To Fill or Not to fill ~ Part 2

Now that we know dermal fillers can be used to restore volume loss, the next question is:

Which dermal filler is the most suitable one for me?
There are many brands out there that claim they have the best fillers on the market, so much so that consumers and even physicians sometimes find it challenging to choose the right one. In reality, though, the ‘Perfect’ filler is yet to be available, and therefore some Filler-101 knowledge comes in handy before making that final decision.

Firstly, let’s look at how fillers can be classified:

Based on the Longevity:
– Temporary (usually lasting less than 12 months)
– Semi-permanent (usually lasting between 1-2 years)
– Permanent ( usually lasting more than 2 years)
Based on Filler Material Origin:
– Heterograph (from donor of different species)
– Allograph (from a donor of the same species as the recipient but not genetically identical)
– Autograph (from the same individual)
– Synthetic Material
The classification above is rather broad and technical. However, during consultations, what is more commonly asked is whether the dermal fillers are:
1. Hyaluronic Acid Fillers or
2. Non-Hyaluronic Acid Fillers
Hyaluronic Acid Fillers
Hyaluronic acid is a naturally occurring glycosaminoglycan in the dermal extracellular matrix (deeper layer of our skin) that provides structural support and nutrients and through its hydrophilic (water-loving) capacity, adds volume and hydrates the skin. Native hyaluronic acid would break down very quickly if injected into the skin and needs to be altered and stabilized primarily by cross-linking to have a longer resident-life in the skin. This is known as HA fillers.
HA fillers are currently the most popular choice for volume restoration because of these factors:
1. Relatively long lasting (some HA fillers on the market now can last up to 24 months)
2. Have minimal adverse effects (side effects are minimised especially in the hands of a skilled injector)
3. Relatively affordable (This is subjective, but definitely a more affordable option than surgery. Price range differs due to injector knowledge and artistry skills, brand of HA filler used by the physician, and also the intricacy of the area of treatment i.e. tear-trough, nose and jawline which are higher risk area and needs more careful and detailed attention by the physician to achieve best results)
4. Minimal downtime (with new techniques involving cannula, minimal puncture site is needed and tendency to bruise from procedure is minimised)
5. Minimal discomfort (most HA fillers have Lignocaine and make the procedure a more comfortable one)
6. No skin-allergy testing is needed prior to treatment.

I feel that HA filler is most suitable if you are considering getting your first dermal filler procedure done. In the events when an undesirable outcome occurs or a sudden change of mind, correction is possible with the injection of commercially available hyaluronidase, which breaks down the unwanted HA filler.

HA DERMAL FILLER BA 4-01_preview

Picture: Hyaluronic Acid Filler for chin retrusion and bone atrophy of mandible (jawline)

Non-Hyaluronic Acid Fillers
Other non-HA dermal fillers (i.e.Poly-L-lactic polymer or Calcium Hydroxylapatite CaHA) have the properties to create a tissue response in the dermis that will produce more collagen to reinforce the structure of the skin. The longevity may also play a role in why one would choose this type of fillers; therefore this can be considered after having tried HA fillers first and are comfortable with the treatment outcomes by the attending physician.

Whose choice is it? Physician vs Patient
Preferences for physician and patients may vary. With temporary fillers such as Hyaluronic Acid fillers, per injection costs are less and complications are minor and rare when treatments are done by a fully-trained aesthetic practitioner. However, in the long run, maintenance costs are higher due to the requirement of repeated injections. On the other hand, with semi-permanent or longer-duration fillers, the time-and-cost horizon is shortened but any complications can potentially be more significant.
Therefore, upon deciding whether ‘to fill or not to fill’ or ‘what to fill’ those factors above should be taken into consideration. A balance is achieved when those are well-thought-out and strengthened by the physician’s expertise and patient’s expectations and acceptance of potential outcomes.

Resources:

  1. Draelos. (2016). Cosmetic Dermatology: Products and Procedures. Second Edition Wiley Blackwell, p 376-377.
  2. Small. (2012). A practical Guide to Dermal Filler Procedures. Lippincott Williams & Wilkins, p11.