Are permanent dermal fillers safe?

By Dr. Aaron Stanes

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    With the progression of the cosmetic industry in recent years, the number of dermal filler types available has expanded rapidly. Knowing the pros and cons of each type of dermal filler will help you to make an informed decision about your cosmetic treatment. Permanent fillers are not widely available in Sydney and Melbourne, and while the fact that they are permanent might seem like an advantage, there are a number of very important things to consider.

    First, let’s take a look at the types of dermal fillers currently available.

    There are several types of dermal fillers that can be used to add volume, reshape facial features and smooth out wrinkles and fine lines in the skin. Some of the most common types of dermal fillers include:

    1. Reversible dermal fillers: These fillers are made from a substance based on a molecule known as hyaluronic acid that occurs naturally in the body and help to add volume and hydration to the skin. These dermal fillers are temporary and can be immediately reversed at any time using dermal filler dissolving. While initially though to only last 6-24 months, new evidence is showing that it is not uncommon for these products to last significantly longer.
    2. Collagen stimulating fillers: These fillers, also known as collagen stimulating injections are made from a substances based on naturally occurring compounds such as calcium hydroxylapatite and polycaprolactone. They are temporary and not reversible. Their key advantage is that the stimulate the body to produce new collagen fibres around the product, giving long term structural support to the treated area.
    3. Power fillers: These fillers are made from a synthetic material based on a compound known as poly-L-lactic acid and are used to stimulate collagen production in the skin. They are produced in powder form and are dissolved in sterile water prior to injection. While they are temporary and not reversible, then do not provide immediate volume to the treated area, and required extensive aftercare to prevent the product from migrating and aggregating.
    4. Permanent dermal fillers: The most commonly used permanent dermal filler is made of a substance based on a compound known as polyacrylamide: These fillers are permanent and can be used to smooth out wrinkles, volumise the face, improve sunken acne scars and reshape facial features.

    What are permanent dermal fillers made of?

    There are a number of different types of permanent dermal fillers currently available. They most common types available are made of either cross-linked polyacrylamide or a combination of polymethylmethacrylate and collagen.

    Why do people get permanent dermal fillers?

    There are several reasons why someone might choose to get a permanent dermal filler. Some people may prefer the idea of a longer-lasting treatment because it means they won’t have to return for repeat treatments as often. Others may feel that the results of a permanent filler are more natural-looking than those of a temporary filler. Further, some people believe that permanent fillers are more cost-effective over the long term, as they won’t need to return for maintenance treatments that is required with temporary fillers.

    Where are permanent dermal fillers used?

    Permanent dermal fillers can be used to enhance many parts of the face. The most common areas people have permanent dermal filler injected are the nasolabial folds, smile lines, lips, jawline, under eyes and nose. People also get permanent fillers to improve the appearance of sunken acne scars or scars from chicken pox.

    Are permanent dermal fillers safe?

    The use of permanent fillers is controversial, as they can have serious side effects and may not always be effective. Additionally, they cannot be easily reversed if the patient is not satisfied with the results. It’s important to carefully consider the risks and benefits of any type of filler, including permanent fillers, before proceeding with treatment. The actual risks of permanent fillers are essentially the same as temporary fillers, but if a complication is to occur, the treatment required to manage it may be much more significant (such as surgical removal of the filler).

    Permanent fillers vs temporary fillers: how to choose?

    When deciding on whether to proceed with temporary or permanent fillers, there are a few things to consider, and some questions to ask yourself.

    • What is your risk tolerance?: If a complication is to occur after permanent filler you may need surgery to fix the problem. Reversible fillers can be removed with a simple injection.
    • Longevity: While permanent fillers can last a lifetime, reversible fillers have now been shown to be capable of lasting many years longer than previously though. This has taken away the key advantage permanent fillers used to have.
    • The result: What if you don’t like the result? Reversible fillers are easy to adjust by either injecting more, or through microdissolving.
    • Future treatments: Most clinics will refuse to treat patients who have previously been injected with permanent fillers.
    • How will the result look over time?: Just because the result from permanent filler looks great now doesn’t mean it always will. With age, your face (and aesthetic preferences) will change, but the filler won’t. What looks good today may look very out of place in the future. Unfortunately with permanent dermal filler, you may need surgery if this occurs. Reversible fillers can be adjusted over time, depending on how you age and how your preferences change.

    How to remove permanent dermal fillers?

    It is more difficult to remove permanent fillers compared to traditional, temporary fillers. The specific method for removing a permanent filler will depend on the type of filler used and the area of the face where it was injected. Essentially, the only option available to remove permanent dermal fillers is surgical excision. Removing permanent filler with surgery can be a risky and complex procedure, and is generally only recommended as a last resort.

    Another option is to wait for the filler to be metabolised. This only works in certain cases and for certain types of permanent filler, although not all of the filler will likely break down.

    If you are considering permanent dermal filler it is vital that you fully understand the implications of such a treatment. Given temporary fillers have been shown to last significantly longer than previously thought and can be dissolved, the advantages of permanent fillers are not what they were once thought to be.

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