Skin with Justine - The Skin Fillers Debate
With 37% of us worrying that lip fillers would leave us with an infamous ‘trout pout’.
And over half of women being more inclined to undertake subtle enhancements to look ‘like themselves but on a good day’ whilst maintaining a youthful appearance (61%), there’s much debate around skin fillers[i]. Here, Dr Justine Hextall FRCP, our Consultant Dermatologist, tells us what there is to know…
It seems that whenever we open a magazine there is a feature where a celebrity appears to have had a cosmetic procedure, which at best one might describe as over-zealous. I am always interested how often this change is attributed to fillers. When I look closely, to my eye there are often several procedures that have been undertaken for example Botox, chemical peels and quite often facial surgery. It is interesting however that it is usually facial fillers that are blamed.
Dermal fillers have been used since the 1800’s when transplanted fat was used to correct a facial deformity. Following that a number of chemicals were introduced with limited success. It was in 1981 when bovine collagen was first injected. Since then research has continued in the quest for the perfect filler. Technology is rapidly evolving in this area and we now have much safer products to use, the best in my view based on hyaluronic acid (HA), found naturally in our skin.
The problem comes, when these products are injected by untrained individuals and when the products used are unsuitable – I would not recommend the so-called permanent filler.
Safety is the key here and as I always advocate less is more. Injecting small amounts of a safe filler, such as Juvederm, and adding more after 2 weeks if required is always the best approach in my view. Natural hyaluronic acid –based fillers are safe and become naturally absorbed over time. We have hyaluronic acid in our skin therefore our immune system is very unlikely to react and cause problems, this is key. Here are a few questions I am commonly asked regarding fillers:
I WANT TO LOOK YOUNGER, HOW WOULD A FILLER HELP ME THOUGH?
There are so many factors that make us look older, it isn’t just lines. One change which is very subtle and we may not notice at first, is loss of volume. This is often below the cheekbones, an area we call the mid-face, around the nose and mouth, the temple areas and below the eyes. Interestingly, very small amounts of filler in specific areas of loss can have a remarkable rejuvenating effect.
BUT I DON’T WANT A "TROUT POUT”
I agree, why would you? The key to lip fillers is using temporary fillers that contain hyaluronic acid (HA). This is a natural substance found in our own skin. Successful lip filler will gently correct loss of volume in lips. Also as the HA is what we refer to as a humectant - meaning it will also attract water. This keeps lips looking hydrated and will reduce fine lines around the mouth. How do we avoid problems? The practitioner injects a small amount of filler, the individual is assessed in two weeks and more is added if needed. This way there is no danger of over filling lips and hopefully the perfect result is achieved.
EVEN AFTER A GOOD NIGHT’S SLEEP I OFTEN LOOK TIRED, CAN FILLERS HELP?
As we get older we lose collagen and fat, underneath our skin. One area this change is most noticeable is under our eyes. Particularly when we are tired or dehydrated we can develop dark circles. Effectively as the skin is thinner here as we age we can see underlying structures such as blood vessels, which appear as dark circles. By injecting a small amount of filler to this area, this can be improved but this must be carried out by an expert, as the technique and choice of filler is paramount to a successful outcome.
MY SKIN JUST LOOKS DULL, IT’S LOST THAT GLOW NOW I HAVE HIT MY FORTIES. I LOOK AFTER MY SKIN AND MOISTURIZE REGULARLY, CAN YOU HELP?
This is a common request I hear as a dermatologist. The perfect solution here is skin boosters. This is a technique where hyaluronic acid (HA) is injected into the skin. This boosts the hydration to the skin, a bit like injecting a moisturizer into the deeper layers. The HA attracts water and maintains hydration. It really does give you back that glow.
ARE THERE ANY SIDE EFFECTS TO FILLERS?
There are always potential side effects to any interventional treatment. In order to reduce risk, I would advise the following: Look into the clinic you plan to visit, who are their practitioners? No reputable clinic will mind being asked about the experience of the staff. Ask the clinician you see about their experience too. Ask about the products they are using. Make sure your first treatment is with a temporary filler. I advise HA–based fillers such as Juvederm or Restylane. A good practitioner will choose the right filler suitable to the site of injection and will place it at the appropriate depth. In right hands the risk of side-effects from a filler should be minimal. Finally, injecting in stages is always a good idea. Wait to see the effects of the first treatment and have a top up if needed. All good clinics will advocate at least a two- stage procedure.
WHAT IS THE PROBLEM WITH PERMANENT FILLERS?
The problem here is that permanent fillers are just that, a permanent change that you will carry for years. This is not a problem if you are happy, but what if you are not? The second problem is that many permanent fillers are more likely to cause lumps and bumps, such as granuloma formation where the body’s immune system recognizes the filler as ‘foreign’ and mounts a response. These can be visible and disfiguring. Granulomas are more likely to occur if the substance is injected at the wrong level for example too superficially. Expertise is vital therefore to inject such fillers, which begs the question; how many experts would inject a permanent filler?
Finally our faces change over time, a permanent filler will not change and adapt and therefore may well start to look unsatisfactory over the years.
IS THERE ANY AGE LIMIT FOR FILLERS?
In my view there is no substitute for youth. When we are young our lips are at their most plumped and beautiful. I would rarely wish to carry out augmentation unless there was a correction needed. I would certainly not recommend lip augmentation in the under 18’s as is the policy of Harley street medical group. As we get older, we often lose volume in our lips and this can be ageing. I do recommend however that the face is treated in a balanced way. Treating lips in isolation may highlight other changes that should also be addressed. a good practitioner will be able to advise you here.
I AM KEEN TO HAVE AN INJECTABLE TREATMENT. ONCE I START THOUGH DO I NEED TO CONTINUE?
Not at all. Over time the treatment will naturally breakdown very gradually and be absorbed into the body. There won’t be any overnight dramatic changes that need to be maintained so if you do not wish to have ongoing treatment there will be no need.
Fillers when applied safely and expertly can be truly rejuvenating. This is a fantastic method of correcting loss of volume and just giving your skin that fresher, younger lift that we all aspire to. Choosing the right practitioner who will put safety first is absolutely key. A careful consultation with examination is important. Discussing outcomes individual to you, and what you can expect to achieve is hugely important to enable you to make the right choice. Finally as with all aspects of medicine, expertise and safety first!
[i] The Harley Medical Group independent survey conducted by OnePoll of 2,000 respondents