What are fillers?
Fillers are substances of gel consistency injected into areas that have lost volume or that are to be supported. The most widely used today are those based on hyaluronic acid; hyaluronic acid is a molecule found naturally in the body, with a high capacity to hold water.
With ageing, the change in the face is not confined to the skin; it takes place in the deep fat pads and in the bony support as well. A filler aims to reduce shadows and loss of contour by replacing part of that lost volume.
Which areas are treated?
- The cheekbone region and support of the mid-face
- Hollowing beneath the eye (an area that calls for fine and careful application)
- Lip volume and adjustment of the contour
- The point of the chin and the jawline
- Deepened lines between the nose and the mouth
- The temple region and the back of the hand
Types of filler and how long they last
Hyaluronic acid fillers are produced for different areas according to the density of the gel: denser products are used where deep support is needed, and softer ones in fine areas such as the lips and beneath the eye.
How long a filler lasts varies with the area, the product and the person’s metabolism; it is generally measured in months, and the material is absorbed by the body over time. In areas where movement is considerable the period is shorter.
Permanent filler materials are not preferred, because they cannot be reversed and can give rise to problems at a late stage.
The procedure and afterwards
The procedure is carried out with a needle or with a blunt-tipped cannula; a topical anaesthetic cream is used and it takes minutes.
Swelling, tenderness and bruising may occur in the first days; the greater part of this subsides within a few days. It is advised that the area not be rubbed for the first 24 hours, that strenuous exercise be avoided on the same day, and that excessive heat such as a sauna or a solarium be avoided for two weeks. The result becomes clear within 2 weeks, as the oedema resolves.
Risks
The common effects are temporary: swelling, bruising, tenderness, irregularity that can be felt, asymmetry.
Blockage of a vessel (vascular occlusion), on the other hand, is a rare but serious condition: because the filler blocks a vessel or presses upon it, the blood supply to that area is disturbed. If it is not treated, it can lead to loss of tissue and, in applications around the eye, to loss of vision.
Where the findings below are present, the doctor who carried out the procedure must be reached without losing time:
- Pain during or after the procedure that is more severe than expected and steadily increasing
- Blanching of the skin, followed by a purple, mottled change in colour
- Blurring or loss of vision, severe pain around the eye
That hyaluronic acid fillers are reversible is important in this respect: they can be dissolved with an enzyme called hyaluronidase. For this reason the procedure needs to be carried out under medical conditions, by a doctor who knows how to manage complications and who keeps the necessary medicine to hand.
Who is it not suitable for?
Pregnancy and breastfeeding, active infection or inflamed acne in the area to be treated, a known allergy to the substance, uncontrolled autoimmune disease and bleeding disorders are conditions that prevent the procedure or cause it to be postponed. The use of blood thinners increases the likelihood of bruising.
Realistic expectations
A filler is temporary; repeat application is needed for the effect to continue. It does not move sagging tissue back into place and does not take the place of a lifting operation.
Exaggerating volume distorts the proportions of the face and leads to an appearance that is not natural. Measured application is preferred not only for aesthetic reasons but for reasons of safety as well.
Assessment
The right approach begins with establishing in which layer the loss of volume lies. In some cases a filler is not appropriate; surgery or another method gives a more accurate result.
You may make an appointment for an assessment; if you have had filler before, it is important that you bring information about which product was used, when, and in which area.