Fillers: The evolution. Dr Christine Reader explains what they’ve traditionally been used for and what they can do now.
When speaking of fillers, it simply refers to substances that are injected by a needle into the skin with the purpose of enhancing and/or altering the appearance.
As we age, we lose general volume and plumpness of the skin. Features such as our cheeks and temples appear more sunken. The skin also becomes lax, losing its elasticity and firmness.
Fillers are traditionally used to smooth out wrinkles or boost volume to lips, but they also play a significant role in remodelling, adding volume to cheeks and chins. Now you can add one more to the list – skin rejuvenation.
So, what do they do and how did we get to this point?
The idea of enhancing or altering appearance by injection is not a new one. Unfortunately, as with many new ideas, this one had some growing pains. It was in the early 1900’s that paraffin was first injected in the attempt to smooth wrinkles and even as an early attempt at breast augmentation. There were complications, one being paraffinomas or hard lumps that would form under the skin.
Silicone came next. It was first used in the 1940’s, but in the early days was often contaminated with heavy metals, increasing the complications. Silicone is a permanent filler and some practitioners still strongly believe in this product, but it is not FDA approved for this use.
In 1981 the FDA approved collagen as an injectable. It initially came from cows, but being animal derived, there was a significant risk of allergic reactions. This meant a skin test had to be done a few weeks before the treatment.
Since then, collagen derived from human cells has been introduced. However, collagen fillers have largely been overtaken by hyaluronic acid fillers, which were first introduced in the 1990’s.
Hyaluronic acid is essentially a type of complex sugar naturally found in our bodies. Initially, as an injectable, it was derived from rooster combs and, as with bovine collagen, carried a risk of allergic reactions. This all changed with the development of hyaluronic acid derived from non-animal sources.
What they do, where they’re used for and how long they last in our bodies depend or how they’re made – or to be specific- how they’re cross-linked.
Generally cross-linked hyaluronic acid fillers tend to last about 6-12 months, with some individual variation. When this filler is in a gel form it reacts with water and swells, which gives the smoothing and filling effect. It’s said that hyaluronic acid can hold up to 1000 times its weight in water.
In addition to hyaluronic acid, there are other types of temporary fillers. Calcium hydroxylapatite is a type of temporary filler that is similar to the mineral commonly found in our bones and teeth. Calcium hydroxylapatite is a denser (thicker) product and can be injected deeper into the skin. This is a popular product to use on the hands – which can be a dead give away of our age, and for augmenting the jawline. It lasts a decent amount of time, on average about 18 months.
It can also be used for a procedure that’s growing in popularity – the non-surgical rhinoplasty or “nose-job”.
Another temporary filler that is FDA approved has a tricky name: poly-L-lactic acid (PLLA for short). This is a man-made, but biocompatible and biodegradable product. PLLA can be described as a semi-permanent filler, as it can last up to two years and can be used to add volume in thick-skinned areas such as the nasolabial folds and marionette lines (around the mouth).
When it comes to permanent fillers this FDA approved one is a real mouthful: Polymethylmethacrylate, or PMMA for short. This man-made product is biocompatible, but not biodegradable. That means the body will not be breaking this one down, so the effects are permanent. It basically consists of tiny round beads that is usually injected in combination with bovine collagen.
It is specifically FDA-approved for use on the nasolabial fold (the thick groove that runs from the nose to the mouth) and for filling in the scars left on the cheeks from previous acne.
Now for the rejuvenation bit. This involves a hyaluronic acid that has been formulated slightly differently, so its flows like honey under the skin. This is where the filler moves into the world of bio-remodelling.
This treatment is usually done on the face, arms, neck and chest and the back of the hands. It involves making multiple injections in strategic spots and when it’s used this way the goal is to actually treat the skin itself, leaving it deeply hydrated and plumped from within.
But it goes further than that, as it also acts to promote collagen and elastin production, improving the skin’s overall firmness.
Profhilo is an example of this. When injected, it lasts about 28 days inside the skin as a stabilised product and in this time it starts to stimulate the body’s natural collagen and elastin production. This gives the skin improved elasticity and creates a smoother and more youthful complexion.
Next comes the art. Some practitioners may use a layering technique where different types of fillers are used at different depths and in different areas to achieve spectacular results.
This takes a significant amount of skill to master. The fillers may even be combined with other treatments such as Botox, laser or other skin-tightening procedures, such as radio-frequency or ultrasound, to give a complete overhaul – lift, smooth and rejuvenate.
Just so you know, some fillers now contain a numbing agent, which makes the application significantly more comfortable.
It seems to be a constantly evolving field with improving products and increasingly refined techniques, which are yielding some very impressive results.
As always, if you are thinking of undergoing these treatments, make sure your practitioner is medically qualified, has completed the appropriate training and is capable of dealing with any adverse side effects should they arise.
Dr Reader is a medical practitioner who is taking time out to raise her family and concentrate or writing.