Cosmetic Hyaluronic Acid Fillers

There is quite an extensive range of HA fillers products available in the medical field that differ in quality and production methods. These different HA fillers also have subtle but important variability in their characteristics, which mean that some are better suited for certain areas of the face than others. Furthermore, those from leading pharmaceutical companies have undergone robust research and development with excellent safety records. However, this is not necessarily true of products from other manufacturers which may have different qualities, efficacies and long-term safety records.

We therefore strongly recommend that any patient seeking cosmetic filler treatment always makes sure that they understand what filler type and brand is used by the practitioner. Dr Rhobaye uses a premium range of the safest class of temporary and reversible HA fillers that have both an excellent long-term safety record and research-proven efficacy, namely Juvederm^® Vycross, Teosyl^®, and Restylane^®.

Hyaluronic Acid fillers are commonly referred to as a type of ‘Dermal Fillers’, as they were initially mainly injected into the dermal (skin) layer to fill out fine lines and wrinkles, either in combination with or instead of BOTOX^®. The name ‘Dermal Filler’ however is a misnomer as most modern indications for their use are actually below the skin, or subdermal, where they are injected into fat compartments or deeper on the surface of the skeletal bones and cartilage to restore volume, reshape, contour and define features (a process called soft tissue augmentation and remodelling). Subdermal fillers are also injected above, below and within individual muscles to selectively modify the action of specific facial muscles in a favourable way (a process called myomodulation). We, therefore, prefer to use the term Cosmetic Fillers to encompass both Dermal and Subdermal Fillers. Consequently, contrary to popular misconceptions, the science and techniques involved with modern cosmetic filler procedures are much more advanced than most people assume.

HA fillers are clear soft gel implants made from hyaluronic acid molecules that have been cross-linked (bonded together) to varying degrees to improve their functionality and make them more stable and resistant against degradation. Unlike the non-cross-linked HA in our bodies, HA fillers can last for months rather than days although they are eventually broken down by natural enzymes. When injected into the skin or underlying fat, they bind with water molecules to form a viscous substance that gradually integrates with the host tissue to varying degrees. In doing so, the filler restores volume and provides tissue support, lift and hydration. With time, this substance gets broken down by natural enzymes in the body. However, there is increasing research evidence suggesting that HA filler injections can also stimulate healthy new collagen formation, potentially giving longer-term benefits even after the filler has degraded. Radiological studies such as MRI have also shown that fillers can last for many years (yet remain dissolvable if needed to be reversed), which may also explain the longevity of results in patients.

Different densities of HA fillers can target selective layers of skin and underlying layers for specific results. For example, less dense fillers can be injected superficially into fine lines/wrinkles to smooth them. In contrast, intermediate-density fillers can be injected just below the skin such as in the lips or areas of mild depressions or irregularities to shape and soften. The densest versions of HA fillers are predominantly injected into the deep layers of the face to restore volume, add contour/definition and provide soft-tissue support as well as lift against facial sagging. Different cross-linking and production technologies also result in HA fillers with specific characteristics and properties that behave differently when injected into human tissue.

Newer generations of HA fillers have had a transformative effect on non-surgical aesthetic treatments and can now achieve results comparable to surgery, with much less risk and downtime.*

*Individual results and reactions may vary

As with any invasive medical procedure, patients can experience some degree of temporary side effects such as redness, swelling, itchiness, tenderness, and occasionally bruising at the site of injection. These are not complications but are normally expected reactions (sequelae) of this type of medical treatment. Unexpected complications are uncommon with HA-based cosmetic fillers but include nodule formation and possible skin infection. Serious complications have been reported in the medical literature, but these are rare to extremely rare and are more related to the injection technique and experience of the practitioner. These complications include facial abscesses, excessive swelling (angioedema), and vascular occlusion (blockage of blood vessels leading to skin or tissue death and even blindness). Allergic reactions are virtually unknown (which is why patch testing is unnecessary); if they occur, they are likely to be due to reaction to other substances that are combined with the filler, such as lidocaine anaesthetic, rather than an actual allergy to hyaluronic acid itself.

It is essential to understand that these are medical procedures and should only be conducted by medical professionals with suitable training, skill and experience. Overall, however, treatment with HA fillers is significantly safer than equivalent surgery with substantially less downtime, and have the advantage of being able to be broken down and reversed if needed.

Following injection, the HA fillers are progressively broken down by a naturally-occurring enzyme (hyaluronidase) in the body in a similar way that the hyaluronic acid in our bodies gets broken down. In rare circumstances, the HA fillers injected may need to be removed by injecting hyaluronidase enzyme into the filler deposit to break it down. This is another significant advantage of HA fillers over other types of fillers (particularly the permanent and semi-permanent class of products).

Modern injection techniques for HA fillers have significantly evolved from older ad-hoc methods of injecting. These advanced systems of injecting are based on targeting strategic points in each facial feature and over the full face. They have substantially increased the versatility and efficacy of fillers in facial aesthetics enabling experienced practitioners to now offer surgical grade results through a non-surgical, minimally invasive approach.

By building on his experience in facial surgery, understanding of filler science and in-depth knowledge of facial anatomy, Dr Rhobaye has developed and refined an advanced and highly specialised system of injecting fillers. His techniques are based on the core principles of volumetric support, facial anchor points, contour enhancement, myomodulation, light and shadow concepts and facial proportionality. This treatment methodology also addresses the principle of direct versus indirect correction where treating one area of the face can have a positive or negative effect on an adjacent or even distant area of the face. By considering the face as a whole rather than in isolation, these techniques can avoid over- or under-correction and achieve an optimal natural-looking rejuvenated appearance that addresses areas of volume loss, shadows and sagging as well as defining key features of a patient’s face.