What are Dermal fillers and how do they work?
As the skin ages, it gradually loses some of its collagen and fat. These are the materials that prevent the skin from becoming saggy. Thus, as we age, our skin can become thinner and more wrinkled and lined.Juvederm® is the dermal filler we use to help to restore your skin to its former youthful appearance. It is injected into the skin in areas where it needs to be plumped up again and made to look firmer.
Juvederm® come in different thicknesses, and in general, the thicker the product, the deeper it is injected into the dermis (middle layer of the skin - see diagram below) to help plump out fine to deep lines and wrinkles.
What are the different types of Dermal fillers used?
Dermal fillers tend to be broadly classified as being either non-permanent or permanent in their effect by both manufacturers and practitioners using these products.Non-permanent or resorbable dermal fillers
In 1981, Collagen was the first filler approved in the U.S. for soft-tissue filling by injection. It is made from bovine (derived from cows’ skin) collagen.The collagen is taken from the cow and then purified to such a degree that it resembles the collagen which occurs naturally in our own skin. It is necessary to have a skin test before this treatment, however, as some patients may be allergic to bovine collagen.
The leading dermal filler used by most practitioners now is a hyaluronic acid based product.
Hyaluronic acid is a naturally occurring substance found in the spaces between the cells of body tissues in all animals. It has already been used widely in general medicine to help eye surgeons perform cataract operations, and for injection into arthritic joints to aid movement. It is estimated that 30 million patients around the world have been treated with some form of hyaluronic acid. Hyaluronic acid has now largely replaced collagen as the favourite filler of cosmetic experts. This is because it is more likely to be compatible with our bodies than collagen, and so people are less likely to be allergic to it and do not require a test prior to use.
Restylane® or Restylane Perlane® is manufactured using bacteria.
Hylaform® and Hylaform Plus® - Manufactured from cockerel combs.
Juvederm® is a Hyaluronic acid based brands derived from non-animal sources.
A newer filler using polylactic acid is promoted under the brand name Sculptra®.
Another product is calcium hydroxylapatite, the key component of Radiesse . Calcium hydroxylapatite has been safely used in the body for many reasons including dental applications where bone build-up is needed for reconstruction and also in block form for cosmetic applications such as cheek, jaw, cranial and chin implants.
Radiesse is marketed as a long lasting dermal filler and facial sculpting agent where results can last for 2 years or longer.
Most of the ingredients of available non-permanent or temporary fillers have been widely used and clinically tested for safety and effectiveness.
Permanent or non-resorbable dermal fillers
These are newer fillers that can give a longer lasting effect, or even a permanent effect.These products are currently not widely used, but include the following brands:
Artecoll® - Rounded PMMA beads in bovine collagen.
What skin problems can Juvederm® treat?
Juvederm® is very effective in both men and women in helping to fill out lines around the lips, the lines from the nose to the corners of the mouth (nasolabial lines), smile lines on the cheeks, as well as crow’s feet and forehead wrinkles.Thicker forms of Juvederm® can also be used to add volume to sunken cheeks and weak chins, reshape the tip of the nose, as well as filling out deeper acne or other scars.
Usually, if you need to have fillers in the upper part of your face for movement lines associated with expression i.e., crow’s feet, forehead and general wrinkle lines, it is usually recommended that the fillers are used alongside injections of botulinum toxin (or Botox®).
Depending on the area treated, and the depth of wrinkles or scars or sagginess of the skin, a combinations of types of Juvederm® may be used in order to achieve the best results.
What happens during Juvederm® treatment and how long does it take to recovery?
During your first visit, you should explain what you expect from a Juvederm® treatment and how you would like to look afterwards. Potential problems connected with the treatment will be described. You will discuss which filler is best for you and how much it will cost.A medical history will be taken to make sure that there are no reasons why you shouldn’t have the treatment. Then you will usually be asked to read detailed information and sign a consent form which means that you have understood what the treatment may do, along with any potential side effects from the filler(s) being used.
Photographs may also be taken for comparison after the treatment. For treatment of lines and wrinkles, an anaesthetic cream is sometimes applied to the area 20 minutes or so prior to injection. This helps to numb the area to be treated and reduces pain when the needle is inserted into the skin.
Different injection techniques are used depending on the type of filler and the area being treated.
For filling out wrinkles, the two main techniques are:
- linear threading technique, where the full length of the needle is inserted into the middle of the wrinkle and the material is then injected while pulling the needle slowly backwards;
- serial puncture technique, where several injections are made in a line along the wrinkle or fold to lift the wrinkle;
- for plumping out the face, or filling larger areas such as hollow cheeks, either a fan technique or cross hatching technique is employed.
Follow-up treatment
Depending on the type of filler used, and the area treated, top up treatments are usually required to maintain the effect.Recovery time for Juvederm®
Depending on the area treated, and which filler is used, treatment times can vary from around 30 minutes to an hour, and recovery time can be from a few hours to a few days. However, most people find that they can return straight back to work after treatment with Juvederm®.Juvederm® Side Effects
Does Juvederm® hurt and what are the side effects?
Depending on the area injected and the type of filler or pain control used, patients may find the procedure relatively painless to mildly uncomfortable. Treatments around the nose or lip areas are usually more painful.The obvious immediate side effect is of slight bleeding after the needle has been inserted into the skin. Other risks include mild bruising, redness and swelling that may also occur around the site of injection. These signs may take 2 - 3 days to vanish completely, especially around the lips where there is little flesh and the skin is tender.
Rarely, allergic type reactions can occur after treatment with some fillers. These include prolonged redness, swelling, itching and or hardness and bumps in the skin. Such signs may appear at some or all of the points of injection. Sometimes, they can last for several months or longer, but this is extremely unusual.
If you have a history of cold sores, or fever blisters in the treated area, filler injections may cause them to break out again. In these cases, an anti-herpes medicine may be provided before treatment, to help reduce the likelihood of an outbreak of cold sores.
Very occasionally, delayed side effects can occur many months after the first treatment. These side-effects usually appear as red lumps showing up underneath the skin. Sometimes, these may be permanent. There is some evidence that these may be more common with some of the newer, permanent, bead containing fillers.
What should you do after treatment?
It is important that you follow the advice of your practitioner carefully after Juvederm® treatment. This will help you to gain maximum effect from the procedure and reduce the risk of complications.Post-treatment advice may include:
* iced water soaks or ice packs to help to reduce swelling;
* the use of pain-killers such as tylenol, if required for a few days after treatment;
* bruising and swelling should go down after a couple of days, but if you continue to experience very painful swelling and bruising, or if any blistering occurs, you should contact your practitioner;
* similarly, if you experience any delayed reactions such as lumpy redness occurring any time after treatment, you should contact the clinic immediately.
Additionally, when you leave the clinic after a Juvederm® treatment you are likely to suffer from varying degrees of redness depending on the areas treated, which may not be the most attractive face that you wish to present to the public. There is however a solution.
Glomineralstm skin care makeup has the ability to promote the healing of damaged or postprocedural skin and can be used on the skin immediately following treatment, allowing you to face the world without a red face.
Who should not have a Juvederm® treatment? As in any treatment to the skin, injections should be avoided in areas where the skin is swollen or where infections are present e.g. active acne. This will reduce the risk of infection at the injection site after the treatment.
Juvederm® have not been tested in pregnant women, so their use would normally be not advised by practitioners if you are expecting a child.