by: Dr Harryono Judodihardjo Created on 25th April 2012
Confused by all the different dermal fillers on the market? let Dr Harryono Judodihardjo of the Cellite Clinic lead you through the filler maze
Botulinum toxin and dermal filler injections are the two most commonly requested treatments in aesthetic medicine. This is because these are the two most effective and safe treatments to reverse the signs of ageing. Botulinum toxin injection is most effective for the treatment of lines on the upper face while dermal filler injections are mainly used to increase the volume in the lower two thirds of the face.
There are many ways of classifying the dermal fillers that are used in aesthetic medicine. the classification that is most commonly used is classifying according to the longevity of the dermal fillers in the skin. This can be; temporary, semi-permanent, or permanent.
Temporary dermal fillers are the ones that are most commonly used. They are temporary because they are made of biodegradable materials, so they are safe and usually last for about six to 18 months before the body breaks them down and the treatment need to be repeated.
Semi-permanent dermal fillers are made of materials that are harder for the body to break down so typically they can last for about two to four years.
There is no universally accepted definition of permanent dermal fillers but personally I would classify any dermal fillers that last more than four years as a permanent fillers. Most doctors actually do not like to use the term permanent dermal fillers as this may mislead the patient into thinking that they only need one injection and the effect will last a lifetime. Permanent dermal fillers are not absorbable and therefore they do last in the skin for a lifetime but their effect does not have a similar longevity.
This is because as we age, we all will continue to lose bone, fat and collagen from our faces and to correct this we will need more dermal fillers to be injected. Therefore most doctors now would prefer to use the term ‘longer-lasting dermal filler’ rather than ‘permanent dermal filler’.
Longer-lasting dermal fillers are not used much in aesthetic medicine because historically they are linked with bad side effects that are often permanent. This made most doctors uncomfortable in using the longer-lasting dermal fillers.
Personally, I am very cautious, and the only one I do use is Aquamid, which is made of 97.5 per cent water and only 2.5 per cent polyacrylamide. Aquamid is well tried and tested for over ten years, has an excellent safety record and after injection Aquamid stays soft and natural to the touch.
Two of the reasons why Aquamid is safe is due to the high water content and the purity of the polyacrylamide used. Aquamid only causes a minimal inflammatory reaction in the skin, in contrast to many other long-lasting fillers, which rely on a foreign body reaction for their filling effects. Aquamid is also a very cohesive gel so it does not disperse easily under pressure. This is an important property because if the patient or I do not like the aesthetic result of the treatment, I can squeeze the product out with just a small puncture of the skin.
Longer-lasting dermal fillers are most suitable for busy people, who cannot afford the time to keep visiting a doctor for repeat treatments. also, for people who have such a high metabolic rate that the effect of temporary dermal fillers becomes unacceptably short, and for people that need large volume filling which makes repeated treatments with temporary dermal fillers very expensive.