By Anna Głowacka, DNP from NuFaceGlow in New York
As we age, collagen and elastin in the skin break down. At the same time, fat compartments lose volume and become thinner, particularly in the upper half of the face. The facial skeleton changes due to bone loss at strategic sites such as the mid- face and orbital bone around the eye. These factors combined result in skin sagging, prominent skin creases such as nose‑ to‑ mouth lines (nasolabial fold) and jowl formation. This volume loss cannot be addressed by Botox and requires dermal fillers to fill or plump out the areas that have effectively become deflated.
It is bad practice to treat individual areas in isolation (e.g. just the jowls); it is important to maintain balance and harmony in the whole face and so a complete facial aesthetic assessment should be carried out prior to any treatment.
What fillers can treat?
Facial sagging, lines and loss of volume: Fillers have an excellent role in treating facial sagging, lines and even chin augmentation. I’ve had small volumes of strategically placed fillers to treat nose‑to‑mouth lines (nasolabial folds) which had become more noticeable around the age of 35; the lower half of my face had started to look slightly heavy and even a bit saggy. I was pleased with the results of the filler. While it may not be for everybody, I have no doubt I’ll have more in the future.
Lip augmentation: Hyaluronic acid fillers are used most commonly and when injected into the lips can enhance shape, structure or volume. The results typically last six months and need to be repeated for as long as one wants their effects. Lip fillers are not suitable for everyone and an assessment of facial shape needs to be made first otherwise there is a risk that the end result will look unnatural. Ageing of the lip results in a downturn of the mouth and lip definition is lost. Filler can be used around the mouth to correct this.
Hand rejuvenation: Volume loss in the hands as we get older gives them a sunken appearance, and bones, tendons and veins become more visible. Filler containing calcium hydroxylapatite is commonly injected into the backs of the hands. This is massaged and swelling can occur for a few days. The filler lasts about six months or so. This is a relatively safe area to inject, with few side effects.
The different types of dermal fillers. There are many on the market including products that contain hyaluronic acid (e.g. Juvederm, Restylane), calcium hydroxylapatite (Radiesse), and poly‑L‑lactic acid (Sculptra). The vast majority of fillers now used are the hyaluronic acid varieties. These have increased in popularity over the years because they are non-permanent but long-lasting, cause few allergies and can be reversible and dissolved if necessary.
Profhilo. This is a relatively new injectable treatment made of synthetic hyaluronic acid. It is not, however, a dermal filler. Its purpose is to improve the texture or hydration of the skin rather than correcting deep wrinkling, significant sagging or volume loss associated with facial ageing. Profhilo can potentially help boost collagen and elastin production. As with any injectable treatment, there are risks such as bruising, swelling and infection. It can be a good treatment in the right patient when done by the right hands.
Before filler is injected, a medical consultation is necessary. Full facial assessment is vital to determine which areas require filling or volumising. A thorough medical history and details of any medications or supplements should be taken first.
Are fillers painful and how long do they last? Numbing cream can be applied for 20 to 30 minutes before injecting or ice can be used for numbing directly before the injections are placed. Results usually last for six to 18 months depending on the product used.
Side effects and risks of dermal fillers. Side-effects include swelling, bleeding and bruising. Aspirin, ibuprofen and supplements such as vitamin E, fish oils, gingko biloba and ginseng should be discontinued as they can promote bleeding. Other potential problems include lumps, inflammation, filler migration to another site and infection.
Certain areas are considered ‘high-risk’ sites such as the forehead, under-eye area and nose. There have been rare reported cases of blindness, so it is absolutely vital that the person you choose to inject you has been trained to the highest level in facial anatomy. While the risks sound scary, in competent hands the procedure is safe.
This is very important!!!!
Keeping it subtle: It never ceases to amaze me how many aesthetic practitioners themselves look rather odd as a result of their own overuse of injectable treatments - think big lips and ‘chipmunk cheeks’. My personal feeling on this is that somewhere along the line, these individuals have lost their ‘aesthetic eye’ – that is, they are no longer able to perceive what is normal for a person’s face. The purpose of these treatments should be to create natural results, not artificially enhanced or exaggerated features. I suspect that in many cases, this type of face is all such practitioners see on a daily basis, be it in their colleagues or their patients. This, in turn, may be driven by the pressures to appear ‘young’ that are prevalent in the industry but also sadly still and unnatural body images all over social media.
Finding expert hands. You need to be confident that you are being given the best advice on any injectable treatments available and sometimes the right answer is that it’s not the right treatment for you. Practitioners should be sensitive to this and give you an honest facial assessment. They should not automatically carry out a treatment just because they can. I certainly have no qualms about saying no if I feel an injectable treatment is inappropriate. This conviction has grown over the many years it has taken to become a consultant dermatologist (I am not afraid to admit that I’m now a much better practitioner – and communicator than I was years
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