THE TRUTH ABOUT HYALURONIC ACID FILLERS

Hyaluronic acid (HA) is one of the most popular ingredients in skincare treatments. It is beneficial regardless of whether it is applied in fillers or topically. Topically applied HA demonstrates significant benefit to decreasing wrinkle depth, skin hydration, skin firmness and elasticity.  The biggest challenge in topically applied HA is to have formulations of HA that allow better skin penetration.  The smaller the HA particle, the better the penetration into the skin.  This is why topical low molecular weight HA has better efficacy in penetrating the skin, treating wrinkles, improving elasticity and increasing moisture content. This low weight HA is one of the key ingredients in Soothe & Smooth, and Lift & Lustre to instantly plump and hydrate your skin.

Dermal fillers have revolutionized non-surgical aesthetic enhancements and are used for soft tissue augmentation, volumization, hydration and biostimulation.  All dermal fillers have the potential to cause complications. While many complications are related to volume and technique, some are associated with the material itself.

There are over 200 dermal fillers on the market worldwide and are considered a medical device.  It is imperative that clinicians and patients understand the safety profile of the dermal filler and the safety of the product they wish to inject.  In the USA this is governed by the FDA (Food & Drug Administration) and in Europe, the CE (Conformite Europeenne).  As the UK widely accepts the status of approval by the FDA, which undergoes a more stringent vetting process, I advocate using FDA approved dermal fillers.  It is imperative to stay away from less expensive alternatives that do not have a full safety profile and approval status, particularly as they are marketed at a cheaper cost.

There are temporary biodegradable and permanent nonbiodegradable dermal fillers.  The body resorbs biodegradable fillers and therefore their effects are relatively short lived.

Biodegradable:

The most common form of biodegradable fillers used is hyaluronic acid (HA) filler, which last 6-18 months.  Biodegradable fillers that stimulate the body to produce collagen have a longer duration of effect of up to two years; common ones include calcium hydroxyl apatite (Radiesse), and poly-l-lactic acid (Sculptra).

Non-biodegradable:

Non-biodegradable fillers initiate a foreign body reaction that stimulates fibroblastic deposition of collagen around the nonabsorbable microsphere. Polymethylmethacrylate (PMMA, Artecoll, Aquamid, Silikon) are the most common of this subset.

I personally do not believe that there is a role for permanent nonbiodegradable fillers in my practice.  All fillers are associated with potential short duration and long duration complications.  The management of adverse events depends on the severity of the complication, the duration of the complication, and the time course of complications.  There are a plethora of potential complications and I will touch on the most frequently occurring ones.

Swelling, erythema (redness), and ecchymosis (bruising) may develop after any dermal filler treatment and usually resolve spontaneously.  Lumps and nodules can sometimes be seen or felt after treatment because too much material is injected, clumping of the filler occurs or there is dislocation of filler by muscle movement.  Meticulously placed filler and firm massage can help avoid its visibility.  However, if overcorrection, irregularity and nodule formation arise, they are persistent for longer and are more difficult to treat with semi-permanent and permanent fillers, often because of the particulate nature of the filler.  For this reason, I advocate using HA fillers to the lips, periorbital area, forehead, temples and nose.

If an adverse events happen with HA filler, they often resolve with hyaluronidase treatment with or without other adjunct treatments like steroids or antibiotics.  Treatment becomes much more difficult when using a nonbiodegradable dermal filler and can lead to surgical drainage and unsatisfactory cosmetic outcome.

Most adverse reactions result from technical faults such as wrong indication, placement site and infection and are not specific to a particular filler.  Nonbiodegradable fillers can have clinically prevalent complications that are more pronounced and persist for longer.  The key to success with dermal fillers is to know the facial anatomy, know the characteristics of the dermal filler used, implement proper technique and to have a conservative approach to avoid pitfalls and complications. Using a dermal filler with the potential of reversibility is ideal in the management of those complications.