Dermal filler treatments

A filler is a gel that is injected beneath the surface of the skin. Injected into the skin, it smooths wrinkles and adds volume to tissues.

More than 90 percent of all filler treatments worldwide are done using hyaluronic acid. Hyaluronic acid is a substance familiar to the skin. It is a large sugar molecule that binds a significant amount of water. When the skin’s natural hyaluronic acid levels decrease as a person ages, tissue volume diminishes. As tissue volume decreases, the skin becomes looser and more wrinkled. The reduction of hyaluronic acid is also visible as skin dryness.

Hyaluronic acid filler treatments help address these age-related changes. During the treatment, the skin’s own hyaluronic acid reserves are replenished. Tissue volume increases, which smooths wrinkles and restores fullness to facial features. Hyaluronic acid fillers always provide temporary results. An enzyme called hyaluronidase gradually breaks down the injected hyaluronic acid over the course of several months.

There is some research evidence that hyaluronic acid gel fillers may also stimulate the skin’s collagen production.

The fillers used by Cityklinikka are safe. They have been studied and used for over ten years.

Filler treatments are most commonly performed on the face.

Skin fullness, elasticity, firmness, and the definition of facial features all decrease over the years. Changes occur in the skin, but muscles and bones also gradually shrink with age. All of these changes become visible as wrinkles and sagging facial features. Fillers can correct some of these age-related changes. Hyaluronic acid restores youthful volume to the face, while calcium-based fillers build the skin’s structural support from within.

Fillers can be injected into the lips to correct their shape and size. Fillers placed in the cheeks help redefine sagging facial contours and restore youthful fullness to the midface. It is also possible to correct the shape of the chin and nose with fillers. The nasolabial folds, which run from the sides of the nose to the corners of the mouth, are one of the most common treatment areas for fillers. Some upper-face wrinkles and age-related changes are also treated with fillers. However, botulinum toxin often provides the best results for rejuvenating the forehead and eye area.

Filler treatments are also performed in the neck and décolleté areas — although still relatively rarely in Finland. Hand rejuvenation with fillers is a slowly growing trend, also in the Nordic countries.

Filler treatments are not strictly pampering treatments. On average, the more experienced the injector is, the less painful the treatment feels. However, it is clear that, for example, injections into the lips always cause some discomfort unless the area around the mouth is numbed.

At Cityklinikka, different types of anaesthesia methods are used:

• topical anaesthetic cream — numbs the surface of the skin: the needle prick is still felt, but not as much as without the cream
• nerve block anaesthesia during lip augmentation — a so-called dental anaesthetic: the lips become numb for a few hours, and the filler treatment itself is not painful
• anaesthetic injections — before the filler treatment, the area can be numbed by injecting an anaesthetic into the skin with a needle: the anaesthetic injection itself is slightly felt, but the filler treatment is painless
• lidocaine-containing fillers — some fillers already contain a numbing agent: the first injection is felt, but after that the area becomes numb

After possible numbing, a filler gel is injected under the skin. The procedure is quick and, when performed by a professional, straightforward. The treatment takes between 15 and 30 minutes. After the treatment, the patient may sit for a moment and apply a cold compress to the treated area.

Immediately after the procedure, injection marks are visible on the skin. These can be covered with makeup, although organic products are not recommended due to the risk of infection. Bruising is possible, as is swelling. If the filler treatment is performed on the lips, swelling is almost always present.

After the procedure, the patient receives aftercare instructions. Following them is important. Cityklinikka doctors recommend the use of arnica-containing creams. These help reduce bruising, swelling, and redness. If bruising occurs, arnica cream can help it resolve more quickly than without treatment.

The results of a filler treatment are visible immediately after the procedure. It is good to remember that the results continue to improve over the following two weeks. For this reason, the final outcome can be reliably assessed only 2–4 weeks after the treatment.

The duration of the results depends on many factors. The following, among others, affect how long the outcome lasts:

• how firm the filler used is
• how many filler treatments the area has previously had (after a few sessions, the filler tends to remain in the tissue longer)
• how much filler has been used
• the patient’s metabolism
• how active the patient’s lifestyle is

Since exercise speeds up metabolism, it is advisable to limit intense physical activity before and after the treatment if one wants the results to last as long as possible.

After a filler treatment, extreme temperatures should be avoided. Sunbathing, tanning beds, saunas, and ice swimming should be paused for about two weeks.

Bruising occurs in relatively few patients, but it is always possible. If bruising is to be avoided, the treatment can be performed using a cannula.

Swelling is a typical side effect of filler treatment during the first few days.
Redness is almost always present. It usually subsides within an hour after the treatment. Redness can also be covered with makeup.

Irregularities may sometimes occur. You should ask the practitioner whether the area should be massaged or not.

There is always a risk of infection whenever the skin is pierced with a needle. When filler treatments are performed in appropriate conditions and the practitioner understands the importance of asepsis, the risk of infection is minimized. The patient can help prevent infection by following aftercare instructions. The skin should not be touched unnecessarily. If makeup is applied immediately after the procedure, it is important to ensure that the products are hygienic.

The probability of very serious complications (such as necrosis or blindness) is estimated in some assessments to be 0.0005%.

Hyaluronic acid can be removed if necessary with an enzyme called hyaluronidase. It is the same enzyme that is naturally found in the human body, where it breaks down the body’s own—and also injected—hyaluronic acid.

There are many reasons for filler removal:

1. The patient is not satisfied with the result of the filler treatment; there is too much filler.
2. The patient becomes tired of filled lips and wants their “own lips back.”
3. Swelling in the treated area does not subside; this sometimes happens after tear trough treatments.
4. Lumps and nodules in the lips do not disappear despite massage.
5. In rare cases, the patient may be allergic to one of the filler’s ingredients.

Cityklinikka physician Piotr Sikorski specializes in hyaluronic acid removal treatments. The demand for hyaluronidase treatments has increased somewhat over the past year.

Usually, lidocaine (a numbing agent) is mixed with hyaluronidase, so the procedure is not very painful. Before the treatment, it is important to understand a few facts:

Hyaluronidase treatment is not as precise a procedure as filler injections themselves. For example, when removing lip nodules, it is possible that hyaluronic acid is also broken down in areas where it is not intended.
Dosing hyaluronidase can sometimes be challenging. For this reason, dissolving hyaluronic acid gel may require several treatment sessions. If a very firm hyaluronic acid gel has been injected into the skin, dissolution may take more time and more hyaluronidase than usual.
The result of the treatment may be visible immediately after the procedure. However, in most cases, the final outcome becomes apparent only after 1–3 days.

Hyaluronic acid (HA) is an organic compound found in the human body. Due to its large molecular size, it cannot be absorbed deeply into the skin from the surface.

On the skin’s surface—when using cosmetic products, for example—hyaluronic acid acts as a moisturizing ingredient. Because an HA molecule can bind up to a thousand times its own weight in water, it is widely used in products such as moisturizers. In cosmetic products, hyaluronic acid hydrates the outermost layer of the skin.

When hyaluronic acid is injected beneath the surface of the skin, it attracts moisture and thereby adds fullness to facial features. Hyaluronic acid is naturally present in the dermis, the skin’s deeper layer. However, as a person ages, the skin’s hyaluronic acid levels decrease. When hyaluronic acid is introduced into aging skin via injection, it replenishes the skin’s natural hyaluronic acid reserves.

In high-quality fillers, the hyaluronic acid used is 99% identical to the skin’s own hyaluronic acid. The difference lies in its longevity. The duration of filler hyaluronic acid has been extended by adding a very small amount of a stabilizing agent.

HYALURONIC ACID IN THE BODY

The hyaluronic acid in the skin is fluid and breaks down quickly. The body’s own hyaluronic acid molecules are degraded within 1–2 days. The cycle of breakdown and renewal is therefore very rapid.

HYALURONIC ACID IN FILLERS

When developing fillers, the aim has been to create a gel-like, stable form of hyaluronic acid. It would not make sense to inject hyaluronic acid into the skin if it broke down within two days after the procedure.

Hyaluronic acid is made long-lasting by creating cross-links between the long hyaluronic acid chains. These cross-links keep the hyaluronic acid molecules in fillers bound together for several months. Cross-linking is mainly achieved using a compound called BDDE. BDDE (or another stabilizing agent) is the only component in fillers that is not found in the body’s own hyaluronic acid.

Hyaluronic acid gel increases the volume of the subcutaneous tissue. This effect is noticeable immediately after filler treatment. Because hyaluronic acid binds water, the skin’s moisture balance also improves.

After filler treatment, wrinkles and lines are lifted from within: fine and moderately deep wrinkles disappear completely, while deep wrinkles become significantly shallower and smoother. The skin becomes more even, hydrated, and radiant. Sagging facial features are also lifted to some extent.