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Introduction

The use of cosmetic dermal fillers, particularly hyaluronic acid (HA)-based fillers, has become the predominant standard for non-surgical treatment of aging skin. These dermal fillers have surpassed collagen as the most popular cosmetic filler. Producing minimal side effects, having a reversible nature, and lacking immunogenicity, these treatments are preferred by practitioners and patients alike.

As with all cosmetic procedures, the outcome of this treatment largely depends on the physician’s skill and knowledge, rather than simply the filler itself. The demand for safe, long-lasting, and biocompatible dermal fillers continues, as a growing number of individuals prefer these minimally invasive treatments for cosmetic procedures.

Pre-procedure care

It cannot be stressed enough that dermal filler injections must only be performed by properly trained, experienced and licensed medical professionals. Aside from having the appropriate credentials, the medical professional must have a comprehensive knowledge of the process of aging and concomitant skin conditions, the types of fillers available, and the appropriate injection techniques.

Patient Assessment

It is the responsibility of the treating physician to determine the appropriateness of any requested procedure. There are many factors to consider before the appropriate treatment plan can be devised for a patient. Some patients will have unrealistic expectations of their results, which should be clearly addressed early on.

Prior to dermal filler treatment:

  • Assess the patient’s expectations / mindset
  • Obtain a thorough medical history of the patient – particularly allergic reactions
  • Address the desired outcome of the patient
  • Assess the area with the patient in an upright position to properly evaluate skin condition
  • Take pretreatment photographs for study
  • Identify the injection sites using washable marker

Dermal Filler Selection

Reversible or temporary fillers are typically recommended for patients who are unfamiliar with dermal filler injections. Appropriate fillers depend on the defect to be corrected, the type of material used, and the longevity desired. HA fillers do not require allergy testing, while collagen-based fillers are of bovine origin, and as such must be pretested prior to administration.

Intra-Procedure Care

Cleansing

On the day of treatment, patients should remove any cosmetics from their face prior to treatment. Patients should sit in an upright position in a comfortable chair. The area will be prepared for filler injection following standard aseptic techniques.

Anesthetizing

The type of anesthesia required will depend on the area to be treated, as well as the patient’s pain threshold. To reduce discomfort, topical anesthesia can be applied 30 to 60 minutes prior to the procedure. Topical anesthetics include lidocaine and tetracaine. There are also a wide variety of dermal fillers pre-mixed with lidocaine.

For physicians – injection

The treating physician should be aware of the right injection techniques used for each filler, and site where they will be deposited. Unwanted effects such as overcorrection, can be remedied by injecting the enzyme hyaluronidase (for hyaluronic acid-based fillers) into the skin.

During the procedure:

  • Always adhere to correct depth of injection
  • Record product label / batch number sticker on consent forms
  • Document the procedure by indicating the filler used, quantity, and area(s) treated

Common Injection Methods

Indication

Technique

Threading Method Typically used for treating the vermillion border Involves depositing the product as the needle is being withdrawn from the tissue
Serial Droplet Method Treating glabellar lines and periorbital hollows Commonly used for silicone injection
Fanning Method Treating nasolabial folds The preferred method for superior, natural, and longer lasting results. Needle is passed back and forth under the fold, depositing the filler as the needle is inserted and withdrawn

Post-Procedure Care

After the procedure is complete, the treatment area should be fully cleaned, and markings removed using alcohol, hydrogen peroxide, or a similar antiseptic solution. Always ensure you follow all instructions for aftercare methods as provided by the injector.

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