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Dermal Fillers: To inject or not to inject
Dr Ahrooran Sivakumar
D ermal Filler is a product that is synthetically made primarily from Hyaluronic Acid. Hyaluronic acid is naturally found in the skin and it makes up 50% of the body’s total HA. Dermal Filler can be hugely beneficial to certain individuals experiencing problems with their skin or facial volume and injected with specific techniques to provide a natural- looking result. Dermal Filler have been around for decades but have been increasingly popular with advances in technology in aesthetics, popularity and an increase in Cosmetic Injectors. Facial dermal fillers’ main function is to provide volume and shape. Most HAs in dermal filler are cross-linked with a chemical called BDDE, (1,4-Butanediol Diglycidyl ether) which allows the HA to provide volume definition. The variety of cross linking can directly affect the fillers rheology such as elasticity, cohesivity and viscosity. SO WHY DO WE USE IT IN AESTHETICS? THE ‘STIGMA’ There is a real stigma surrounding dermal fillers due to poor published results on social media and news headlines of botched jobs, however not all treatments are like this. Dermal fillers can be really beneficial to an individual who suffers from volume loss in various parts their face. It can be used very safely, and a good injector can mitigate or lessen the risks of a complication through good knowledge of the anatomy, injection techniques and even the use of ultrasound. The most important aim is not to change someone but to
enhance what they already have. As an injector, I need to be able to treat any potential complications from any treatment I offer or to be ready in the rare eventuality of an emergency. This is why I also teach complications to my delegates in the Foundations and Advanced courses at the A Aesthetics Training Academy. THE FACIAL AGEING PROCESS As we age, there is four main culprits which contributes to our ageing appearance. Think of it this way, if we treat each culprit naturally, we can really look much younger and achieve a natural look.
by the retaining ligaments of the face and fibrous tissue. As we age literature would suggest that we lose volume in these pads or they may even descend or migrate elsewhere due to the loss of strength off retaining ligaments of the face and gravity. The most common finding I find in all my patients is the loss of fat pads posterior to the retaining ligaments of the face including the buccal and lateral temporal cheek fat pads. Posterior to these retaining ligaments the layers of the face are like an onion skin so re-inflating or ‘filling’ these hollows will cause changes in the whole face and allowing the layers to glide, so treating the temples can truly change the structure of your jawline by creating lift.
Simply treating specific areas of the face can have a profound effect for your patient providing natural results with small amounts of filler preventing ‘overfilling’ and complications. WHAT CAN YOU DO AS A PRACTITIONER? • Pick an evidence-based product such as MaiLi with its Oxi-Free ™ technology. • Take time and book your patients for a comprehensive consultation. • Map out your plan prior to injecting. • Think of the layers and anatomy of the face. • Do NOT overfill – Treat the cause NOT the problem.
Medical Director of the esteemed Dr A Aesthetics and A Aesthetics North Coast. He is also highly regarded as a clinical trainer at A Aesthetics North Coast Training.
Number 1: Skin Number 2: Muscle Number 3: Bone Number 4: Fat Pads
As this article is based around dermal fillers we are going to focus on Bone and Fat pads. Our face is made of a variety of bones but remember just like the bones in the rest of our body they undergo bone resorption at different rates and as we get older the resorption of bone can impact our under eye area, upper lip area and chin. Bone - How can we help that with dermal fillers? Some dermal fillers specific to their rheology of the product itself can mimic bone and have a high cohesivity and viscosity. Such fillers are placed down to bone just overlying the periosteum. Fat pads – One of the most important issues to address. Our face is made up of many fat pads both superficially and deeper ones all interconnected with each other
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