Dermal fillers: What? When? Which?
Dr Nicola Vella explains what dermal fillers are all about
What are temporary dermal fillers?
The most commonly used dermal filler is a clear, viscous liquid called hyaluronic acid (HA). It is composed of two molecules linked together called N-acetylglucosamine and glucuronic acid. This substance occurs naturally in the skin and gives it elasticity and hydration. Unfortunately, the natural ageing process and sun exposure cause it to decrease, leaving us with fine lines and wrinkles.
If left in the pure form, hyaluronic acid is a very thin substance and cannot give the volumizing effect required to restore volume to lines and wrinkles. That being said, Profhilo, a popular skin rejuvenator is exactly this and aims to generally refresh the skin without giving any volumizing effect. Other skin booster treatments combine this idea with other additives like vitamins, anti-oxidants and amino acids.
In order to give volume, HA needs to be cross-linked. This means that chains of it are joined together using a chemical reaction process. This prevents the substance that breaks it down (hyaluronidase) from accessing the HA and therefore slows the break down process. The main agent used for this process is 1,4-butanediol diglycidyl (BDDE). This is removed following the reaction. The more cross-linking that occurs, the thicker and more volumizing a filler is. This has led to manufacturers producing a wide range of filler types for different areas of the face.
Are they a new thing?
It turns out that using dermal fillers is not a modern phenomenon – people in 1899 yearned for a smoother face and augmented breasts too! Austrian surgeon, Dr Robert Gersuny, injected Vaseline and paraffin in order to smooth out wrinkles, enhance genitalia and augment breast shape and size. This gained some significant popularity until it was found that after some years it disperses and causes lumps to form, infections and tissue death. Despite this being known, it was continued to be used in the Far East until as recent as the 1960s. A case report documents a woman who had to have both breasts removed due to ulceration and fistulas caused by the treatment.
Liquid silicone was produced in 1962 for use in breast implants but soon found to be unsuitable as a filling agent due to the frequent and serious complications caused. Infected material and nodule/lump formation had to be treated surgically, causing scarring and deformity.
In 1981 bovine collagen was used, but with scares about Mad Cow Disease and the propensity to cause allergy, this was abandoned in favour of hyaluronic acid, a more stable and safe compound.
What are the latest dermal fillers?
Nowadays, several major brands serve the premium dermal filler market. Juvederm, Restylene and Belotero have long been go-to premium fillers favoured by many aesthetic clinicians. Teoxane have developed a technique which creates HA with longer chains rather than more cross-linking. This makes the filler more dynamic and gives natural looking results during facial movement, but retains volume when static. This technology is used for their RHA (Resilient Hyaluronic Acid) range, which is perfect for treatment of fine lines right through to jaw contouring. With the market for dermal fillers growing year on year, no doubt further techniques will continue to refine their production for even better results.
References
Sattler, G., Gout, U. (2016) Illustrated guide to injectable fillers. 1st ed. Quintessence Publishing.
De Boulle, K., Glogau, R., Kono, T., et al. A review of the metabolism of 1,4-butanediol diglycidyl ether-crosslinked hyaluronic acid dermal fillers. Dermatol Surg. 2013;39(12):1758-1766.
Burdick, JA., Prestwich, G.D. Hyaluronic acid hydrogels for biomedical applications. Adv Mater. 2011;23(12):H41-56.
Glicenstein, J., The first ‘fillers’: vaseline and paraffin. From miracle to disaster. Ann Chir Plast Esthet. 2007;52(2):157-61.
Peters, W. (2012) The history of biomaterials used for breast augmentation in Biomaterials in Plastic Surgery.
Yeom, J., Bhang, S.H., Kim, B.S., et al. Effect of cross-linking reagents for hyaluronic acid hydrogel dermal fillers on tissue augmentation and regeneration. Bioconjug Chem. 2010;21(2):240-247.
Shen, Y., Pang, Q., Xu, J. Long-term complications after liquid silicone injection: A case report and literature review. Chinese Journal of Plastic and Reconstructive Surgery. 2021;3(4):189-192.
