Introduction to Dermal Fillers:
Dermal fillers have become a popular choice for enhancing facial aesthetics. Among the various types, hyaluronic acid (HA) fillers are the most commonly used due to their effectiveness and safety profile.
What is Hyaluronic Acid (HA)?
Hyaluronic acid is a substance naturally found in the human body, particularly in the skin, connective tissues, and eyes. Its primary function is to retain water, keeping tissues well-lubricated and moist.
The Role of HA in Dermal Fillers:
While natural HA is beneficial, the HA used in dermal fillers is structurally and chemically modified to improve its performance. This cross-linking process enhances the filler’s rheology and longevity, making it more effective in cosmetic applications.
Why Use Cross-Linked HA in Fillers?
Improved Longevity: The cross-linking process makes the HA fillers last longer in the body, providing extended results.
Enhanced Rheology: Structural modifications enhance the filler’s ability to integrate smoothly into the skin, offering more natural-looking results.
Safety and Biocompatibility:
Despite being synthetically modified, HA dermal fillers are biocompatible, meaning they are safe to use and well-tolerated by the body. These fillers have a well-established safety profile, backed by several decades of clinical use.
Application of HA Dermal Fillers:
Think of HA dermal fillers as “synthetic fat.” They are injected into areas of the face experiencing volume loss or structural defects, helping to restore a youthful appearance and correct imperfections.
Instantly Visible Results:
The benefits of HA dermal fillers are immediately noticeable following the treatment. While you will see an instant improvement, the results typically appear more natural after about two weeks.
Safe Injection Techniques:
For safety, we exclusively use blunt-tipped micro cannulas to inject dermal fillers. These cannulas are long needles (38mm to 50mm) that cannot penetrate the skin directly. Instead, a diluted local anesthetic is injected near (but not at) the treatment site to create a small needle puncture.
Pain and Discomfort Management:
Discomfort or pain mainly arises from the manipulation of the cannula. If the cannula can be maneuvered easily, the pain or discomfort is typically minimal. Factors that can complicate cannulation include the treatment area, presence of scarring or fibrosis from previous procedures (e.g., implants, surgery, fat grafts), and anatomical structures like ligaments.
Pain Levels by Treatment Area:
Based on our experience, the pain levels associated with dermal filler treatments vary by area, but are generally expected to be mild with appropriate anaesthesia
Individual Pain Perception:
It’s important to note that pain perception is highly subjective, and these levels are meant to serve as a general guide.
At YVL Medical Aesthetics, we offer the following brands of fillers, biostimulators and skin boosters:
HA Fillers
Collagen Filler
Biostimulator
Understanding Dermal Filler Rheology:
Each brand of dermal filler has unique rheological properties, meaning the consistency and behavior of the gel differ. These properties significantly impact the shaping and contouring of the treated area. Consequently, different facial areas require specific types of fillers to achieve optimal results.
Tailored Treatment for Optimal Results:
There is no universally “superior” or “best” dermal filler. The effectiveness of a filler depends on its suitability for the specific area of the face being treated and the unique needs of the patient. Our experienced doctors will recommend the most appropriate filler based on their expertise and your individual requirements. As our doctors’ techniques and preferences evolve, the range of fillers we offer may also change to ensure the best possible outcomes.
Infection: HA dermal fillers can sometimes get infected shortly after injection, typically starting at the injection site. Less commonly, late infections can occur weeks to months after the initial treatment.
Granuloma Formation: As synthetic substances, HA dermal fillers are sometimes perceived by the immune system as foreign particles. Rarely, the immune system may react abnormally, forming hard lumps known as granulomas. This reaction can be triggered by a recent viral infection (e.g., flu, gastroenteritis) or after heavy drinking. Granulomas often appear months to years after the initial injection and can occur with any type of dermal filler, even when no palpable filler remains.
Tyndall Effect: When HA dermal filler is placed too close to the skin surface, it can cause a greenish discoloration, known as the Tyndall effect, particularly common in the under-eye area for Asian patients.
Treatment Options: The above side effects can be treated with a combination of:
Understanding Filler Induced Vascular Occlusion (FIVO):
The most serious complication of dermal fillers is Filler Induced Vascular Occlusion (FIVO). Though rare, FIVO is considered a medical emergency.
What is FIVO?
Dermal fillers, whether hyaluronic acid (HA) or biostimulators, are particulate in nature. These filler particles can cause obstruction in the facial arteries. In severe cases, filler particles can travel through these arteries and block the eye arteries, resulting in blindness, strokes, and even death.
Consequences of Arterial Obstruction:
Facial Arteries: Obstruction can lead to necrosis (death of skin tissue) and sloughing of affected areas due to lack of blood supply. Without prompt intervention, healing may take weeks and result in scarring.
Eye Arteries: Although extremely rare (with around 400 reported cases globally as of 2023), obstruction can cause blindness. The retina is highly sensitive to oxygen deprivation, and irreversible damage can occur within 15 minutes. Blindness is often severe and permanent.
Brain Arteries: Occurring in about 20% of filler-induced blindness cases, this can result in strokes, though it is even rarer than eye artery obstruction.
Preventive Measures:
Blunt Tipped Micro Cannula: Using blunt-tipped micro cannulas (25G and larger) significantly reduces the risk of FIVO. The blunt design minimizes the chances of perforating an artery, and allows for lower injection pressures.
Slow Injection Technique: Slow and gentle injections help prevent filler material from being injected into an artery. High injection pressures, especially with traditional small hypodermic needles, can exceed systolic blood pressure and increase the risk.
Understanding Risk Areas: The highest risk areas for FIVO resulting in blindness are the nose, glabella, and forehead, in that order. For skin necrosis, the nasolabial region is also considered high risk.
Immediate Response:
If FIVO occurs, immediate injection of hyaluronidase to dissolve the filler is essential. In cases of visual loss or stroke, emergency transfer to hospital or specialist care is required for inpatient treatment.
Longevity of HA Dermal Fillers:
Hyaluronic acid (HA) dermal fillers are commonly known to last between 6 to 12 months. However, the duration can vary significantly between individuals. In rare cases, HA dermal fillers may resorb within weeks or last longer than five years. Factors influencing the longevity of HA dermal fillers include the amount of filler used and the specific area of the face treated.
Variability in Absorption:
Certain facial areas tend to absorb HA dermal fillers more slowly. For example, the under-eye area often shows slower absorption rates due to lower production of hyaluronidase, the enzyme that breaks down HA.
Partial Absorption of Synthetic Fillers:
While HA dermal fillers are synthetic and do not fully absorb, they are generally largely absorbed over time. The residual HA filler does not pose any known health risks and should not be a cause for concern.
What Is Hyaluronidase or Hyalase?
Hyaluronidase is the enzyme that is used to dissolve HA dermal fillers. It may be used in very large doses in an emergency setting like during FIVO, or it may be used in smaller quantities to dissolve previously administered HA dermal filler.
By controlling the quantity of hyaluronidase administered, we can effect partial dissolution of the HA dermal fillers, in cases where “over-filling” has occurred and whereby the intended effect is to remove only the “excess” filler (and not all). This commonly happens in the under area, the cheeks, and the lips.
Some patients are concerned that hyaluronidase can dissolve their own body’s HA, which it does. However, the human body has 15000mg of hyaluronic acid at any given point in time, and 5000mg is being turned over daily (i.e. manufactured as well as broken down). In comparison, the 20-30mg of hyaluronic acid in any syringe of filler is inconsequential, and similarly so are the effects of hyaluronidase on the body’s total hyaluronic acid.
Skin redness or mild swelling may be possible for some patients after the treatment. However, it will subside eventually within a few hours. Most patients will not have downtime, unless a higher energy setting is required to treat some lesions. If downtime is required, the doctor will inform the patient beforehand.
The number of sessions needed to effectively treat your skin concerns can vary, typically ranging from three to 10 sessions depending on your specific skin condition.
PicoPlus Laser treatments are safe for most patients. It will not cause thinning. Side effects of laser potentially include redness, swelling, post-inflammatory hyperpigmentation and others.
An ideal candidate for the PicoPlus laser treatment would be individuals with issues such as pigmentation or redness, or those seeking skin revitalization.
Depending on the case, it usually takes 10-15mins to finish. Typically, treatments are scheduled every two to up till six weeks.
Patients may experience a slight tingling sensation during the procedure. The discomfort is minimal and easily manageable. Most patients do not require numbing cream. However, numbing cream can be applied should the need arise.
