Fillers

Fillers

Ageing of skin causes the loss of collagen and hyaluronic acid from the underlying layers of skin. Collagen and hyaluronic acid are elastic, hydrating materials responsible for the structure and volume of the face. Due to the loss of these materials with advancing age, skin loses its inherent elasticity and tends to sag, forming lines and wrinkles. Fillers are a means of non-surgically enhancing facial features by using injectable materials to smoothen out skin imperfections like wrinkles or fine lines. They have been used by millions of people in order to achieve a younger, smoother looking skin. Fillers are meant to be injected into the dermis of the skin; therefore, they are also known as dermal fillers. The most commonly targeted areas of the face for dermal fillers are the nasolabial fold (lines next to the nose and mouth) underneath the eyelids, around the eyes, into cheeks, and the lips.

How do fillers work?

Dermal fillers are formulated as smooth, injectable materials which contain collagen and hyaluronic acid. Upon injection, they add volume to the skin and can stimulate the production of collagen. Various dermal fillers possess different properties; however, their mechanism of action is two-fold. Firstly, they lift the skin and a replace the collagen lost due to biological ageing. Secondly, they promote the formation of natural collagen in the skin, thereby resulting in the improvement of skin elasticity.

What are the most commonly used filler materials?

1. Collagen – Available as Zyplast, Zyderm, Cosmoderm, Fibrel among others, these fillers are an injectable form of collagen, derived from cows or from human cells. Due to the presence of animal-derived components, patients should be tested for allergies to bovine collagen. These fillers are effective and natural-looking but do not last for long periods of time. To maintain the treatment, collagen fillers may be required two to four times a year.
2. Hyaluronic Acid (HA) – Some of the hyaluronic acid fillers available in the market are Captique, Elevess, Restylane, Perlane, Juvéderm^® HA based fillers are the most popular filler for cosmetic use. Hyaluronic acid is derived from bacteria or from rooster combs. In some cases, the HA in the filler can be chemically crosslinked to enhance its longevity as a filler. HA fillers may stimulate the skin’s ability to generate collagen; this reduces the appearance of fine lines and wrinkles. Results from HA based fillers may last anywhere between 9 to 12 months.
3. Calcium hydroxylapatite – Calcium hydroxylapatite is a normal constituent of human teeth and bones. It is available as afiller under the brand name In this formulation, particles of calcium hydroxylapatite are dispersed in a gel-like material and injected into the area where reconstruction is required. This material has also demonstrated the ability to produce collagen within the skin. The effect of this filler lasts anywhere between 12-18 months.
4. Polymeric fillers – These include man-made polymers such as polymethylmethacrylate and poly-l-lactic acid as a component in the filler injection. They can be used by themselves or in combination with natural materials such as bovine collagen. Due to their synthetic nature, they are absorbed by the body at very slow rates, or not absorbed at all. Therefore, their effects as facial fillers last as long as 18-24 months.
5. Autologous fillers – Autologous fillers are injectable materials derived from the patient’s own body and subsequently used as dermal fillers. More often than not, fat derived from the patient’s buttocks, stomach or thighs is used. Two procedures are required. The first procedure removes the fat and the second procedure injects the fat in the desired location. Alternatively, injections of plasma derived from patients’ blood can also be used as fillers. Blood is drawn from the arm and separated into the plasma-rich component and then used as facial filler.

Which are the most popular dermal fillers available on the market?

1. Juvéderm^® – The Juvéderm^® family of dermal fillers are formulated from crosslinked hyaluronic acid which can be injected into different areas of the patient’s face for desired results. Juvéderm^® XC is designed especially for fine lines and wrinkles and maintains excellent results for 1 year. Juvéderm Voluma^® XC is formulated to provide volume in a cheek-lift application for a period of 2 years. Lastly, Juvéderm Ultra^® XC is used for adding volume to the lip and perioral areas in lip augmentation procedures for as long as 1 year.
2. Restylane^® – Restylane^® is another range of dermal fillers made of hyaluronic acid which can be used to augment lips, smoothen lines and wrinkles on ageing skin. The Restylane^® family of fillers is FDA-approved for lip augmentation in patients over the age of 21. Another product under the same range, Perlane, is also a hyaluronic acid based dermal filler designed specifically for deeper injection into the skin enabling the correction of more severe wrinkles and facial lines.

What are the adverse effects associated with fillers?

• Common side-effects – These include bruising, redness, swelling, pain, tenderness, itching and rashes.
• Rare side-effects – These include the formation of inflammatory nodules or granulomas which may need surgery, infection, open wounds, sores at the injection site and allergic reaction.
• Extremely rare side-effects – In very rare instances, severe allergic reactions, loss of vision, movement of the filler material from the site of injection, injury to the blood supply in the region have been reported.

Dermal fillers are the most common non-surgical method for minimising the effects of ageing and scarring on the skin. Over the years, improvements in the technology have provided cosmetic surgeons with a variety of fillers to use on patients. However, fillers vary from one another and need to be selected in accordance with the needs of the patient and his/her expectations from the treatment. This will enable the surgeon to ensure long-term benefit, minimal risk and effective treatment.

Despite the minimally invasive and safe nature of dermal filler injections, they should only be carried out by trained surgeons with significant experience and training. When performed by inexperienced practitioners, they may lead to a range of side-effects ranging from mild to severe.

Dr Debraj Shome is a highly experienced oculoplastic surgeon based in India. He has various accolades and medical distinctions to his name.

Getting pretty eyes is easy with the best fillers for under eyes!

If you are on a search for the best fillers for the under eye areas, to get beautiful eyes, then you need to visit Dr. Debraj Shome at The Esthetic Clinics. Your dark circles or eyelid bags or crows’ feet may have led you on your search for the best fillers for the under eyes.

The good news is that there are a huge variety of best fillers for under eyes available. From Restylane to Juvederm, there are many best fillers for under eyes available. The best person to advice you on this is obviously Dr. Debraj Shome, based in Mumbai, India. He will be able to assist you to get the best possible filler treatment for the under eye areas, to camouflage all the under eye problems.

There are many types of filler available for under eye problems, that claim to be the best fillers for under eyes. As we age, the fat starts accumulating under the eyes, creating bags and dark circles. To inject the best fillers for under eyes, you need an expert practitioner who knows how to use the fillers, to camouflage the fat evenly, so that the smooth appearance of the eyelid cheek junction returns.

We stress the importance of only getting the fillers injected by the experts, because in the hands of non expert injectors, even the best fillers for under eyes will appear not to do their job. Injecting the lower lids should be only performed by those who have an advanced knowledge and experience in the area. Some of the best fillers for under eyes such as Juvederm, Restylane, Belotero that have hyaluronic acid as a component, can be dissolved by injecting hyaluronidase into them. Therefore, if anything goes wrong like appearance of unevenness or if they are affecting blood supply to the face, then these fillers can be dissolved. However, there are some best fillers for under eyes such as Radiesse®, Silicone, Sculptra®, Artefill®, which cannot be dissolved and therefore should be avoided for the under eye  region.