Volumising Dermal Fillers
Restorative Fillers: “Liquid Facelift”,
“8 Point Lift”, and “MD Codes”
Many of the facial changes that occur with age are due to loss of volume. In recent years it has been established that there are separate fat compartments in the face, and as we age these fat compartments lose volume, contributing to the sagging and sinking of the aging face. In addition, bone is also gradually resorbed with age (including the jawline, central face, and around the eyes), exacerbating this sinking and sagging. The result is the gradual deflation of the shape of the face, from the round plump face of the baby to the deflated and sagging face of the elderly. Superimposed on that is the loss of skin elasticity and collagen due to intrinsic aging and external factors, particularly sun-damage.
How can this loss of volume be restored?
One way of restoring this loss of volume is the use of fillers. When these are injected, they can replace the loss of fat and bone.
What types of filler can be used?
Recent advances have led to the development of new fillers of different strength and character, which can be chosen to deal with different layers of the face. At Dermatology Consulting, we usually choose hyaluronic acid fillers. This is because hyaluronic acid occurs naturally as a form of sugar in the body, so it is extremely rare for the body to develop an allergic reaction against it. Furthermore, a natural antidote exists against hyaluronic acid (called hyaluronidase), which can effectively and quickly dissolve the hyaluronic acid filler if one dislikes the result or if there are problems from it.
Sculptra® Aesthetic is another filler that is occasionally used. It is poly-L-lactic acid, which is the same material used in dissolving stitches. It consists of fine granules that are diluted down with sterile water and injected under the skin. The granules then stimulate gradual collagen production around themselves.
What brands of fillers does Dr Farrell use?
Fillers are inserted under or into the skin to restore lost volume. Our dermatologist, Dr Farrell, uses a number of different fillers chosen for their particular properties of strength and elasticity. The selection of fillers used will depend on the area to be treated and the individual patient’s problem. For example, when restoring loss of volume of the face and correcting sagging skin, fillers with high strength and cohesivity, such as JUVÉDERM VOLUMA™, are used deep in the skin to provide structure and support. When restoring volume more superficially, thinner, less cohesive fillers are used, e.g. JUVÉDERM® VOLIFT® and Restylane®. When treating fine lines, lighter fillers that spread out easily are used, e.g. Belotero® Soft, JUVÉDERM® VOLBELLA®, and Restylane® Vital. This global approach both restores the volume and soft contours of youth as well as improving fine lines. Such an approach is often referred to as a “Liquid Facelift”.
Such “Liquid Facelifts” can be used to rejuvenate the face in individuals who either do not want or who are too young for a facelift. They are best used in combination with other treatments as part of a whole treatment plan (e.g. in conjunction with good skin care, muscle relaxing injections, and lasers).
What are the “8 Point Lift” and “MD Codes”?
The “8 Point Lift” is a method for injecting fillers in the face developed by Dr Mauricio de Maio, a skilled plastic surgeon from Brazil. It is designed to maximise the revolumising effects of strong fillers, such as JUVÉDERM® VOLUMA™, by injecting certain sites to achieve optimal improvement. Dr Farrell has adopted the principles of this approach and included some additional techniques she has developed from many expert injectors from North America and France.
On what sites of the body can fillers be used?
Fillers can be used at any site where volume has been lost. They are most frequently used on the face, but other sites can be treated, including the hands, neck, and chest.
What problems can occur with fillers?
It is very unusual to react to hyaluronic acid fillers as they are composed of sugars that occur naturally in the body. Therefore it is very rare for allergic reactions to them to occur, unlike the earlier collagen fillers which previously had a high chance of producing allergies.
It is very important that any practitioner injecting fillers has a thorough knowledge of anatomy to avoid fillers being injected into blood vessels, which could cause loss of skin in the involved site or even rare cases of blindness. For this reason it is important that fillers are injected in the correct anatomical sites. Where possible, Dr Farrell uses cannulas rather than needles, which reduces the chance of injury to blood vessels and reduces the chance of bruising.
When using hyaluronic acid, there is also the advantage that there is a natural antidote that can dissolve the filler if necessary.
How long do fillers last?
Hyaluronic acid fillers can last from between 6 months for very fine fillers to 24 months for thicker fillers. The fillers are broken down naturally by the body. The presence of the fillers helps to stimulate some production of the body’s own natural collagen, so there is some long-lasting improvement. Most patients who decide to have fillers have an initial course of fillers to achieve the result they want and then have occasional repeat sessions every 12-18 months to maintain the improvement.
Who performs the fillers?
All the filler injections are done by Dr Anne Farrell, Consultant Dermatologist. Dr Farrell has been using fillers for over 15 years, and she has trained alongside some of the best injectors in the world, particularly from her visits to the US and Canada.
Tear Trough Treatment
Many individuals become more aware of noticeable “tear troughs” developing under their eyes as they age. These tear troughs are located under the eye. The natural process of aging can deepen these hollows, causing them to appear darker. Patients often dislike this as they believe the eyes look more tired, heavy, and sad. Dr Farrell offers a range of treatments to help improve the appearance of this area.
What causes tear troughs to develop?
Hollow-looking tear troughs are caused by a steady loss of volume of the structures of the face. With age there is a loss of the fat compartments and a gradual loss of bone, particularly of the central face and orbit (eye socket). In addition, the overlying skin starts to lose collagen and elastin. All these changes can result in hollows developing under the eyes and the appearance of dark shadows.
How can they be treated?
Fillers can be used to replace the loss of volume and fill in the tear troughs. Very soft, thin fillers (e.g. Restylane® Vital, Belotero® Soft, and Redensity II®) are used to avoid the filler being visible under the delicate skin of the eyes. At Dermatology Consulting, Dr Farrell prefers to use cannulas to reduce the chance of bruising.
In addition, the texture of the skin can be improved with skin care products, including retinoids.
Lasers can also contribute to improving the texture and tightening the skin. Such lasers include Fraxel® Restore, Fraxel® Repair, and Fractora™.
The best results are usually obtained by a combination of these methods.
How can I decide the best approach for me?
Dr Farrell can discuss the best treatment, or combination of treatments, to deal with your individual concerns.