Dermal fillers have revolutionised non-surgical approaches to the face – both for facial rejuvenation, and also for facial sculpting. This allows a freshening up of the appearance, a rejuvenation, and also the potential for enhancement of features. Over the last few years, with the development of the latest generation of fillers, a new era has been entered. Fillers are no longer simply used to enhance lips and to fill lines and depressions. They are now used to restore lost volume to bones (such as the chin and the cheeks), to address lower lid ageing (tear troughs, or under eye bags and grooves), to subtly change the appearance of the jaw bone and also to address areas that might not have been thought of previously (such as the hollowing in the temples (temporal hollowing)) to produce stunning results. Mr Pacifico has an increasing proportion of his facial practice devoted to the advanced use of fillers.
“Injectables such as toxins (Botox, botulinum toxin) and dermal fillers (particularly the Allergan Vycross range, Volbella, Volift and Voluma) make up a significant part of my facial practice. When used methodically and accurately, they are fantastic in freshening up and rejuvenating the face, in a very natural way.
Many people have the fear of the dreaded “pillow face” and frozen appearance that so press love to highlight in glossy magazines, websites and newspapers. However, if the face is carefully and systematically analysed and the filler is well placed and Botox is not overdone, then the result is a fresher, brighter and less tired version of the person pre-treatment.
My non-surgical patients come from Tunbridge Wells, Kent, London and the surrounding areas, as the reputation for the naturalness of my results continues to grow.
Another aspect I find extremely exciting is how I am combining the non-surgical treatments with surgery – either at the same time, or to enhance or maintain the surgical result. For example, I may perform an eyelid lift, use Botox to soften the wrinkles and filler to enhance the cheeks. Or else, the patient who initially comes to see me for a lower eyelid lift is actually better served by filler to their tear trough grooves (eye bag grooves) and cheeks, and surgery can be staved off for another 5 plus years”
What is Hyaluronic Acid?
HAs, as hyaluronic acid is often referred to are a group of substances that are present throughout our body. Naturally occurring HAs act in different ways in our bodies, including helping to give our skin its elastic properties. In recent years, man-made HAs have been commercially available and have proven incredibly popular in their use as temporary fillers. They can be used for a wide variety of enhancements on the face, from lips to cheeks and chins to temples.
What is it like to have HA filler?
Hyaluronic acid is a clear jelly-like substance that comes in pre-filled syringes. The right HA filler for your needs and for your tissue type must be chosen appropriately. Nowadays HA fillers also come with local anaesthetic already in them which has significantly reduced the need for numbing creams.
The filler is injected in the clinic, and you are able to go home straight afterwards – a “lunchtime” procedure. The filler will be injected either into a deeper position (such as when used in the cheeks) or a more superficial plane (when used in some areas of the lips).
What are the benefits HA fillers?
The principle reason behind the popularity of HA fillers is that they are not permanent. Whilst the results can last 6-12 months, depending on where in the face the filler is used (and what type of HA filler is used), repeat injections are needed. This is because the body naturally breaks down and dissolves HA filler over time. This has actually addressed many of the problems that used to be encountered with permanent fillers and has made their use more predictable and safer.
How long does it take to have the filler?
Filler treatment can take anywhere from 15-minutes to 45-minutes or so, depending on the amount of filler required and the specific areas being treated.
How long before I recover?
Normally the area treated remains numb for several hours due to the local anaesthetic in the injections. If the filler is used in a deeper plane, such as when treating the cheekbones or chin, the recovery is very quick (hours). However, if used in the lips, it is normal for the lips to swell for 24-48 hours after the injections. Please bear that in mind if you have social engagements arranged.
Sometimes, some discomfort can be experienced after the filler has been given. Local effects of the filler can include bruising at the injection site, as well as pain, itching and redness. Theses usually settle down over the following few days (or weeks if you are unlucky and have sustained a bruise).
What should I do after the injections?
Specific instructions will be given to you after you have had your filler. Sometimes this may involve gentle (or firm) massage to the area, if you notice any lumpiness that concerns you. This can help to distribute the filler more evenly. If you are in any discomfort, then mild over the counter analgesia, such as paracetamol, can be helpful. Do not exercise for the rest of the day after you have had filler, as this might increase swelling in the area. It is ok to wash the treated area as normal.
What about future HA filler?
As explained above, as HA is a naturally occurring substance in the body, it will naturally be broken down over 6-12 months, and further treatments will be required after that. It is common for patients to return for repeat filler every 6-12 months.
Is there anyone who should not have HA fillers?
Fillers are not licensed if you are pregnant or breastfeeding. You should also be cautious if you are a bad scar former, as occasionally even a tiny injection can result in a scar in a small minority of people. If you take blood thinners you have a much higher risk of bruising so this must be borne in mind. If you suffer from cold sores, please speak to Mr Pacifico about this as you may need treatment with an anti-viral medication to reduce the risk of these coming back following HA treatment.
What are the complications associated with filler?
Fortunately significant complications with HA filler are unusual. Bruising and unwanted lumpiness are probably the most common risks. If the filler persists as a lump and does not settle down well, then hyalase injections can be used to dissolve the filler (this may be at cost).
The two most significant, but fortunately very rare, complications are skin necrosis (death of the skin) and there have been case reports of blindness. These have both been caused by unrecognised injection of filler directly into a blood vessel, using some force. Mr Pacifico is very careful to inject very slowly and cautiously, and ensures that the needle is not in a blood vessel for each injection he performs.