Dermal Filler: Myths and truths

So what is a dermal filler? Lots of people have an idea of what they think fillers are, how they are used and what happens during treatment. However filler can be quite different to what you might think. Here Dr Giulia D’Anna discusses dermal filler and helps to highlight the benefits, but also break down the myths.

What is dermal filler?

Generally these are composed of non-animal derived sugar molecule. This is a naturally occurring in our deep layers of skin. The sugar molecule can be a small all the way through to a very large molecule. The larger the molecule, the more stable and hard the dermal filler is. So generally large molecule fillers are used to replace or replicate bone, like the cheek bone, jaw line and similar.

Since Dermal filler is a sugar molecule, when it is in our skin, it attracts lots of water. In fact one molecule of dermal filler can generally attract around 1000 molecules of water. Water is necessary for skin cells to function well, transport nutrients and waste and give our skin hydration. The dermal filler molecule is normally found surrounding the collagen in our dermis. This means that the skin will be hydrated, healthy and voluminous. 

As we age, hitting just the age of 25, the amount of this sugar in our skin starts to decline. This means that the volume of our skin and face starts to gradually decrease and our skin will hang and drape differently creating wrinkles and folds. So this then is where cosmetic injectable dermal filler really shines.

What actually happens when dermal filler is used

1. When we inject dermal filler where there has been natural volume loss, our skin will begin to look younger again because the amount of water naturally held in the skin will increase. This means that the cells will communicate better, carry nutrients to the skin surface better and also lose waste more efficiently.

2. With dermal filler, the face looks younger as the collagen is infused with water and the natural volume of our face is increased. This means that small lines and wrinkles will iron out as though there is a small balloon of water inflating under them, and pushing them out.

3. Dermal filler starts to induce skin health, with the increase in hydration and cellular communication. This means that we will have better skin recoil and elasticity as the collagen and elastin are better protected from stretch and sag

4. With water levels at optimal levels after dermal filler, any superficial capillaries will now be sitting deeper in the skin since the filler is positioned more superficially. This is great news for people with reddened skin. The redness of the face is decreased.

5. Over time, the dermal filler that has been injected will naturally dissolve and be metabolised by the body. This is actually great news as the dermal filler needs to be in a position that suits the face as we get older. Who would want filler that was placed when you were 30 in the same position when you are 60? No one. The reason for this is the surrounding skin has stretched and the bones have changes shape too. So permanent filler would be a night mare, as the filler would no longer look correct. Placement of dermal filler will vary wildly when we are in our 60’s compared to when we are in our 30’s. So as the filler dissolves, the cosmetic injector can place new filler that suits the changing proportions of the face.

6. A skincare ingredient, hyaluronic acid is usually incorporated into serums, moisturisers and other creams. This ingredient cannot penetrate the deep layers of the skin, no matter the marketing hype. So a cream can simply not do what a dermal filler injection will do. Period. It does however sit in the upper cell layers, giving the skin hydration and cellular communication in the epidermis or surface layers. This is perfect for reducing very fine lines and wrinkles that appear due to dehydrated skin.

7. Dermal filler is not just about adding volume. It is also about adding proportion and redraping the skin on the face. What this really means is that by adding dermal filler to the face, the skin sits higher. This will reduce the jowls, and other skin folds since the skin no longer sits around the jaw line. When we look at a patients profile, the cheek bone will be better highlighted and catch the light in ways that illuminator can only dream of.

How can dermal filler turn ugly?

1. Not all fillers are made of a dissolvable sugar. Some are a more permanent filler. You would think that this is a positive quality, but permanent fillers do not necessarily attract water when they are injected. This can create some heaviness in the skin. So now instead of assisting the collagen, the skin can be heavy and pull in that direction. Additionally permanent fillers, do not dissolve over time. This means that if filler is placed in position that is correct when you are in your 30’s or 40’s, this may look out of place in later life when you are in your 50’s or 60’s. This is can create real cosmetic concerns as it is very difficult to deal with.

2. We have had one case in Australia to date of blindness. There are a number of problems that occurred with this particular case, which should be examined to avoid recurrence. This is one of the most serious of complications associated with dermal filler. A responsible and ethical practitioner should deeply understand the anatomy of the face intimately, and avoid using dermal filler in the danger zones. Additionally the cosmetic injector should only proceed with treatment if both the patient and injector are both on the same page. Both parties should understand the consequences of the treatment. This means proposed enhancement results, risks, benefits, after care, costs and so on. Some of the areas of the face where there can be serious consequences are between the eye-brows or frown area, and also around the tip of the nose. There are other options for replacing lost volume or dealing with deep lines in these areas, and an ethical practitioner should discuss this with you.

3. Lost proportions of the face. Thank goodness the public are demanding an end to this practice. Most people that I work with request a natural look, or one where they just look really good and healthy for their age. A cosmetic injector will actually measure the proportions of the face and remain within these proportions to keep the face looking healthy and proportioned. Over inflated lips or cheeks that are positioned too long, are not attractive and I consider this an unsatisfactory result.

4. Whenever we use a needle in the face, there are some minor risks associated with that. This can be bruising, swelling and tenderness. These are expected side-effects of treatment, but the good news is that these are transient and do not persist long-term. Bruises can be unsightly, but are not anything to really be concerned about. A bruise is always possible whenever the skin is penetrated.

5. If you are not happy with the outcome, non permanent filler can be dissolved in most cases with an enzyme. This enzyme is injected and you will see the results almost instantly. This is not your get-out-of-jail-free card. This is a safety net that is available. It is important to point out that some people can be allergic to this enzyme and cannot proceed with dissolving the filler. This means that you need to ‘wait it out’.

The take home messages about dermal filler

Dermal filler has some incredible properties that not only revolumise and add proportion to the face, but also improve the water carrying potential for the skin. This can seriously make your skin glow. But on the other hand, there are also some serious risks that need to be considered. Whatever you decide to do, I strongly encourage you to only proceed if you have great confidence about the treatment and are comfortable with your injector. After all your face will be in their hands.

Thanks for reading!

Written by Dr Giulia D’Anna

BDSc (Melb), MRACDS, FIADFE (New York), Graduate Dip. Cosmetic Dermal Therapies (AACDS) + | + 3 Belmore Road, Balwyn North, Victoria, Australia 3104 + | + Founder of iDental and Dermal Distinction

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