The most popular fillers in the UK are Hyaluronic Acid (HA) based due to their safety, versatility and ease of administration. The various HA fillers differ in concentration, formulation and degree of cross-linkage. This affects their duration of action and the amount of swelling following the procedure. Most HA fillers now contain lidocaine to improve patient comfort and reduce the need for additional anaesthetic.
Radiesse®, a longer acting filler, is also popular for particular concerns and gives great structural support. It helps to stimulate fibroblasts which in turn help to synthesize new collagen.
The filling effect is apparent after the procedure and the treated area may be red and tender with some swelling. As there is a risk of bruising this may start to appear following the procedure. However, bruises will be more obvious in the subsequent days.
Certain medications and supplements thin the blood making bruising more likely. When possible, it is advised to stop taking aspirin, vitamin E, St John’s wort, gingkgo, evening primrose oil, garlic, feverfew and ginseng 2 weeks before treatment. It is best to avoid alcohol and nonsteroidal anti-inflammatory medication, such as ibuprofen and diclofenac, 2 days before.
Arnica tablets or gel may be used 2 days prior to treatment and continued afterwards for 2-3 days.
Cold compression just after the procedure will reduce swelling and constrict blood vessels, reducing any further bruising.
Warm compression may be used a couple of days after if bruising has developed. This will help speed up the healing process.
Pineapple and papaya both contain bromelain which helps to break down proteins releasing trapped blood from the tissues. Topical and dietary vitamin C will also aid the healing process as it helps to build collagen around vessels.
Camouflage make-up may be worn, although it is best to avoid application on the day of treatment if possible. Advice can be given on recommended make-up coverage.
The vast majority of dermal filler treatments have no complications. Initial swelling, redness and tenderness usually settles within a couple of days. If bruising does occur it can take up to 14 days to heal so procedures should be planned well in advance of important events.
Any asymmetry that may occur can usually be managed by correction with additional filler. Bumps or lumpiness can be improved with massage during and after the treatment. If they persist, HA fillers may be broken down using the enzyme hyaluronidase.
Below is a list of rare but more serious complications:
Tissue Necrosis: Injected filler can obstruct blood supply to skin tissue causing ischaemia which can lead to necrosis. It may occur immediately after injection or hours later. All practitioners should be trained in managing these rare events should they ever occur.
Granulomas: These are nodules that may appear months or years after a treatment and they are more common with permanent fillers. They arise when the body reacts to the filler material by walling it off. They can be treated with corticosteroid injections or excision.
Infection: As the skin is breached, there is always a possibility of infection. To reduce this risk, the practitioner will ensure the area is adequately cleaned and that equipment and techniques utilised minimise any risk of contamination. Any persons with a history of cold sores in the area to be treated should be warned about the risk of reactivating infection. This may be prevented with prophylactic medication and treatment following the procedure.
Scarring: Although rare, it is possible for a scar to form if there has been any infection of if an individual has a history of hypertrophic or keloidal scarring. This information will be gathered whilst taking a medical history.
Dermal filler treatments are tolerated very well with mild discomfort. The fillers usually contain an anaesthetic which helps to minimise pain and a topical cream anaesthetic can also be applied if required. As the procedure uses different injection techniques and generally takes slightly longer than a botox treatment it may seem more uncomfortable.
Hyaluronic acid fillers normally come in 0.5 and 1ml syringes. The volume used will be decided on the area to be treated and the best possible filler for that indication.
Radiesse® or Calcium Hydroxylapatite is available in 0.3, 0.8 and 1.5ml and would be used for a semi-permanent result where more structural filling is required. Again, the volume used would be decided after examination of the particular area.
After the procedure the practitioner will massage the area to smooth any obvious lumps. At home a gentle massage may be used with the tips of fingers for the next 48 hours only if a lump can be felt. Usually the filler settles down within 2-3 weeks and feels 'normal'. If a bump persists it is advised to see the practitioner who may be able to correct this with a firm massage or break the product down.
Although rare, it is possible to be allergic to filler material. This may be a mild allergy which could result in prolonged swelling or a severe hypersensitivity with swelling, redness, bumpiness and a rash. Treatment for these rare reactions usually requires antihistamines and steroids which would be arranged by the practitioner.
If the area is aggressively massaged after treatment, the product can move. Therefore it is best for individuals not to touch the area after treatment unless they feel any lumps or bumpiness whereby gentle pressure is recommended.
It is very rare to be able to ‘see’ the filler. HA fillers are colourless gel and not visible when injected correctly. If a filler is injected too superficially, the product may be seen as a bluish discolouration of the skin. This can be managed with compression and sometimes an injection to break some of the product down.
Once the swelling subsides, the filler takes 2-3 weeks to settle and feel more like the surrounding skin/lips.
Usually people ‘look better’ without obvious changes in their appearance. Good practitioners will be replacing volume that has been lost over the years and hence rejuvenating the overall features. As particular areas may swell more than others, such as the lips, a treatment may be obvious to family/friends.
This depends on each individual. Most fillers used last 6-12 months, however, as they also help to stimulate collagen and plump the skin it may not be necessary to have a repeat filler after this period of time. Unfortunately, some individuals may break the product down more rapidly than others. Advice is best sought at consultations or review appointments
Usually this is fine if there have been no complications. The Dermal Fillers London practitioner will want to know when the treatment was carried out, which product was previously used and the reasons behind wanting a different filler.