As our skin ages, the dermis gradually loses its major constituents: collagen, elastin and hyaluronic acid. Collagen acts as the major support protein for our skin; elastin allows our skin to stay firm and resist wrinkles; hyaluronic acid helps to trap water and add volume and shape to our skin.

Dermal Fillers

Dermal fillers are being used more and more to help reverse the changes associated with aging. Because the goal is to return the dermis to its original youthful state, dermal fillers can give a more natural appearance than surgical face lifts. Dermal fillers are being used to reduce or eliminate wrinkles, raise scar depressions, enhance lips, and replace soft-tissue volume loss.

Types of Dermal Fillers:

Several classes of dermal fillers are marketed in the United States today. They include: collagen based fillers (i.e. Zyplast and Cosmoderm), hyaluronic acid based fillers (i.e. Restylane and Hylaform), and calcium hydroxyl apatite fillers such as Radiesse. Moreover, promising dermal fillers are in development that will offer superior capabilities in the future.

The ideal dermal filler should be easy to administer, provide reproducible cosmetic results, remain in the dermis for a significant period of time, and have a superior safety profile. Injection of fillers usually requires the use of either a topical numbing cream or a local injection of numbing medication. Then, using a small needle, the dermal filler is injected into each wrinkle or scar that requires treatment. Some mild burning and stinging is normal and quickly resolves.

The results can last from three months to five years, depending on the filler being used. Collagen provides the shortest duration with effects lasting anywhere from three to six months. Restylane tends to last a bit longer with effects lasting from six months to one year. Radiesse can provide results that last greater than 3 years.

Side effects are uncommon but can include limited allergic reactions (hypersensitivity), ulceration, reactivation of herpes infection, bacterial infection, localized bruising, and granuloma formation.

Hypersensitivity reactions to the older collagen-based dermal fillers were frequent and required skin testing ahead of the treatment, but are becoming less common with the use of human collagen (Cosmoderm, Cosmpolast) instead of cow derived collagen (Zyderm, Zyplast).

Ulceration is rare and occurs when the filler is injected into a blood vessel; cutting off the blood supply to the overlying skin. Bacterial infections are rare and may be treated with antibiotics. Localized bruising is temporary and may be reduced by applying ice before and after injection. Granuloma formation is a rare complication that may require steroid injections, or surgical extraction of the granuloma.

• What are facial dermal fillers?
• What are the risks of dermal fillers?
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