What are Dermal Fillers?
Dermal fillers (also known as facial filler) can plump up the lips, smooth wrinkles and fine lines, and fill in bags under the eyes.
Additionally, filler can also be used to sculpt a jawline, add projection to a weak chin, add volume to cheeks and temples, and smooth out moderate to severe acne scars. Injectable fillers can even be used for non-surgical nose jobs.
"Liquid facelifts" that combine dermal fillers with neuromodulators such as anti-wrinkle injections, can restore a youthful appearance in patients who are experiencing the early stages of volume loss as a result of aging. These combined procedures may delay the need for more invasive plastic surgery procedures such as facial fat transfer surgery.
In any case, dermal filler won't be able to replicate the results and level of revitalization possible with cosmetic surgery such as a facelift. Results are far more temporary and subtle.
The Therapeutic Goods Administration (TGA) of the Australian Department of Health prohibits open discussion of filler brand names and ingredients. Dermal fillers are prescription-only, requiring a doctor's consultation to choose the right brand for your needs.
Dissolvable fillers are the most popular TGA-approved facial filler, they allow easier fixes in event of a complication or change of heart.
What are the pros and cons of Dermal Fillers?
- When performed by an experienced, licensed healthcare professional, this injectable cosmetic procedure is quick, relatively painless, and safe.
- Dissolvable fillers closely resemble chemicals produced naturally by our own bodies. They are metabolized (broken down) over time and pose little risk of allergic reactions. It is also possible to reverse the effects with an enzyme that breaks down the filler if you are unhappy with the results.
- Results can be immediately seen
- Apart from some bruising and swelling, there is usually no downtime after the procedure.
- There is evidence that all injectable fillers stimulate collagen production.
- There is a high satisfaction rating from patients who undergo this procedure, with many saying they look more well-rested after under-eye fillers, finally have the lips they always wanted and love their new face shape.
- Dermal filler injections produce only temporary results. Maintaining the look over time will require touch-ups, which can be expensive.
- Visiting an inexperienced or unskilled injector can pose a serious health risk
- The reason many practitioners recommend fillers that can be dissolved is because some side effects like migration and nodules, can last as long as the filler does without medical intervention.
- There may be some bruising in the face for up to three weeks after injecting fillers.
- There is a wide range of possibilities with filler, from very subtle to overly dramatic. You should clearly communicate your aesthetic concerns and desired results (using photos) to your practitioner, ensuring they can deliver the type of enhancement you are after.
How much do Dermal Fillers cost?
Average Cost: $1,250
Range: $320 - $3,900
Several factors determine the price of your procedure, including the sort of filler and the number of injections (priced by syringe), the experience level of your practitioner, and the location of their clinic.
What are the risks and side effects of Dermal Fillers?
When administered by an experienced injector, dermal fillers are considered safe, although the procedure still comes with risks and potential side effects.
- Redness and bruising at the injection site, asymmetry, lumps and bumps are the most common side effects of fillers. To minimise bruising, do not take aspirin and other blood-thinning supplements (vitamin E, fish oil, garlic etc) for a week or two before your treatment.
- Dissolvable fillers are known to migrate or move from their intended positions. Longer-lasting formulations and larger-dose injections are most susceptible to migration. Dermal fillers should be injected slowly, at the correct depth, and in small droplets to ensure they remain in place over time.
- Other negative effects of fillers can also include granulomas (hard lumps under the skin), delayed inflammatory reactions (occurring months to years after treatment), and allergic reactions (particularly with fillers made from animal products).
- If the filler is not quickly dissolved, it is possible to cause serious complications such as tissue death, blindness, and even stroke. This occurs when filler is accidentally injected into a blood vessel (vascular occlusion). Select a board-certified dermatologist or facial plastic surgeon with deep knowledge of facial anatomy, who also carries dissolvent in the case of emergencies if you are considering injectable fillers. Practitioners are also more commonly offering ultrasound screening to map blood vessels and reduce the risk of vascular compromise.
- If you have an infection on your face or near the injection site, avoid getting fillers because it could spread or lead to complications.
- A psychological risk of facial filler is perception drift, the desire for additional treatments due to the inability to see improvement or differences from your “before photos”.
- People with body dysmorphic disorder (BDD) experience distress and repetitive behaviours caused by their belief that there is a flaw or defect in their physique. Please keep in mind that even after filler injections, you may still not like your appearance if you have untreated BDD.
Dissolvable Dermal Fillers
Dissolvable fillers are the most popular type of filler among doctors and patients leaving you with many different choices.
In Australia, there are 4 main brands of dissolvable filler manufactured by the companies: Allergan, Galderma, Teoxane and Merz. Each brand will have multiple formulations containing different levels of thickness made to target distinct areas of the face.
Formulations are commonly split to target the following areas:
- The smile lines around your nose and mouth (nasolabial folds and marionette lines)
- Lips and vertical lip lines
- The area under the eyes (tear trough)
- Cheeks and middle of the face
- Chin and jawline
- Other deep wrinkles and folds
Dissolvable filler results should last from 10 to 18 months, while smaller doses for fine lines may only last for 6 months.
Other types of Dermal Fillers
Other types of dermal fillers include facial fat transfers and non-dissolvable fillers. These approved alternative fillers are also manufactured by Galderma and Merz. In Australia, there is currently no TGA-approved permanent filler material (substances lasting 5 years).
As opposed to dissolvable fillers these other dermal fillers are characterised by:
- Their inability to be dissolvable by any chemical agents
- They are generally more viscous and firmer
- Stimulates more natural collagen production compared to dissolvable fillers
- Last longer versus their non-dissolvable counterparts (1-3 years)
Facial Fat Transfer
- This surgical treatment, also known as fat grafting, fat injections, or lipofilling, takes fat from your hips, thighs, or tummy to plump up your lips and cheeks, and to fill in nasolabial folds and the tear troughs under your eyes.
- Also a recommended procedure for pitted acne scars
- The 2-step procedure, which includes both liposuction and fat grafting, requires at least 2 hours to complete, and the recovery time ranges from 7 to 10 days.
- A board-certified dermatologist or plastic surgeon typically performs facial fat transfers, unlike other fillers that are routinely injected by nurses and doctor assistants.
What should you expect during your Dermal Fillers procedure?
During your consultation with your injector, you will discuss your desired outcome, the type of filler best suited to your goals, as well as any risks involved.
Getting a personalised cost estimate at this time will inform the amount of filler you need and prevent sticker shock when you pay your bill.
After this meeting, here is what you can expect during the treatment:
- If necessary, a topical anaesthetic will be applied after your injector has cleaned the treatment area (even though most fillers already contain an anesthetic).
- To ensure even distribution, they will slowly inject the filler with a needle or blunt-tipped cannula, gently massaging the area with their fingers as they inject.
- It is likely that your injector will be conservative when it comes to how much filler you need the first time you go (particularly lip or cheek filler). When the swelling has gone down, your injector may suggest you return to assess the results and decide whether you want additional filler. Non-dissolvable filler requires multiple treatments over a few months, as new collagen is produced.
- Although each injection just takes a few seconds, the complete cosmetic process may take an hour or longer if your injector is treating multiple areas.
- The results will be immediately noticeable, such as more volume or smoother skin.
- After your treatment, you may be given a lightweight ice pack to apply against your skin to soothe any discomfort, tenderness, or swelling, but take care to not apply excessive pressure.
- With non-dissolvable fillers your injector may provide instructions on how to massage injection sites to distribute and prevent nodule formation, usually a series of exercises over a week period.
Melon Tip: Make sure the person performing the procedure is either the prescriber or a registered health practitioner under a prescriber’s supervision. The national register maintained by the Australian Health Practitioner Regulation Agency (AHPRA) lists all individuals that are registered with the Medical Boards of Australia and can be searched for free on the AHPRA website.
How much recovery time will you need after Dermal Filler injections?
Although you won't need any actual time to recuperate, you may encounter bruising and swelling at the injection site, which might mean skipping out on social engagements. These side effects can take a few days to a few weeks to subside.
Even though bruises can usually be concealed with makeup, getting fillers too close to a big event isn't a good idea.
To minimize swelling, avoid sun exposure, heat, exercise, and alcohol for at least 24 hours after injections. Arnica ointment may also be advised by some doctors to lessen pain and swelling.
How long do Dermal Fillers last?
Depending on the type of filler, the amount your injector uses, and how fast your body metabolises it, filler may last anywhere from 6 months to several years. Some dissolvable fillers can last up to 18 months, while the longest-lasting non-dissolvable fillers typically last for 5 years.
A quick metabolism may cause the effects of filler to fade faster, though after 2 to 3 additional appointments you will notice the results begin lasting longer and longer.
The longevity of fillers has proved more complicated than initially thought. Studies have indicated that dissolvable fillers can last far longer than advertised, with material visible on MRI and ultrasound years after injection. It also appears that there are certain areas on the face that retain filler longer, such as under the eyes.
What are the long-term effects of Dermal Filler injections?
When administered correctly, facial fillers do not change the face permanently or have long-lasting consequences. However, when fillers are overused, usually in a misguided attempt to perform a “facelift” they can lead to a variety of issues.
Although dermal fillers rarely have long-term side effects, too much dissolvable filler can distort the face and make it look cartoonish or alien. Filler has the ability to draw and hold water, giving the face an unnaturally puffy and doughy appearance.
In addition to disrupting muscle mechanics, cheek and lip fillers can alter the eye shape (especially when smiling), make the mouth move in an odd manner, and even affect speech clarity. Excessive filler around the eyes can also block lymphatic channels, resulting in persistent puffiness and eye bags.
Choosing an injector who takes a conservative approach and does not adhere to some predetermined schedule for topping up fillers is the best way to avoid a pillowy face and overfilling issues.
It has been shown that dissolvable fillers last longer than their manufacturers advertise-and it is important to avoid layering new filler over old.
Are Dermal Fillers better than Anti-Wrinkle Injections?
Many people mistakenly believe that anti-wrinkle injections are fillers, however, they function quite differently. While fillers increase volume, neuromodulators relax muscles to minimise the visibility of fine lines, wrinkles, and creases (and prevent new ones from forming).
For optimal facial rejuvenation, anti-wrinkle injections can be combined with fillers during the same treatment. Currently, anti-wrinkle injections are TGA-approved to treat crow's feet, frown lines, and forehead lines. Discuss which treatment is best, based on your aesthetic goals during your consultation.
Sources & Studies
Dental Board of Australia 2022, Dental Board of Australia - Fact sheet: The use of botulinum toxin and dermal fillers by dentists, Dentalboard.gov.au, viewed 13 December 2022, <https://www.dentalboard.gov.au/codes-guidelines/faq/botulinum-toxin-and-dermal-fillers.aspx>.
Haneke, E 2015, ‘Managing complications of fillers: Rare and not-so-rare’, Journal of Cutaneous and Aesthetic Surgery, vol. 8, no. 4, p. 198, viewed 13 December 2022, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4728901/>.
Master, M & Roberts, S 2022, ‘Long-term MRI Follow-up of Hyaluronic Acid Dermal Filler’, Plastic and Reconstructive Surgery - Global Open, vol. 10, no. 4, p. e4252, viewed 13 December 2022, <https://journals.lww.com/prsgo/Fulltext/2022/04000/Long_term_MRI_Follow_up_of_Hyaluronic_Acid_Dermal.12.aspx>.
Medical Board of Australia (Australian Health Practitioner Regulation Agency (AHPRA) 2020, Medical Board of Australia - Guidelines for registered medical practitioners who perform cosmetic medical and surgical procedures, Medicalboard.gov.au, viewed 13 December 2022, <https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Cosmetic-medical-and-surgical-procedures-guidelines.aspx>.
Nursing and Midwifery Board of Australia 2021, Nursing and Midwifery Board of Australia - Position statement on nurses and cosmetic procedures, Nursingmidwiferyboard.gov.au, viewed 13 December 2022, <https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/position-statements/nurses-and-cosmetic-procedures.aspx>.
Therapeutic Goods Administration (TGA) 2019a, Cosmetic injections checklist, Therapeutic Goods Administration (TGA), viewed 13 December 2022, <https://www.tga.gov.au/news/news/cosmetic-injections-checklist>.
― 2019b, Things to consider before undergoing procedures involving dermal fillers, Therapeutic Goods Administration (TGA), viewed 13 December 2022, <https://www.tga.gov.au/news/news/things-consider-undergoing-procedures-involving-dermal-fillers>.