[6 min read] Considerations for the safe practice of dermal fillers

Dermal fillers are a potent rejuvenation tool in aesthetic medicine. The materials used are of different origins, but their purpose is the same – soft tissue augmentation. The main goal is adding volume to skin or subcutaneous fat. Practitioners in primary care may use dermal fillers for the following indications:

  • Facial wrinkles and creases
  • Lip volume enhancement
  • Scar improvement
  • Facial deformities
  • Sunken eyes (dark circles)
  • Breast and buttock augmentation
  • Earlobe plumping
  • Jawline definition
  • Hands and neck rejuvenation

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Applying dermal fillers in a controlled environment by a trained professional is generally safe. In rare cases, however, severe complications may occur. That’s why following the safety guidelines is essential.

Types of dermal fillers

Choosing the correct filler requires taking into consideration all the vital factors. The most important ones are the fillers’ attributes. These include:

  • Type and source of the substance
  • Mechanism of action
  • Duration of effect
  • Indications
  • Substantiation

The elementary classification of dermal fillers is by longevity, material, and application site.

Longevity-wise, dermal fillers may be:

  • Temporary
  • Semi-permanent, or
  • Permanent

The filler material classifies as:

  • Heterograft,
  • Allograft,
  • Autograft, and
  • Synthetic filler

The site of placement can be:

  • Dermal
  • Subdermal
  • Supraperiosteal

Patients benefit from expert guidance during this process. So, it is up to a doctor to manage their expectations by informing them about all the pros, cons, potential complications, etc. For example, temporary fillers cost less per injection and are less likely to cause serious complications. However, the maintenance of the effects requires regular injections.

More permanent fillers cost more initially, but the effects are long-lasting. Also, the possible complications are potentially more severe.

Various brands of fillers are also available.

General safety guidelines

After a thorough consultation, the patient should sign an informed consent form. The document needs to include the following details about the filler:

  • Source,
  • Chemical nature,
  • Indications,
  • Duration of effects,
  • Approval status,
  • Potential side effects, and
  • Cost

Physicians also have to possess knowledge of the injection site anatomy. They need to manage patients’ expectations properly and own the sense of aesthetic appeal.

Preparation

Taking the patient’s medical history is the first phase of preparation. That involves the history of previous similar procedures, allergies, and currently used medications.

Physical examination and counselling are next, followed by pre-procedure photography.

Procedure

The first step is cleaning the injection site and the surrounding skin with an antiseptic.

The procedure may cause some discomfort, but it is not painful. The lips area and nasolabial folds may require the use of a local anaesthetic.

In some patients, anaesthesia can also have a psychologically soothing effect.

The last phase of the procedure is injecting the filler using the appropriate technique.

The physician chooses the injection style.

Post-procedure care

The most valuable post-procedure care tips are common for all types of dermal fillers:

  • Avoiding exposure to extreme temperatures
  • Avoid massaging the injection site for at least 24 hours after the procedure
  • Avoiding strenuous physical activity

Pain medications may be necessary to manage the discomfort for a few days.

Complications

If complications occur, they are usually minor. Severe complications are more likely with permanent fillers. We can divide them into two groups:

  1. Immediate complications
  2. Late complications

Immediate complications may include:

  • Pain
  • Bruising
  • Erythema
  • Oedema
  • Lumps formation
  • Asymmetry
  • Anaphylaxis
  • Acne flare-ups

Late complications are:

  • Allergic reactions
  • Infections
  • Vascular occlusion
  • Inflammatory nodule
  • Granulomas
  • Tyndall effect

– Dr Rosmy De Barros

Read another article like this one: Managing complications in aesthetic medicine


References:

  • Ballin AC, Brandt FS, Cazzaniga A. Dermal fillers: an update. Am J Clin Dermatol. 2015;16(4):271-283. doi:10.1007/s40257-015-0135-7
  • Scheuer JF 3rd, Sieber DA, Pezeshk RA, Gassman AA, Campbell CF, Rohrich RJ. Facial Danger Zones: Techniques to Maximize Safety during Soft-Tissue Filler Injections. Plast Reconstr Surg. 2017;139(5):1103-1108. doi:10.1097/PRS.0000000000003309
  • Bass LS. Injectable Filler Techniques for Facial Rejuvenation, Volumization, and Augmentation. Facial Plast Surg Clin North Am. 2015;23(4):479-488. doi:10.1016/j.fsc.2015.07.004
  • Witmanowski H, Błochowiak K. Another face of dermal fillers. Postepy Dermatol Alergol. 2020;37(5):651-659. doi:10.5114/ada.2019.82859

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