The Most Interesting Uses for Dermal Fillers
Dermal fillers are a fantastic alternative to surgery for those looking to enhance their features. Sometimes confused by consumers with botulinum toxin, it could not be more different (other than being injected). Most TSLMS members are highly aware of the value that these injectables have brought to our field, and for those who have not yet delved into it, we are offering this as both an introduction and an enhancement. This article lays out both the fundamentals of what dermal fillers are and what they are not and then goes into some of the most innovative and unique uses they have.
What Dermal Fillers Are
As noted by the American Board of Cosmetic Surgery, “Dermal fillers are gel-like substances that are injected beneath the skin to restore lost volume, smooth lines and soften creases, or enhance facial contours.” There are a number of different common fillers. As noted, they include:
- Hyaluronic Acid (HA), which is a natural substance found in the skin that helps it to stay hydrated and plump. These fillers tend to be softer and last 6-12 months, or a little longer, before the body absorbs it back. FDA approved brands include Juvéderm products: Juvéderm XC, VOLUMA, VOLBELLA, VOLLURE; Restylane products: Restylane, Restylane Silk, Restylane Lyft, Restylane Refyne, and Restylane Defyne and Belotero Balance
- Calcium Hydroxylapatite (CaHA), which is also naturally occurring but found in bones. As a filler, the calcium from the bone is very small. These tend to be thicker than HAs, and last longer. On average there is a solid 12-month window prior to needing re-treatment. It also may help to stimulate collagen and is recognized for being appropriate for deeper lines and deep wrinkles. FDA approved brands include Radiesse®
- Poly-L-lactic Acid, which is biocompatible and biodegradable synthetic. It has a long medical history in medicine and medical devices. For instance, it is used in dissolvable stitches. These fillers are designed to stimulate collagen, which is how they help the skin. They “smooth fine lines by helping your skin rebuild natural collagen—the filler gel itself dissipates a few days after treatment. Poly-L-lactic acid is typically used to treat deep facial wrinkles, and results can last more than 2 years.” The FDA has approved Sculptra® Aesthetic.
- Polymethylmethacrylate (PMMA), which is also biocompatible and synthetic. It has a century old history in medicine and when used as a dermal filler it takes is essentially a ‘microsphere’ which is a tiny ball. All the balls build up to stay under the skin “indefinitely” and provide support to the skin. These also have collagen in them, as well as instigating additional collagen. The collagen provides additional firmness and structure. The FDA has approved Bellafill®.
- Autologous fat injections, which require surgery and last for years. This is basically a fat transplant. The fat is taken from another part of the body using liposuction; it is then processed and injected into the face as a filler, helping to bring back volume to areas that have lost it. Typically these procedures are performed by board certified cosmetic surgeons, but in all cases this should only be done by highly trained practitioners. There are no brands associated with this, because of the nature of the surgery.
Distinguishing Dermal Fillers From Botulism Toxin
Dermal fillers differ from botulism treatments. While both are performed in a clinic, spa, or doctors office through an injection, and serve the purpose of smoothing out or preventing lines and wrinkles that come with age, they really have nothing else in common. As noted by Medical News Today, botulinum toxin “contains purified bacteria that freeze muscles. In doing so… can help minimize the appearance of lines and wrinkles caused by facial expressions. Dermal fillers contain ingredients that add fullness to areas that have thinned due to aging. This thinning is common in the cheeks, lips, and around the mouth.”
So, instead of freezing the facial muscles for a short period of time, more and more people are opting to have fillers put into their faces which last longer than the 3 to 4 months. Fillers also have some very interesting uses that botulinum toxin does not.
Interesting Uses for Dermal Fillers
Beyond filling in wrinkles and lines in the face, there are some pretty interesting uses for dermal fillers. One of these is treating scars. The American Society for Dermatologic Surgery actually recommends “soft-tissue fillers – injections commercially known as Juvederm, Radiesse, Restylane and Sculptra – can be used to temporarily improve the appearance of depressed scars.” Beyond this, there is a lot of buzz around using fillers to improve acne and other scars in the beauty and fashion media, as well as among doctors and scientists. The Derm Institute, for instance, has an entire write up on the possibilities and the National Institutes of Health have published a series of papers around the uses of certain fillers for acne scar treatment. They also published a piece on using fillers to treat traumatic atrophic depressed scars, indicating the very broad range of possibilities we have as practitioners to help our clients and patients heal.
Fillers can also be used to enhance the skin of knees, feet, hands and even butts. These may be more unusual requests, but chances are you may get one. So it is better to be prepared than not!