Let’s Talk Dermal Fillers: What You Need To Know

Young, old, and everything in between, women are always on the lookout for techniques to enhance their natural beauty. One way to do this is by investing in Botox and other forms of botulinum toxin. The problem with these treatments is that they do not address all aesthetic concerns, and some undesirable side effects have been linked to their usage as well. In response to this, doctors are complementing the neurotoxin benefits with dermal fillers. Ever wonder what are

fillers' pros and cons

are fillers safe

Botox VS Fillers

Dermal fillers are injectable substances that are used to plump up sunken areas of the face, such as the cheeks and lips^[1]. Fillers are used by doctors to treat and reverse the effects of aging, acne, and other skin conditions. They have become an increasingly popular choice for those seeking to improve their appearance. Dermal fillers represent a quick and easy fix for your beauty woes.

We previously explained that Botox works by blocking the nerve signals that cause the muscles to contract (a form of paralysis)^[2]. Dermal fillers are a little different in the sense that they are literally used to fill, contour, and lift the skin to make it look smoother and much more attractive^[1]. Whereas Botox^® is ideal for dynamic wrinkles (those caused by making expressions), dermal fillers are recommended for static wrinkles (visible when your face is at rest)^[1][2].

There are many types of dermal fillers available, some of which are made from natural ingredients and others from synthetic chemicals. Coming next, we will review

fillers' side effects

1. Hyaluronic Acid or HA

   (Restylane, Juvederm, Belotero, Rejeunesse)^[3]
   

   This compound is naturally present in many parts of the human body, including the skin. Hyaluronic acid is actually a glycosaminoglycan that helps retain moisture, acts as a cushion, promotes collagen/elastin synthesis and is involved in the wound healing process. The hyaluronic acid used in fillers is produced through a microbial fermentation process. This means that it is 100% cruelty free, biocompatible and biodegradable.

   Uses
   • Moisturizes
   • Plumps lips
   • Corrects the nose
   • Improves facial contour
   • Adds volume to cheeks and chin
   • Fills fine lines, wrinkles and creases/folds
   Advantages
   • Instant and long-lasting effects (6-12 months).
   • Minimal discomfort.
   • Can be easily dissolved.
   Disadvantages
   • More costly than collagen injections.
   • Injection site reaction: edema, pain, redness, itching, bruising.
   • Hypersensitivity reaction: infection (herpes, abscess, etc.), surface irregularities, nodules, vascular occlusion, local tissue necrosis, blindness, stroke and Tyndall effect. (bluish hue caused by superficial application of the acid)
   • Delayed onset adverse effects: biofilms (slimy layers of microorganisms), dyspigmentation, scarring and granuloma.

2. Poly-L- lactic acid or PLLA

   (AestheFill, Sculptra)^[4]
   

   This is a synthetic dermal filler (polymer) that has been around for more than four decades. It is non-toxic and biodegradable. Polylactic acid comes in the form of an injectable gel with microspheres that trick the body into producing collagen. So, it acts both as a filler and biostimulator.

   Uses
   • Lip augmentation
   • Adds volume to sunken cheeks, temples and tear troughs
   • Smooths out nasolabial folds, forehead wrinkles and marionette lines
   Advantages
   • Lasts up to 2 years
   • Stimulates collagen synthesis
   • Little side effects
   Disadvantages
   • At least 3 separate sessions are needed
   • Produces gradual results
   • Short-term complications: edema, bleeding, bruising, discoloration, edema, embolism, overcorrection and localized cellulitis (deep tissue bacterial infection)
   • Long-term complications: granulomas (including paraffinoma, which is a lipogranuloma, persistent papules and subcutaneous nodules

3. Calcium hydroxylapatite or CaHa

   (Radiesse)^[5]
   

   This naturally occurring substance can be found in human bones. The FDA approved professional grade filler, though, is produced synthetically. The calcium microspheres are suspended in a carboxymethylcellulose gel that is injected at the subdermal level. CaHa is biocompatible and does not contain any animal-derived ingredients.

   Uses
   • Nose and chin augmentation
   • Improvement of facial contour and definition
   • Improves the appearance of acne scars
   • Correction of expression lines, particularly nasolabial folds
   Advantages
   • Lasts 1-2 years.
   • It is fully absorbed by the body
   • Does not usually migrate to other areas
   • Boosts collagen synthesis
   • Provides very natural results
   • Has very low allergy and adverse reaction potential
   Disadvantages
   • Not suitable for highly mobile and thin areas such as lips, mouth, under-eye
   • Expensive compared to other options
   • Common, short-term complications: bleeding, bruising, bumps, lumps, redness and swelling
   • Uncommon complications: allergic reactions, blisters, blindness, cysts, infection, inflammation, numbness, migration to another site, scarring and vascular occlusion

4. Polymethylmethacrylate or PMMA

   ^[6]
   

   This filler is made up of bovine collagen (80%) and polymethylmethacrylate microspheres that add volume and firmness to the skin. Even though it has been around for quite some time, it is not as popular as other dermal fillers because it is not versatile. Its rejuvenating effects, nevertheless, are pretty dramatic and long-lasting.

   Uses
   • Lip augmentation
   • Acne scars correction
   • Reduction of medium to severe facial folds and wrinkles
   Advantages
   • Provides noticeable volume
   • Stimulates collagen synthetic
   • Firms up the skin and improves dermal texture
   • Its results are considered semi-permanent due to their longevity (up to 5 years)
   Disadvantages
   • Lack of versatility
   • It is non-biodegradable
   • The gel is very thick and can lead to overfilling
   • Requires a special injection technique
   • Collagen needs an average of 3 months to provide the expected results
   • Complications: blindness, bruising, haematomas, itching, foreign body granuloma, redness, swelling, hypertrophic scarring, hypersensitivity, palpable nodules, and tissue necrosis

We do not blame you if, after reading this overwhelming list of side effects, you want to opt for a filler and

Botox alternative

Botox injections

• Chemical peels
• Peptides: argireline (acetyl hexapeptide-8), matrixyl 3000, etc.
• Ultherapy (focuses ultrasound waves)
• Fractionated radiofrequency
• Fractional C02 laser
• Facial yoga
• Facial massage
• Facial acupuncture
• Face patches
• Microneedling
• Red LED
• Active ingredients: retinoids, vitamin C, niacinamide and alpha hydroxy acids

Dermal fillers are a great way to help women of all ages look and feel their best. They are quick, easy, and practically painless to use. There are many different types of dermal fillers available, each with their own benefits. Keep in mind that fillers are not permanent and they all have their fair share of complications. Only a licensed dermatologist or plastic surgeon will be able to recommend the best option for you based on your budget, aesthetic needs, health concerns, etc. A full medical appraisal will help to minimize adverse effects and maximize results.

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References:

[1] How Does BOTOX Work - AAFE - American Academy of Facial Esthetics

[2] Dermal Fillers: What They Are, Types, Benefits & Side Effects (clevelandclinic.org)

[3] Complications of hyaluronic acid fillers and their managements - ScienceDirect

[4] Late Onset Foreign Body Reaction due to Poly-L-Lactic Acid Facial Injections for Cosmetic Purpose - PMC (nih.gov)

[5] Injectable Calcium Hydroxylapatite (asds.net)

[6] Complications after polymethylmethacrylate (PMMA) injections in the face: a literature review - PubMed (nih.gov)