Dermal fillers: What you should know

Dermal Fillers are gels used to add volume under the skin and can be used in conjunction with other treatments, such as laser resurfacing (skin rejuvenation) or botulinum toxin injections and surgery (facial enhancement and corrective surgery).

Despite the fact that many types of dermal fillers are nowadays available, hyaluronic acid is today considered as the gold standard product in the use case of medical volumetric reshaping, for its innocuous effect on the organism when appropriately used (it is naturally present in the human organism).

Other fillers made out of other molecules do not offer the same level of safety and may come with some serious disadvantages and risks as exposed below.

Types of dermal fillers

In Thailand, only HA-based dermal fillers are FDA approved for injection, other dermal fillers are not FDA approved for injection, and will be talked about for the sake of informing.

There are then absorbable fillers, which naturally undergo progressive resorption over time (usually weeks or months) and non-biodegradable fillers, which will persist for many years and lead to serious complications.

Side effects of non-biodegradable fillers, which are meant to last forever, manifest as inflammations, infections, degradation and the releasing of toxins, the migration of foreign particles: in the case Polyacrylamide products (Bio Alcamid, Aquamid, Outline), the breaking down in smaller units (silicon) and granuloma in acrylic derma-gel such as Dermalife. These transformations are not reversible and almost always lead to future complications (infections, granuloma) with time.

Absorbable fillers comprise of two groups: collagen-based fillers and hyaluronic acids fillers. Collagen-based fillers are usually derived from bovine or human collagen and are used to replace the progressive loss of collagen in the dermal layer of the aging skin.

But the superiority of the hyaluronic gels over the collagen-based fillers comes from the fact that they are biocompatible, have water-bonding and non-immunogenicity properties (unlike collagen), come adapted (with more or less viscosity) to the different tissues they are meant to be injected in, and can be worked in concert, avoiding a mix of substances and simplifying the resolution of any complication during or after the intervention with local injections of a specific enzyme (hyaluronidase).

Hyaluronic acid was originally isolated in 1934, after being extracted from bovine vitreous humor, and it proved to be versatile for therapeutic purposes, such as ocular and orthopedic surgery.

Hyaluronic acid used in dermal filler gels are of a non-animal origin and produced by cultures of Streptococcus species, these fillers can be classified as either cross-linked or non-cross-linked, the best results (long lasting, stable) are obtained with cross-linked, biphasic fillers.

Use cases and procedures

The type of product(s) and the volume to be injected will depend on the area to be intervened on, and the anticipated result wished to be achieved (filling or lifting).
Local topical anesthetics might be applied prior to intervention, but local injections of anesthetics might add temporary swelling to the injection site and might be contraindicated under certain circumstances.
For patient's comfort purposes, some hyaluronic acid gels have added Lidocaine. In any given case, the physician is expected to inform you about the choice of products and actions.

Dermal fillers in face contouring

Periosteum
Non-surgical rhinoplasty
Chin augmentation
Cheek augmentation

Dermal fillers in face and body rejuvenation

A visible sign of facial aging is volume dystrophy or shrinkage and displacement of fat deposits. It is particularly evident in the temporal area, the upper lid, the tear through-area below the lower lids, in the cheeks area and the lips. Dermal fillers, sometimes in combination with other techniques improve the restoration and the authentic aspects of the facial volumes

Temporal filling
Nasolabial filling
Cheek filling
Lip augmentation
Peri-orbital rejuvenation
Hand volume augmentation

The products

As a rule of thumb, thicker hyaluronic acid gels are the most stable, and the quality of the product is always reflected in its price.
Metro Bangkok Clinic prides itself for only offering the best of the best, FDA approved products.

As usual in life, the quality of the products and services are always reflected in their pricing. For patients wanting to make sure they are being treated with genuine products, we recommend them to ask to inspect the packaging of the products, including the serial numbers from the factory.

In your best interest, and before agreeing to any intervention, ask the clinic for an invoice reporting the serial number from the lot that has been used in the procedure, so as to avoid counterfeited products and the complications that come with their use. Any doctor or clinic who might deny you the right of being properly informed is hiding something from you and should not be trusted with your health.

The different product lines are designed to affect the different layers of the skin: dermal, hypoderm, and the periosteum (the membrane that lines the outer layer of the bones).
The complete range of fillers allows solving any aesthetic problem from the correction of wrinkles to modeling the shape and volume of the lips and biological reinforcement of face and body.

Each of our patients is evaluated first, then we discuss the different filler options available for each area of concern and finally, we select a filler to give the best correction for that area.

For a filler procedure to be successful and satisfactory, it should deliver a natural result, offer a short downtime, minimal complications, easy to replicate, acceptable longevity and be applicable to most patients, of various ages, skin types, race, etc. We photograph each patient before and after the treatments to follow the patient’s progress and document the length of time each correction lasts.

Metro Bangkok Clinic works with the following fillers:
Juvederm Nouvelle Generation is assuredly the best dermal filler available today. It costs more but lasts longer (up to 2 years for Juvederm Voluma) and it is the only filler with an increase of voluminous within days following the treatment (up to 30%).
Restylane is an excellent product, but because of its viscoelasticity and granulous aspect, better left for specific procedures.
Perfectha from France offers the best value for money as a dermal filler.

Amongst these brands, according to Metro Bangkok Clinic, there is no “best” filler, but a set of variations on the same theme that must be used and adjusted depending on the particularities of the patient’s situation, in fact, every intervention must be thought, planned and tailored to each patient’s needs, as there is no such thing as a standard intervention that can be used for everyone.

Post-injection care

It is advisable for patients to avoid taking blood thinners and exposing the worked-on area to bright sun for 3 days following the intervention. Metro Bangkok Clinic only uses first quality cannulas from Japan.

What to expect and follow up

The effects of contouring quickly become apparent after the first procedure. Since little or no swelling around the injection area is to be expected, the results of the treatment can be observed and evaluated visually rather quickly.
When possible, our patients are invited to come over once again after a couple of weeks so we can reevaluate the treated area and determine if any additional corrections are necessary.

Post injections period and possible complications

It is possible to have an additional procedure performed to augment or to reduce the volume of filler if necessary. Complications such as necrosis (death of living tissues due to the lack of supply of blood), redness or infection are extremely rare with injections of hyaluronic acid and can be easily tackled.

Contraindications

The procedure should not be performed on patients taking anticoagulants, so as to avoid the precipitation of bruises (ecchymosis), patients with a history of allergy or adverse reaction to the hyaluronic acid, or anyone currently suffering of an herpes simplex outbreak on any part of the face meant to be worked on (in which case a special treatment should be administered firstly).

Patients are expected to notify the medical doctor of any previous intervention they may have had, designing the site and the product used, to avoid any adverse interaction.

Nose bridge augmentation with dermal fillers is a complex procedure that is not possible with people who had nose surgery (closed or open rhinoplasty) done and can potentially lead to extremely serious complications.

Non-Authorized Dermal Fillers in Thailand

Calcium hydroxylapatite
Polyalkylimide
Polylactic acid
Polymethyl-methacrylate microspheres (PMMA)

Fillers either work by giving volume to the injected zone, whilst others work owing to the body's inflammatory response to their presence in the organism, such is the case of Poly-L-lactic-acid, or Calcium hydroxylapatite (Radiesse), both biodegradable substances, inducing an adverse reaction from the body. This is of course, not a very desirable quality, as results are totally unpredictable and an inflammatory reaction is the manifestation of a body's reaction to being under attack.