Fillers - Procedure, Risk and Treatment

Dr. Sunita Singh Rathore

What are Fillers?

As you age, your skin becomes more prone to wrinkles and sagging. This happens due to a gradual decrease in muscle volume and elasticity caused due to sun exposure and muscle movement throughout your life like when- smiling, eating, grinning, frowning, and many more. To rejuvenate their face and get rid of these wrinkles and sagging skin, people get fillers, also known as dermal fillers, wrinkle fillers, and soft-tissue fillers.

Why are Fillers used?

As the name suggests, Fillers are used to filling the face/skin to make it look smooth and full. They are natural or artificial soft, gel-like substances that are injected under the skin (lines, tissues, and folds) to enhance it and make it look younger by adding more volume and fullness to that area. Fillers are used for various purposes like -

To smoothen out deep under-eye circles and wrinkles
To eliminate wrinkles
To correct scar depressions
To get more fuller and voluminous lips
To erase smile lines
To smooth outlines around the nose
To smooth out hand wrinkles
Fill in the shallow areas on the face
Improve facial features symmetry

What are Fillers made of?

Fillers can be temporary or long-lasting. There are various types of filters used by cosmetic doctors each having their own features and ingredients. The most commonly used Fillers are -

Hyaluronic Acid (HA)

Hyaluronic acid is a soft gel-like substance already present in your skin. It keeps the skin plump and hydrated by adding volume to cheeks, removing wrinkles around the eyes, lips, and forehead. The results are temporary, they last between 6 to 12 months since it is a naturally present substance in the human body, and the skin gradually absorbs it. To avoid discomfort during and after treatment, Hyaluronic Acid is infused with lidocaine. Brand names are - Juvederm and Restylane.

Calcium Hydroxylapatite (CaHa)

CaHa is found in your bones (naturally occurring substance). Calcium particles are mixed with a smooth gel before they are injected into the skin. When used as a filler, CaHa stimulates the natural production of collagen to smooth out deep wrinkles and lines. Calcium Hydroxylapatite has a thickened consistency than HA, and thus it lasts longer - usually for about a year. The brand name is Radiesse.

Poly-L-Lactic acid

Poly-L-Lactic acid is a biodegradable synthetic substance that is safe to use on the human body. They stimulate the rebuilding of natural collagen to smoothen out lines and wrinkles-and the filler gets dissolved by itself after a few days of the treatment. This filler is semi-permanent as it can last for 2 years. Brand name- Sculptra Aesthetic.

Polymethylmethacrylate (PMMA)

Polymethylmethacrylate is a synthetic substance. When used as a filler, PMMA is made into tiny balls (microspheres) which are injected under the skin and remain there to provide a continuous lift to that area. It also contains collagens, which remove lines and keeps the skin firm. It is a permanent filler with results lasting for 5 years. However, they are not the first choice of a doctor as these long-term fillers have a higher rate of complications like infection. They are marketed under the brand name- Bellafill.

Autologous fat injections (fat grafting)

Autologous fat injections are a technique that requires surgery. In this, fat from your other body parts like buttocks is extracted and injected into facial areas. The fat is vacuumed out of the body with a hollow tube that is inserted into the skin through incisions. This method is called liposuction. It helps restore volume in cheeks, lower eyelids, and other areas. The results last for a very long time. This method should be performed by highly skilled doctors only and it may take a week or two to fully recover after getting this treatment done.

What to expect during treatment?

Pre-Procedure Filler injections are non-surgical (except autologous fat injections) and can take from 15 minutes to 1 hour depending upon the quantity and product which needs to be used. But before the treatment begins, you will meet with the cosmetic doctor for consultation. During this time, the doctor will check the area in which you want fillers and also review your medical history like - any previous medical treatment, skin condition, allergies, or any medication that can lead to harm or treatment failure. They will also inform you about the fillers, how they work and what you should expect in results.

Filler Treatment Procedure

Once you have met with the cosmetic surgeon, and have understood the Filler treatment process. The procedure will be as follows -

Firstly, the place where the filler is to be injected will be cleaned and the area will either be injected with tropic anesthesia or numbing cream will be applied so that you have minimal discomfort during and after your treatment.
Once the area has become numb, the excess numbing cream will be removed (if it is used) and the area which needs to be injected will be marked to avoid injecting fillers in the wrong area.
After clearing the area again, the doctor will inject your skin with the chosen product and amount to give volume and fullness, making it look rejuvenated.
In the end, an antibiotic cream is applied over the injection site.

Post Procedure

You might be able to notice the results immediately depending upon the product type, amount, and the area in which it has been injected. Some people have mild bruising or swelling, but this is temporary and should go away in a few days. Following this, you can return to your all day to day activities. However, there are certain aftercare instructions for Filler Treatment that you should follow-

Don’t massage the infection site for at least 2 days after the procedure.
Don't expose your skin to the sun or excessive heat for 2-3 days.
Don’t do any strenuous activities or exercise for 2 days.
If possible, sleep on your back for the next couple of days.

How long do these Fillers last? The duration of these fillers depends upon the product, site of treatment, and the metabolic rate of the patient. Generally, a product which is denser and more deeply injected will last longer than others. Hyaluronic Acid Fillers -

- - Natural substance
  - Temporary Fillers
  - Lasts for 6 to 12 months
  - Recommended for first-time patients

Calcium Hydroxylapatite Fillers-

- - Natural substance
  - Last for at least 1 year (longer than Hyaluronic acid fillers)

Poly-L-Lactic acid Fillers-

- - Biodegradable synthetic substance
  - Can last for 2 years
  - Semi-permanent Fillers

Polymethylmethacrylate Fillers-

- - Synthetic substance
  - Can last for 5 years
  - Permanent Fillers

Autologous fat injections

- - Fat grafting
  - Last indefinitely

Polymethylmethacrylate Fillers-

- - Synthetic substance
  - Can last for 5 years
  - Permanent Fillers

What are the risks and side-effects of getting Fillers?

There are some patients who have side effects after getting Fillers, but these do not last and might clear away within a week or two.

Side-effects -

Mild Bruising
Swelling
Pain
Skin rash, itching, or pimple-like eruptions
Redness

Risks -

Infection
Filler leakage from the injection site
Filler displacement
Tissue death or blindness due to blockage in blood flow
Lumps, Nodules develop around filler injected area (may need to be surgically removed)

Don’t get fillers if -

You are pregnant, breast-feeding or are below the age of 18
You have a rash or active acne
You have a bleeding disorder
You are allergic to any of the ingredients used in the filler.
You have keloid or overgrowth of scar tissue

What are the things to be kept in mind before getting fillers?

Even if getting Fillers is generally safe, there are certain things which you should keep in mind beforehand -

Only go to a highly experienced and trained medical professional to get your Fillers done.
Make sure to tell the doctor about your medical history, health conditions, or any medication you are on. For example - you should not take ibuprofen before getting fillers, as it makes the blood thin which could lead to bruising.
Make sure that the treatment is done in a sanitized medical setting and not in places like- home, spa, hotel, etc.
Only use the filler that the medical provider gives, don’t purchase it online. Make sure they are medically approved and ask them about the ingredients in it to avoid anything which could lead to allergy.
After getting Fillers, use sunscreen daily to preserve the fillers and save them from inflammation.

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