By: Dr Serena Cardoso DipPEC (SA), BHSc, MB BCh (WITS)
Dermal or soft tissue fillers are an injectable medical product that is used in various ways to improve the aesthetic appearance of the face. They marry well with botox for the aesthetic improvement of the face. Fillers can be used to sculpt the face, provide contour, plump fine lines and lift the face in what is called a “liquid facelift”.
There are various types of fillers containing different substances. In our practice, we prefer hyaluronic acid-based fillers because of their natural feel and appearance but every doctor has their favourite medium. Certain fillers are better suited to various places in the face and even within hyaluronic acid fillers there are various types that act differently under the skin once injected. Hyaluronic acid fillers around the eyes should be avoided in patients with malar oedema.
I usually use the Juvederm range of hyaluronic acids. I am not sponsored by them, it’s more a personal preference. In their range, there are various types of HA fillers with different properties. Some are more structural and stronger like Volux and Voluma which are used to lift and sculpt a face. They are placed in areas like the cheek or jawline. Volite and Vobella are softer fillers used in areas like fine lines around the eyes and lips. Volite can also be used in the hands and necklines. Volift is great for volumizing and sculpting lips and is often layered in other areas too as part of a structural build. If you are very thin one should be careful to no inject a filler that can be seen under the skin.
There are various cultural ideals of the perfect face and as we age there are structural changes in this shape. Fillers can be used to beautify the face beyond just anti-ageing. For instance, filler along a man’s jawline and chin can create a more handsome, masculine appearance and in woman, a beautifully lifted eye and cheek with a soft lip is equally as attractive. Fillers also allow for the subtle correction of ageing by lifting the face and filling in small lines. A liquid facelift doesn’t replace a traditional surgical facelift especially if you have severe jowls and looseness in the lower 1/3rdof the face but it does create a subtle improvement. Fillers last between 6 months and 2 years. If you have a lot of hollowness and sagging if may be more cost-effective to consider lipofilling instead (liposuction of your fat and using that instead of temporary fillers). In your appointment with us, we assess your face and advise accordingly.
Dos and don’ts:
- Do see your doctor in advance of your filler appointment to plan how much filler is required and where the filler should be placed. This process can take time and careful consideration, much like how you would spend time with an architect drawing up the plans for your house before the build starts. It’s better than building as you go. We also go over all the risks and prepare you.
- Don’t do filler in the month preceding a big event like a wedding. You may bruise and swell afterwards. Also, the filler may require a top-up or an adjustment a few weeks afterwards so that it looks perfect. Bruising and swelling are difficult to predict and happens even in the most experienced hands. This complication has many causes, sometimes related to the trauma of the needles but also due to personal factors like coagulation, immunity, medication, alcohol, etc. Most of the time this doesn’t happen and you should be fine to go to work the next day, looking fabulous and refreshed. I wouldn’t, however, take the risk of doing it the morning before a dinner party!
- Don’t take anti-inflammatories like ibuprofen in advance of your appointment and refrain from alcohol for a couple of days prior to your appointment to prevent bleeding and bruising. If you take anticoagulants for medical reasons, this is not a reason to stop them and put your health at risk over the possibility of a little bruise. It can always be concealed.
- Your pain threshold goes down a little during menstruation and one tends to be a bit more emotionally sensitive especially if you get severe PMS. Rather defer your appointment to a different time of the month.
- Don’t book a filler appointment in the month preceding or after any surgical, cosmetic, facial or dental procedures (not even a routine clean). This is because the fillers may develop a biofilm reaction that, apart from looking very abnormal and swollen, requires the fillers are dissolved and a prolonged course of strong antibiotics be taken. Discuss with your doctor if you are uncertain, some exceptions in terms of facials can be made.
- Don’t massage your filler after the appointment. Initially, the filler may still be moldable.
Lastly, don’t overdo the filler or do it too frequently. This is when things go wrong and you may start to look bizarre. I prefer to do fillers for my patients only once a year to maintain a natural appearance. It may take a couple of sittings to get it done but thereafter good skin should be maintained with botox and skin treatments like peels, micro-needling, and lasers. Rather, discuss with your doctor how frequently you require filler and take their advice. Most good physicians with your best interests in mind will probably be conservative and advise that less is more.