the muscle, or within the deep fat pads to restore volume and provide a natural rejuvenating effect. These areas include the temples, cheeks, deep mid-face fat pads, jaw angle or jawline, and chin. Fillers can also be placed sub-dermally or even intradermally in other areas to provide more support and smooth out lines and creases. Finally, fillers can also be used on the lips to hydrate, plump, enhance, or even out symmetry.
What is LipStrobing with Dermal Filler?
With LipStrobing, facial fillers are used strategically to strengthen weakened muscles, weaken depressor muscles, and ‘resuspend’ the mouth in a more youthful position. In a sense, LipStrobing stretches the perfect canvas for the lips to be displayed on. The perfect lips in an unbalanced or aged face may create an unnatural look – almost like an old building with a bright red door. The perfect renovation project improves structure and function and takes place on all levels. The same is true for the face. LipStrobing delivers naturally beautiful lips on the canvas of a beautifully balanced face.
What is the Natural-Lift with Dermal Filler?
The N-LIFT™ (or Natural-Lift) precisely places small volumes of Hyaluronic Acid filler in multiple areas, building deep structural support to shift the balance between the elevator and depressor muscles of the face. After a consultation, a bespoke plan is created, which may include jawline tightening and definition, defining and slimming the cheeks, temple lifting, chin augmentation, mid-face reshaping, nose profiling, and Lipstrobing. The result is a beautifully refreshed, contoured, and balanced face.
What are the benefits of Dermal Filler?
The benefits of dermal filler lie with the selection of different types of fillers that are available to us, based partly on their Hyaluronic acid concentration, as well as their behaviour once injected into the particular area. This allows us to treat a variety of facial aesthetic concerns, whether it is restoring lost facial contours that lead to sagging, reshaping lips, or even rejuvenating the skin! When using the correct dermal filler and respecting the different areas of the face, one can produce a beautiful natural result.
How do Dermal Fillers work?
Dermal fillers can be likened to a soft gel that can be placed within the tissue structures of the face and can act as a support pillar in places where you have lost volume. By injecting small amounts of filler in the rights areas and tissue planes one can restore the contours of the face without the fear of looking over-filled or full or different. Over time, this biodegradable product is broken down by your own Hyaluronic Acid degrading enzymes (called Hyaluronidases), which means that it is not permanent and therefore also not a once-off treatment. The added bonus of using a dermal filler is the improvement in the quality of the skin and underlying soft tissue structures.
What can Dermal Fillers achieve?
Fillers are made with varying consistencies (hard or soft) or G-prime. This impacts how suitable they are for use in specific areas of the face. As an example, soft fillers are used in the lips whilst more robust fillers are used on the angle of the jaw, along the jawline, and in the chin to mimic bone and support the lower face. By using the correct product for each area, dermal fillers can smooth out lines, augment lips, restore midface volume, correct facial asymmetries, improve sagging, and provide a natural, rejuvenating effect for the patient.
What can’t Dermal Fillers achieve?
Dermal fillers can be used for rejuvenation all over the face but are sometimes not ideal for deep lines around the mouth, puffy or very hollow eyes, poor skin quality or severe skin laxity, and certain nasal deformities. The ideal treatments for these areas may include:
Deep peri-oral (around the mouth) lines: For this, we would recommend treatments such as CO2 laser resurfacing and stem cell injections.
Puffy or very hollow eyes: Around the eyes, dermal filler may sometimes worsen puffiness. Therefore we prefer our signature EyeLight 360 procedure for puffy or hollow eyes, which may include blepharoplasty (eyelid surgery), CO2 laser, fat, and stem cell injections in addition to foundational fillers.
Poor skin quality: Certain skin conditions, such as poor texture, impaired skin barrier, pigmentation, and increased vascularity are best addressed with our Skin Science team and may include laser, microneedling, PRP, and various peels.
To rejuvenate and tighten the deeper layers of skin, biostimulator injections, radiofrequency needling (Morpheus Enhance) or laser treatments combined with stemcells may be more effective than dermal fillers.
Excessive skin or severe skin laxity: These conditions are best addressed with cosmetic surgery: a facelift, our signature BELLA Lift, blepharoplasty, or surgical lip-shortening may be indicated.
Severe nasal deformities: Conditions like severe nasal deformity or a deviated septum may need to be addressed surgically by a plastic surgeon who specialises in these procedures.
Who is the ideal candidate for Dermal Filler injections?
Anyone who experiences any form of volume loss whether it be deep bony foundational loss, or subtle volume loss can benefit from dermal filler injections. A typical dermal filler candidate is someone who notices changes in the shape and appearance of the face as they start to age. Looking tired around the eyes, sad around the mouth corners, or droopy around the jawline are all signs of volume loss within the face and hence are excellent candidates for dermal filler.
In the end, it is about a natural restoration of the facial features to look more rejuvenated and youthful, not distorted or different.
What is the best age to get Dermal Fillers?
There is no specific age that fillers should be used. Hyaluronic Acid-based dermal fillers can be used to treat a variety of concerns for patients and, as such, each patient needs to be individually assessed to see if they are a candidate. Younger patients may require the use of fillers to enhance their lips, for facial contouring, or for profile balancing.
Dermal fillers can also be used to treat signs of ageing such as volume loss, sagging, facial creases (smoker’s lines and nasolabial folds), and hand rejuvenation. Dermal fillers can even be used for improved intimate wellness with labia majora augmentation.
Dermal Fillers: before and after
Sometimes the impression is created on social media that dermal filler results can be assessed immediately and should make a drastic difference. The truth is that straight after your facial fillers, you may be slightly swollen and the true functional and skin improvement takes time to show.
Your face is a beautifully subtle creation and subtle changes that bring balance and overall beauty will always look the best. Think of classical art versus pop art – in classical art, paintings are subtly layered and crafted to best depict someone’s unique characteristics. With pop art a dramatic red lip may make the painting pop, but is that truly beautiful?
Can Dermal Fillers be reversed?
Hyaluronic acid fillers can be reversed using an enzyme called Hyaluronidase. It is produced by your body in order to break down and maintain your own naturally occurring hyaluronic acid, but it will also break your filler down over time. If there is a complication or unwanted effect from a hyaluronic acid filler injection, Hyaluronidase can be injected to dissolve the filler.
Allergic reactions may rarely occur due to Hyaluronidase injections, and for this reason, both dermal filler injections and reversals should only be done by a registered doctor in a fully equipped medical practice.
Dermal FIller side effects
As with any injectable product – there are some risks. The most common side effect from injecting dermal filler is a bit of bruising if the doctor was unlucky in catching a small blood vessel usually resulting in a small spot bruise. Bruises heal over a short period of time and thus it is important to plan your dermal filler treatment to fit your schedule.
Very, very rarely, dermal filler can be injected into a blood vessel (it can even happen to the most experienced doctor). What this means, is that one can potentially comprise the blood supply to sensitive structures within the face, and if this event is ignored, it could potentially compromise tissues – usually the skin but even more rarely the eye. The importance of noting this potential side effect largely pertains to the fact that you want to be treated by a qualified aesthetic doctor who can identify the early signs of this serious side effect and act as quickly as possible.
We have an antidote to Hyaluronic Acid dermal filler that can reverse complications by dissolving dermal filler within a very short space of time. The take-home message to you – pick your aesthetic doctor carefully…
Are Dermal Filler injections safe?
In most patients, filler injections are very safe as Hyaluronic Acid-based fillers are recognized by the body as something not to worry about. However, if you suffer from an unstable autoimmune condition or you have recently (2- 4 weeks) undergone an event that raised your inflammatory markers, your body may react to any foreign body, filler included. For this reason, we advise that all patients who have recently had an infection, dental work, or any inflammatory flare wait 2 – 4 weeks before dermal filler will be deemed safe.
What is the recovery time for Dermal Fillers?
There is no downtime for dermal fillers. Whilst it is never the aim, as with any injectable there is always the risk of bruising and tenderness at the injection site. There may also be some swelling which should settle within a few days (up to two weeks). Lip fillers, in particular, have the potential to swell significantly so it is important not to perform these fillers close to an event in order to ensure that the lips will be fully recovered in time.
It is recommended that patients have fillers a minimum of two weeks before any major event. Patients are given strict aftercare instructions to follow. No make-up should be worn or products layered on the skin for the rest of the day post-filler injections. Ice and anti–inflammatory medication can be used to treat any swelling if necessary.
How to prepare for a Dermal Filler treatment
As a patient, it is important to adhere to the guidelines for filler treatment set out by their doctor. Planning is key. One should not schedule fillers within two weeks of any other skin or aesthetic treatments. The patient must also ensure that they have not been to the dentist or the dental hygienist for two weeks on either side of the dermal filler treatment.
There should be no active breakouts or skin infections and the patient must be well in the two weeks preceding their treatment.
If the patient has had Covid or a Covid vaccine, then they should wait six weeks prior to having fillers. Accordingly, if a patient had fillers, then he/she should wait 6 weeks before going for another vaccine. These guidelines are important to minimise the risk of the patient developing an inflammatory reaction to the fillers such as a biofilm or granuloma.
Patients are advised to avoid using any products that can thin the blood and increase the risk of bruising such as alcohol, omega 3, anti-coagulants, aspirin, or anti-inflammatories.
If there is any change in the patient’s medical history or if they become unwell, then we ask that the patient communicate this to us timeously so that we can reschedule the planned treatment.
Lastly, we request that our patients do not fly for at least 48 to 72 hours after any fillers. This is to ensure that we are able to treat any possible complications that may occur in an appropriate manner and without delay. Ultimately, we have the best interest of our patients at heart and want to minimise risks as much as possible.
How long do Dermal Fillers last?
Dermal fillers may last anything from 6 to 24 months, depending on the specific filler used and the area injected. At Dr. Nerina Wilkinson + Associates, we use Vycross technology fillers, which typically last a bit longer: lip fillers usually need to be topped up every 9-12 months, and foundational and contouring fillers every 12-18 months.
The longevity of your fillers may be influenced by your body’s unique response, as well as your metabolic rate, exercise routine, and sun exposure. We can recommend assessing your fillers when you see your doctor for your next Botulinum Toxin top-up (which usually takes place every 3 – 4 months) so that your dermal results can be optimised and maintained.
Which Dermal Filler treatment should I get?
Life nowadays is all about options and choices, however, when it comes to choosing what is the best for your appearance, I would highly recommend that you see a qualified aesthetic medical practitioner who understands your unique aesthetic concerns and translate that into the best aesthetic treatment plan going forward.
We encourage each new patient to start with an aesthetic couture consultation to guide you on your bespoke aesthetic journey to feeling more confident, radiant, and the best version of yourself.
To embark on your aesthetic couture journey, email capetown@drnwilkinson.co.za to get started today.
Dr. Nerina Wilkinson + Associates
