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Dermal filler where botox cannot be used

In my previous article I discussed botulinum toxin A to paralyze muscles that cause deep facial wrinkles. Let’s now look at dermal fillers.

Dermal Fillers

This treatment opens another whole new aspect of nonsurgical face lifts, with immediate results and no down-time. There were 2.6 Million dermal filler procedures reported in 2016.[i]

Areas most frequently treated are deep creases in the nasolabial folds ("smile lines" or "laugh lines"), oral commissures (“marionette lines”), glabella (deep scowl lines between the eyebrows), tear troughs, and to lift the cheeks. You probably also know it is used to plump the lips or define the lip borders.

The procedure takes about 20-40 minutes. A topical numbing cream is applied 15 minutes prior to injecting dermal filler which makes an otherwise mild burning sensation barely detectable. Results last from 6 to 12 months or longer.

You might wonder what is in the dermal filler and if it is safe. There are five main kinds (including fat transfer), I prefer to use Hyaluronic acid (HA) dermal fillers, which is the main structural component found in skin, much like collagen. It is a polysaccharide (long sugar chain) that makes the dermis layer of your skin smooth and healthy. Its other main effects are to lubricate joints (synovial fluid) and heal connective tissues.

The HA in dermal filler is formed naturally by streptococcus bacteria. It is not immunogenic (cannot cause an immune reaction) and naturally biodegradable. Furthermore, hyaluronic acid is hydrophilic (“water-loving”), which means it can hydrate the skin too.

To make HA in commercial dermal filler last longer, it is chemically “cross-linked” a viscous, moisture-absorbing gel such as BDDE (1,4-butanediol diglycidyl ether). When these two naturally degrade, they become harmless byproducts that are identical to substances already found in the skin.[ii]

If a dermal filler injection results in an uneven or bumpy area, or if it is overfilled, it can be reversed[iii] (dissolved) by injecting the enzyme hyaluronidase—without dissolving the natural hyaluronic acid of your surrounding normal tissue.



[i] https://www.plasticsurgery.org/documents/News/Stat...

[ii] De Boulle K, Glogau R, Kono T, Nathan M, Tezel A, Roca-Martinez JX, Paliwal S, Stroumpoulis D. A review of the metabolism of 1,4-butanediol diglycidyl ether-crosslinked hyaluronic acid dermal fillers. Dermatol Surg. 2013 Dec;39(12):1758-66. https://www.ncbi.nlm.nih.gov/pubmed/?term=23941624

[iii] Kim JE, Sykes JM. Hyaluronic acid fillers: history and overview. Facial Plast Surg. 2011 Dec; 27(6):523-8. https://www.ncbi.nlm.nih.gov/pubmed/22205525/

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