Dermal fillers are substances used to fill wrinkles and creases in the skin. They require injection into the skin and soft tissues to replace volume, most commonly lost through the natural ageing process. Dermal fillers may also be used to help lift sagging tissues, fill wrinkles and improve definition of structures such as the lips and cheeks.
Although intuitively simple, the idea of a substance for soft-tissue augmentation in the skin did not reach a practical level until bovine (cattle) collagen arrived in ‘off-the-shelf’ form in the 1970s. Whilst not permanent it was embraced by patients and doctors alike despite needing a preliminary test for allergy that would delay matters for a few weeks, in addition to adding to the cost. Naturally, people clamoured for a permanent substance, but liquid silicones were not the answer to everybody’s prayers and gave rise to an host of problems of their own.
The ideal dermal filler is safe, painless to inject, hypoallergenic, long lasting and not prohibitively expensive. Additionally, results should be consistent and predictable with a natural feel beneath the skin and the procedure itself should exert minimal downtime on the patient and have a low incidence of complications. Filler demand has rocketed in recent years with people increasingly wishing to look better for their years, particularly the so-called ‘baby boomer’ population, and the disinclination for invasive surgery, which has both downtime and important complications to be factored in.
|Course Title||Dermal Fillers|
|Course Author||Mr Miles Berry MS, FRCS (Plast)|
|Estimated course length (hours)||3|
|CME awarded (hours)||3|
|Pass mark required %||90|
|Exam results and certificate issued||immediately on pass score|
Classification of Dermal Fillers
As with many aspects of medicine there is no universally recognised classification system for fillers. With expansion of the dermal filler market, different systems have appeared and find application to varying degrees. The most frequently used are duration of effect and biodegradability.
Duration of Effect
Classification of dermal fillers according to duration of effect provides boundaries as to how long the filler maintains its clinical effect in the patient. It is rather a soft measuring scale with somewhat loose terms as ‘temporary’, ‘semi-permanent’ and ‘permanent’. The term “longer lasting” is also used. Although helpful for some understanding of whether a filler substance will tend to yield shorter- or more durable results the definition of each term has not yet been precisely agreed upon.
Filler classification by physical longevity after injection can provide important information regarding the appropriate uses of a specific product. Those classified as biodegradable are absorbed by the body so tend to have a shorter duration of effect. Those considered non-biodegradable (permanent) have constituents that do not dissipate so may yield excellent longer-lasting results, but tend to be less forgiving. Moreover, they are associated with an increased incidence of granuloma formation and/or extrusion.