Fillers have become a common aesthetic treatment for several cosmetic problems. Dermal fillers have become a sought-after rejuvenation procedure as they offer a youthful, three-dimensional look with minimal downtime. Fillers available in India vary in source, longevity, site of deposition, and cost. With the increasing understanding of the aging process and growing desire for minimally invasive treatments, injectable fillers have great potential for correcting and rejuvenating facial wrinkles/folds and contouring the face.
Injectable fillers are materials that are injected in or beneath the skin layers to restore the lost volume, smooth lines, soften creases, and enhance facial contours. In general, injectable fillers replenish the lost volume in two ways, physical filling and stimulating the synthesis of new collagen. The former shows a greater filling effect after injection but disappears gradually. The classical fillers include hyaluronic acid (HA) and collagen, where the latter stimulates collagen formation by creating a space and structure for the entry of fibroblasts and vascular cells, making them more effective in the later phases of injection. The typical fillers are composed of polymer microspheres suspended in solution, such as polylactic acid (PLA), polycaprolactone (PCL), hydroxyapatite (CaHA), and polymethyl methacrylate (PMMA).
CLASSIFICATION OF FILLERS
Fillers can be classified either on the basis of longevity in tissues, or based on their source.
Based on longevity
Fillers are classified as temporary, semipermanent, or permanent. Temporary fillers stay in the tissue for less than a year, semipermanent fillers for up to 1–2 years, whereas permanent fillers are substances that remain in the tissue more than two years. However, there is some confusion in the classification of semipermanent and permanent status of some fillers, with some sources classifying any filler that lasts more than one year as permanent.
Based on the origin
Fillers may be classified depending on their source as:
- Human
- Animal
- Synthetic
Knowing the source of the filler is important as it helps the dermatologist to take decisions about the need for pre-skin testing and to know the patient’s preference. Many patients may not wish to use animal products for religious or personal reasons.
Temporary fillers
Temporary fillers are also referred to as non-permanent fillers. Their stay in the tissue is for less than 12 months and hence, they have the advantage of spontaneously disappearing if the patient is not satisfied with the results. Similarly, an adverse event with such fillers is also a temporary one, as seen in the majority of the cases. However, rare permanent side effects have been reported even with temporary fillers.
Synthetic fillers: Hyaluronic acid-based fillers
Hyaluronic acid (hyaluronan or HA) is one of the most frequently used dermal fillers allowing the expansion of soft tissues, the filling of wrinkles, and the treatment of skin irregularities. hyaluronic acid of non-animal origin, slowly absorbable over time, colorless, sterile, non-pyrogenic, physiologically transparent, viscoelastic gel. A wide range of hyaluronic acid products is available with varying hyaluronic acid concentrations and cross-linking structure and hence, also in their indications. Hyaluronic acid (HA) fillers have traditionally regarded as medium-term fillers, designed to last between 3 and 12 months.
1. Concentration:
- Higher HA concentration:
Fillers with higher HA concentrations (e.g., 20 mg/g or more) are considered more effective in displacing tissue and potentially leading to longer-lasting results.
- Lower HA concentration:
Fillers with lower HA concentrations may be used for more superficial applications or for patients who prefer shorter-lasting results.
2. Longevity:
- Cross-linking:
The method of cross-linking HA molecules significantly impacts longevity. More dense cross-linking can lead to a more stable and longer-lasting filler.
- Biphasic vs. Monophasic:
HA fillers are sometimes classified as biphasic or monophasic, though these terms lack strict scientific definition.
- Biphasic: May offer greater intradermal durability than monophasic fillers.
- Monophasic: Can be further divided into monodensified or polydensified, with monodensified potentially offering greater durability than polydensified.
- Particulate vs. Non-particulate:
HA fillers can also be classified based on whether they are particulate or non-particulate. Particulate size determines the longevity of particulate manufactured hyaluronic acid filler, whereas cross-linking density determines the longevity of non-particulate manufactured hyaluronic acid filler.
- Factors influencing longevity:
Besides concentration and cross-linking, the longevity of HA fillers can also depend on factors like the injected volume, site of injection, and individual patient factors.
- General Longevity:
HA fillers are typically considered medium-term fillers, lasting between 3 and 12 months. However, some fillers, like those with higher HA concentrations and specific cross-linking, can last longevity.
The cross-linking technology and percentages have major influences on the longevity and diffusion pattern of hyaluronic acid fillers. The enhanced stability of hyaluronic acid could be generated when the hyaluronic acid molecules are cross-linked by means of 1,4-butanediol diglycidyl ether.
1,4-Butanediol diglycidyl ether (BDDE) is a common cross-linking agent used in hyaluronic acid (HA) dermal fillers, enhancing their gel-like consistency and durability. BDDE reacts with HA molecules, creating a network structure that gives the filler its gel-like consistency and makes it more durable. BDDE is used to improve the properties of HA hydrogels, making them more suitable for use as dermal fillers.
General Post-Treatment Care:
- Ice Packs: Apply ice packs to the treated area to minimize swelling and bruising.
- Avoid Heat: Refrain from exposure to extreme heat, including hot showers, saunas, and strenuous exercise, for at least 24 hours.
- Elevate Head: Sleep with your head elevated to reduce swelling.
- Hydration: Stay well-hydrated by drinking plenty of water.
- Pain Management: Over-the-counter pain medication can be used as needed for pain or discomfort.
- Avoid workouts: Avoid workouts for 4 to 5 days post procedure.
- Follow-up: Schedule a follow-up appointment with your provider to check on your progress and address any concerns.
Frequently Asked Questions (FAQs)
Q1. Are treatments at an aesthetic clinic Bangalore safe?
A. Yes, treatments at a reputable aesthetic clinic in Bangalore are safe and effective, especially when administered by certified dermatologists and skilled practitioners.
Q2. How do I know which is the best acne treatment in Bangalore for my skin?
A. A dermatologist will evaluate your skin condition, acne severity, and skin type to recommend the best acne treatment in Bangalore suited to your needs.