Hyaluronic Acid Fillers - What you need to know

Hyaluronic Acid Dermal Filler is a temporary dermal filler used to reduce the appearance of unwanted fine lines and wrinkles, improve face shape and contour and enhance facial features.  Common brands of this type of dermal filler include: Restylane, Juvederm and Belotero.  It works differently to Botulinum Toxin wrinkle relaxing treatments, which are mainly used to reduce lines and wrinkles on animation.

 

Hyaluronic acid is naturally occurring in our skin and body tissue, it is constantly being broken down and replaced by the body.  Hyaluronic acid dermal fillers are made of complex sugars which are compounded with a bonding agent, to help them resist being broken down too quickly by the body.  There are various types of dermal fillers, all formulated with different properties which affect the way the filler behaves in the tissue.  For example, a firm robust filler, with minimal elastic properties is most suitable to add definition to the cheekbone, while a soft smooth filler may be more appropriate to address fine lines around the mouth.  During a consultation I will recommend which filler (if any) I feel would be the best fit for your specific needs.  All hyaluronic acid filler is hydrophilic, in other words it works by binding to water molecules in your tissue, so staying well hydrated will help to maximise your results.

 

My philosophy on dermal fillers is to recognise and respect that every face is unique and beautiful (or handsome) in its own way.  I love to use filler in a way which highlights your most attractive features and distracts from those you are less fond of… all while respecting facial proportions, animation and principals of beauty.  My goal is to help enhance your unique beauty and discover your most confident self.

 

If any of the following apply to you, we will need to discuss your suitability for treatment further, please be sure to mention them on your medical record *

  • Chronic health conditions

  • Acute illness on the day of treatment

  • Autoimmune disorders

  • Uncontrolled Epilepsy

  • Previous Anaphylaxis

  • Currently pregnant or breastfeeding

  • Unstable mental health conditions

  • Unstable heart conditions

  • Unstable diabetes

  • Unstable thyroid

  • Poor dental health, recent or planned dental procedures

  • Overseas travel in the next 10 days

  • Previous reaction to dermal filler

  • History of permanent or non-HA fillers

  • Sunburn in treatment area

  • Active skin infection or disorder on the face

*This list is not comprehensive, other conditions may also apply that will be detailed on your medical form and discussed during consultation.

 

Like all medical procedures, there are possible side effects and adverse events associated with treatment.  The risk of these is heightened significantly if;

  • the dermal filler is not a hyaluronic acid based filler

  • higher risk areas are being treated such as the nose or frown (this only applies to dermal filler, not wrinkle relaxing treatments),

  • the injector is not well educated on facial anatomy or fails to take steps to prevent, recognise or act on early signs of a possible complication.

 

So what can go wrong?  Common side effects include swelling, bruising & tenderness.  I tell all patients to expect one or all of these to some degree post treatment.   Lips and tear troughs (under eye area) are particularly prone to swelling and bruising. The severity or absence of these will vary between treatments, injection sites and individuals.  You might be fine, with no bruising or swelling at all, however it is best you are prepared (ice, concealer, antihistamines, arnica, hirudoid or topical Vitamin K, oral and/or topical vitamin C are all ways you may be able help to reduce the effects of these and/or speed up the healing process).  Injections may trigger a cold sore reaction in some individuals who carry the virus – if you are prone to getting cold sores prophylactic treatment starting the day before your treatment is recommended.

 

Of course, I will take every precaution to try and minimise the incidence of these side effects, however unfortunately given the unique nature of ones anatomy, there may be vessels and anatomical structures I cannot detect under your skin surface and every individual responds differently to bruising/swelling. 

 

Swelling tends to be at its worst 24-72 hours post treatment.  So please do not be alarmed if you experience swelling during this period.  If the swelling is excessive, please do not hesitate to contact me.   As above, lips and undereye treatments are most prone to this.

 

There are things you can do also to help reduce the likelihood of these tissue responses. 

These include:

 

For 2 weeks prior to your procedure, you may wish to consider eliminating or reducing the consumption of the following:

 

  • Gingko biloba, ginseng, ginger, glucosamine, turmeric, fish or krill oil, omega or primrose oil, cloves, St Johns wart, anti-inflammatory medications (such as ibuprofen & voltaren), anticoagulants. If your medication/supplement is prescribed or recommended by your doctor, please discuss with them prior to stopping or reducing  your consumption.

 

For 2 days prior avoid excess alcohol

 

  • On the day of treatment limit coffee or caffeinated tea and avoid makeup if possible

  • On the day of treatment, and for 3 days following, avoid strenuous exercise, spa baths, saunas, steam-rooms & excessive sweating. 

 

If you do experience bruising/swelling: 

 

  • Apply ice to the area for 20 minutes (through a moist tea-towel – not directly onto the skin) and then off for 20 minutes.  This may be repeated as often as necessary for 24 hours post treatment.

  • Taking an oral over the counter antihistamine, may be beneficial in some circumstances.

  • Sleeping with your head elevated (at least 45 degrees) may help reduce the likelihood of you waking with excessive swelling.

  • Taking oral arnica and/or Vitamin C or applying arnica/hirudoid /Vitamin K or Vitamin C topically to the area may help to reduce the duration of your bruising/swelling.

  • Red LED light may be beneficial to assist healing and reduce inflammation.

Consider what you might tell other people if they notice (some patients prefer not to discuss cosmetic treatments with friends and family). White eye eyeliner and a good coverage concealer and/or foundation (eg thin Lizzy) can be effective at covering even dark bruises.

 

Please do not hesitate to contact me if you are concerned or if your bruise doesn’t look normal (eg patchy, motley, blanched or if there are any unusual patterns, broken skin or pustules).  Or if you have severe or persistent pain (not consistent with tenderness from a bruise).

 

Firmness of the product or small lumps in the first 2 weeks following treatment, may occur.  This can be influenced by the type of filler used, your body’s response to the filler and the thickness of your skin.  Please do not be alarmed, it can take up to 2 weeks for some fillers/individuals to have the dermal filler integrate into the tissue.  In actual fact it may be up to 6 weeks to completely settle, but majority of the integration takes place in the first 2 weeks. 

 

It is not uncommon to walk out of the clinic with mild swelling, wake up the next day with moderate swelling (which can feel huge for lips especially), then a few days later feel a bit lumpy and maybe a bit asymmetrical – please stay calm and trust the process.  Give your body the opportunity to integrate the filler into your natural tissue and heal any inflammation that may be present post the injectable procedure.  Equally, if you don’t experience swelling or lumpiness – don’t panic.  In all circumstances stay well hydrated in the weeks following your treatment.  Hyaluronic acid works by binding to water.

 

There are some reported cases of filler hardening or becoming infected weeks to months following treatment.  Although this is extremely uncommon, managing it appropriately is important.  If you suspect this may have happened to you, please book an appointment to have it reviewed. Unfortunately, not all GP’s are familiar with cosmetic treatment, so may not manage complications as per current industry guidelines so please get in contact.

 

Although very rare, it is possible to have an allergic reaction to the dermal filler or lidocaine (numbing solution built into the product) – please ensure you disclose all allergies prior to this procedure.

 

Vascular occlusion is even more rare, but potentially very serious. This is where dermal filler has inadvertently entered a blood vessel, which effects the blood supply to that tissue area.  This would normally present at the time of injecting, however there have been incidences where it has presented up to 3 days following the procedure.  Vascular occlusion usually presents as an abnormal looking bruise or blanched skin, this may progress to a red or blue or grey uneven spiderweb like pattern over the treatment area with or without pustules (that can be mistaken for pimples/infection or cold sores).  Dermal filler injections (particularly fat injections and treatment of the nose and frown) have resulted in blindness and/or stroke.  The incidence of this is suspected to be about 1 per 5 million treatments. 

 

For both of these incidences there are acute protocols in place that will likely commence with the administration of hyaluronidase (an enzyme which dissolves hyaluronic acid).  This enzyme is commonly used for other medical purposes and is always on hand in the clinic.   Should your vision be affected, you will likely be referred immediately to an ophthalmic specialist.  Although this scenario would be very serious & scary – I must reiterate the incidence of this with hyaluronic acid in the areas I treat would be much less than 1:5 million and we have protocols and medications in clinic to help manage this should it occur.  Many medications and procedures hold much greater risks, however given that this is an elective, cosmetic procedure it is important that you are well informed.

 

 

How painful is the procedure?  This depends on the patient and how sensitive their skin is on the day.  This may be strongly influenced by sleep (or lack of), anxiety, stress, hormones or medication.  Please advise me if you are concerned about pain and we can talk through some possible options to help to minimise this (these include prescription grade topical anaesthetic, local anaesthetic and other modalities).  Some clients find brining headphones and music or meditation a helpful distraction.

 

Dermal filler can create a beautiful rejuvenated result.  I will always use my clinical experience and knowledge to best advise you of what treatments and how much product I feel will address your concerns, or whether I feel dermal filler is the appropriate treatment in the first instance.  Unfortunately, however, I cannot guarantee you will be satisfied with the result or that you will not experience any side effects.  You may need additional product at your expense, and you will need to continue to have treatment at appropriate intervals if you wish to maintain your result.   I can give you an estimate on how long the specific treatment may last, based on clinical studies and anecdotal clinical experience, however there will always be patients that fall on either side of these guidelines.  Similarly, a GP cannot guarantee paracetamol will resolve a specific individual’s pain sufficiently to their expectation or guarantee how long it will last.  How long the treatment will remain effective is influenced by the type of filler used, the area of treatment, injecting technique, individual metabolism of filler, lifestyle factors (exercise, medication, stress etc). As a general guideline dermal filler lasts 6-24 months for most individuals.

 

 

If you have a major event planned ensure you plan ahead. It can take time for your true result to take effect.  It is best to allow 3-5 weeks before the event.  If the event is your wedding or if you have significant volume loss, you may even wish to allow more time so that your treatment can be done in stages to produce the most natural looking & best result.

 

I offer complimentary consultations, so if you would like to know if you are a good candidate for dermal fillers or what I might recommend, book a consultation – I’d love to see you.