Dermal Fillers

Key Points

• Safe and easy
• Quick, instant results
• Younger, softer appearance
• Lines and furrows that result from ageing are filled and erased
• Facial scars – and acne scars – can be improved
• Lips natural shape is highlighted, the border more clearly defined.
• Full and sensuous lips.
• Fuller cheeks, reduce under eye circles and tear troughs = less tired looking.
• Nose bumps straightened out (see Nose Reshaping)

DERMAL FILLERS: younger softer appearance by NZ's top injector since 1992......

Dr Beulink’s Personal Comments – Dermal Fillers

Dermal fillers have been a large part of my cosmetic practice from Day One. I began injecting dermal fillers in 1992 and in the mid 1990’s, became one of the first doctors in the world to clinically use the then “new” hyaluronic fillers (e.g. Restylane, Hylaform). As such, I have had vast experience in injecting and using these products.
 

Dermal fillers are often the first line of choice for people looking for some form of cosmetic improvement. Dermal fillers provide the perfect cosmetic solution for those who wish a subtle refinement, or perhaps a generalised re freshening of their look. For others, dermal fillers are the answer for a specific problem wrinkle, a rebuild or enhancement of their thinning lip, or maybe a specific fashion look. For most, dermal fillers may be seen simply as a routine part of their maintenance programme to help slow down the ageing process or hold the status quo. Dermal fillers are relatively cheap and very user friendly, offering simple, quick and fuss free treatment with instant results.
 

What is the difference between a dermal filler and Botox? There is often a lot of confusion for first timers about what this difference is and which one of these may be the more appropriate for their problem. 
 Botox is injected below the skin into an underlying muscle. That muscles action is causing the overlying skin to crease and wrinkle up. The Botox temporarily paralyses or relaxes that muscle, and thus the overlying skin wrinkles are allowed time to repair and seemingly melt away. So Botox works in a delayed secondary sort of fashion on the skin wrinkles. It would be a bit like stabilising the movements in the foundations of a house to stop further cracking in the walls.
 Dermal fillers however, are injected directly into the skin wrinkle, immediately lifting it up. The visible result is immediate. This would be a bit like filling the cracks on the wall of a house caused by sun damage and age, by using some form of putty or gap filler.
Generally speaking, Botox tends to be very good for wrinkles in the upper part of the face where the skin is much thinner and most of the wrinkles are caused by active muscle movement (frown lines, crows feet, worry lines etc), whereas fillers are more suited for areas in the face below the eyes.
Obviously there are exceptions to all this, but at an initial consultation, your doctor should be able to discuss all of this with you and help you to decide which is better suited for your particular needs.

Please remember, a dermal filler is just a product, not a result. Your result will totally depend upon the skill of the person on the other end of the syringe, how and where it is injected into the skin. It’s like a tube of paint in the hands of an artist; the portrait depends entirely on how it is used by the artist, not necessarily on how good the paint is or how much the paint costs. Results of dermal filling from the various clinics and clinicians can be wide and varied, ranging from pure perfection to the absolute abysmal, and since 1992 I’ve certainly seen it all come through my door. Choose your injector carefully; you must live with the result!
 

In my opinion, a dermal filler treatment should be specifically tailored to each individual, taking into account the patients appearance, incorporating their wishes, and designing and crafting a treatment to give a pleasant, tasteful and natural looking result which compliments that person. Dermal filling is an artistic craft, not a "paint by numbers" treatment. Again, choose your doctor carefully.
 

In my experience, I have found that the appropriate placement for the various dermal fillers in the skin is critical. For some fillers, if placed too deep, the patient will not get the longevity of the lift, and for other fillers, if placed too superficially, the product can leave tell-tale marks or lumps on the skin surface. Correct placement of dermal filler in the skin is everything. Choose your injector carefully!
 

"I don't want big horrible lips like that movie star". Inappropriate or bizarre looking lips are caused by either using an inappropriate product, poor injection technique, or just plain bad work or aesthetic judgement. No excuses!!!

Does it hurt?

This procedure requires multiple injections, often in some of the most sensitive parts of the human body. First time patients can obviously be a bit nervous and anxious about this. However, this need not be a painful or dis-pleasurable experience. For all my dermal filler patients I use local anaesthetic nerve blocks to minimise any discomfort.
With no discomfort, the procedure can proceed in a relaxed and timely matter, and enables me to get on with the job of providing the best possible result, without the hindrance of pain, huffing and puffing, and flinching. Virtually every first time patient I have ever seen has commented positively afterwards with such comments as: "not as bad as I thought it would be", "better than at the dentist".
However, some injectors use only a bit of local anaesthetic cream applied to the various  areas, or maybe just some locally applied ice. The problem with this, is not only is the pain relief fair to variable at best, but the micro-swelling and puffing in the surface layers of skin that these cause, temporarily obliterates the finer wrinkles. So how they are then supposed to see and hence treat these wrinkles, is still a mystery to me!
Then there are injectors who either use no anaesthetic at all (ouch!!), or rely on the false pretence that some dermal filler products contain a small amount of local anaesthetic in them. The problem with this, is that each injection only goes numb after the dermal filler is put in. In a typical dermal filler treatment session for a face, there may be up to 100 or more tiny micro-injections required to fill the multiple lines and wrinkles.......that is certainly a lot of uncomfortable injection prickles before each one goes numb!
In summary, this procedure need not be an unpleasant experience. Choose an injector who is well familiar with facial nerve blocks and anaesthetic use. Believe me, it will make a big difference.

This treatment is not a “lunchtime lift” as some injectors like to advertise. There is no such thing! You will be most disappointed if you believe this magic wand can have you back to work immediately after the treatment. I have found that most patients need at least 2 to 3 hours to recuperate (that’s some lunch break!) from the immediate effects of the treatment and local anaesthetic to wear off, while some can remain puffy or blushed in the treated areas for up to 12 or more hours. Avoid the stress and give yourself plenty of time after treatment before any appointments or engagements.

How long do dermal fillers last?

This is one of the most common questions asked about dermal fillers. There are many different factors to consider and hence it's difficult to give an exact answer to this.
Earlier collagen type fillers were derived from cattle hides and were degraded relatively quickly (about 3 months) by the human body due to their "foreign" nature. Although still used by some injectors, these have been largely replaced by the much improved newer hylaronic type fillers (eg Restylane) since the mid 90's.
Restylane is said to last on average approximately 9 months. However it can be shorter and it can be much longer. Extreme examples of this would be a first time treatment on a very tight or broken down lip, where it would most likely be advantageous to do a one off repeat top up treatment within 3-4 months. In these cases, the initial recoil and mechanical stress placed on the first treatment filler is very high, with the subsequent lift being somewhat shortened or compromised (not disappeared though). However, as the lift settles, a second stage and perhaps nicer lift can be achieved and this will tend to last much longer. I have found it advantageous sometimes to stage treatments in this sort of way and virtually never have I needed or wished to use more than one tube of filler at a time. I believe this can also be an advantage to the patient, in that staging the treatments over time can allow for changes to be performed in a subtly stepwise manner, avoiding the anguish of sudden and markedly noticeable change. The other extreme example of Restylane filler longevity, is a lady on whom I did a single treatment to the wrinkles on her top lip area. This women returned 5 years later, not having had any further treatments, and still looking better than she did and obviously very pleased with the treatment. In this example, the superficial depth of placement (see above) was critical and one of the determining factors.
Since using Restylane from 1996, a very interesting observation came to light. I noticed over the years, that what would start as a typical repeat treatment at 6 months for somebody, would then become 9-12 months for the next treatment, and then 12-15 months and beyond. I have numerous patients who after a decade use of Restylane, now only require a touch up every 2-5 years. Not bad for a temporary filler!

What about the longer lasting permanent fillers?

I do not use or recommend permanent products. If you are contemplating one, be very careful what you wish for. The “look” of today may not be the same desired look in years to come. Larger fuller lips on a 30 or 40 something may look fantastic, but on a 60 or 70+ year old, those same lips may appear totally ridiculous! I also explain to my patients that over time it can be a bit like the “melting snow” scenario. The rocks under the snow is your permanent filler, with the snow being your overlying softer skin. As we get older, our skin looses elasticity and structure, and tends to thin and sag or “melt away”. However, the permanent rocks (filler) do not change, effectively rising to the surface and becoming visible as the snow (skin) melts. With time you can be left with tell tale signs, lumps and bumps or a somewhat disproportionate appearance.
And what if the lip or look you have been given, has been poorly done or is not what you thought it would turn out like........ unfortunately you're stuck with it! 
Cosmetic results aside, there is also ongoing controversy over the tissue effects of permanent dermal fillers, with reports of short term and long term delayed reactions and rejection problems in the medical literature. Several of my colleagues, after initial enthusiasm, have since stopped offering these products due to such problems.
It is virtually impossible to entirely remove an injected permanent product. Permanent products can create permanent problems, so why would you want a permanent filler?

All the products I use at my clinic are biologically compatible natural materials, not synthetic permanent fillers. With Restylane^®,I have personally experienced one and a half decades of excellent safety and performance history.
 

Dermal fillers come as prepacked ready to use syringes. They have a limited volume, usually somewhere between 0.5 – 1 ml. I tend to exclusively use 1ml syringes as I find this is usually the minimum amount required to adequately treat a series of fine lines and provide a degree of structural support to the problem area. Without this structural support, the wrinkles will tend to break down much quicker. Often, for example, fine lines on the top lip will be treated in conjunction with the structural corners of the mouth and edge and body of the lip. However, a major disadvantage of dermal fillers is their limitation by pre-packaged volume. If larger hollowed areas need filling, then the volume of dermal filler required, and hence the costs, starts to become prohibitively expensive. In these cases, the newer stronger forms of Restylane such as Sub-Q, which comes in a 2ml syringe, may be more appropriate. Sub-Q must be placed much deeper and is not appropriate for fine lines and wrinkles. It is particularly good for enhancing or lifting hollow or sagging cheeks or making the "cheek bones" more prominent. My "Q Lift" is a specific combination treatment that has become particularly popular. It addresses the very common problem of hollowing in the upper mid-outer cheeks associated with hollowing of the tear trough (this is often seen as a tired look, as bags under the eyes or as dark circles under eyes). For the "Q Lift", Sub-Q is used for replacing volume in the cheeks, with the standard softer Restylane being used to fill the tear troughs. This treatment can have a dramatic rejuvenating effect in 30 and 40 something's  who may otherwise have very little in the way of wrinkles. If hollowing in the face is more generalised, then Facial Lipo-Filling, also known as Fat Transfer may be more appropriate (volume and duration of result is virtually unlimited). Dermal filler treatments and their results can be volume dependent and volume limited, but for the usual wrinkles and lips a 1ml syringe can be ideal. For dark circles under eyes and flat or hollow cheeks, the "Q-Lift" (2ml of Sub-Q plus 1ml of Restylane) can provide remarkable results.