Fillers in Dubai | Dr Matteo Vigo

The face loses volume and contour when we age, the bones and the soft tissue dissolve and contribute to appearance of sagging. Dermal fillers may be used to replace this volume loss and restore the structural support, giving the patient a more youthful appearance. The aim is to make the face more harmonious and rejuvenated. For instance, the lips may be injected to improve their shape, size, symmetry and proportion. The cheeks may be injected to make a face more defined and attractive. An underdeveloped chin may be injected to make it appear more projected and proportionate. The nose may be injected to improve the shape and its contour.

It can be painful if the procedure is carried out by injector who is not as skilled. Generally, basic dermal filler procedures require no anaesthetic as the dermal filler contains local anaesthetic. It is simple and straight-forward, involving a few tiny injections directly into the skin, and takes between 15–30 minutes. Make-up can be applied immediately after the procedure and you can go straight back to work. Result can be seen immediately. Optimal results can be maintained over a long period of time through regular repeated treatments. The procedure varies from person to person depending on your requirements and the severity of the wrinkles that are being treated, in addition to the particular dermal filler being administered.

Results are seen instantly after the treatment, although this gradually improves over the course of the following 2–4 weeks. Results can last between 9–18 months although optimal results can be maintained over a long period of time through regular repeated treatments. The longevity varies from person to person depending on your requirements and the severity of the wrinkles that are being treated, in addition to the particular dermal filler being administered.

Yes. We use only products with proven safety record. Hyaluronic acid (HA) is a substance which occurs naturally in the cells of the skin, thus there is no risk of allergic reactions. Even people with food sensitivities can receive these fillers safely. The brands of dermal fillers I use are available in more than 90 countries and have been used as an injectable cosmetic treatment for more than two decades with an excellent safety record.

Today’s dermal fillers have come a long way since the first-generation of collagen injections. Advanced injection techniques, coupled with the use of micro-cannula (blunt needle) and improved product safety means that significant side effects are extremely uncommon but may include: Injection-related reactions: these reactions may include redness at the injection site immediately after the treatment. Bruising: occasionally bruising can occur. However the use of micro-cannula (blunt needle) dramatically reduces the risk of bruising. Contour irregularities can and do occasionally occur. Massaging can usually smooth out any ‘lumpiness’ however if persistent the filler can be easily and rapidly dissolved. Infection — as with all injections, this procedure carries a risk of infection. The syringe is sterile and standard precautions associated with injectable materials are taken.

Dermal fillers continue to be highly popular due to the natural hyaluronic acid formula featured in most Dermal Fillers brands. Hyaluronic acid occurs naturally in the body but can deplete over time due to ageing or environment, it requires no allergen tests as it does not use animal DNA. It is biodegradable and absorbs over time into the skin leaving no by-products or waste. Dermal fillers aim to be the perfect solution for delaying the ageing process or filling in any depressions left from weight loss or illness. They can be used to get rid of fine lines, wrinkles, shadows and hollows around the eyes, lips and nose area. Dermal Fillers can also help replace lost volume in the face focusing on the cheek and nose area, it can be used to plump up lips and contour the face according to preference. It is a stress-free alternative to invasive surgery and will dissolve naturally over time. Most popular dermal fillers can last between 6-9 months, up to a year or longer depending on the individual strength and formula used. Individual treatments are tailored to each client and customer depending on personal circumstance, lifestyle and requirements. Fillers in Dubai - Alidya Alidya is an anti-lipostrophic agent designed and approved for the treatment and prevention of cellulite. Patented by the same surgeon who developed Aqualyx, it is the first registered medical product to be applied as an injectable treatment for cellulite. Fillers in Dubai - ALIAXIN SR Shape & Restore ALIAXIN SR Shape & Restore is ideal for dermal remodelling. Use Aliaxin SR to replenish facial fullness with natural and well-defined contour. Characteristics The hyaluronic acid gel in this formulation characterises its use in treatments where the primary aesthetic objective is to recover the harmonious balance of the face. It is therefore ideal for dermal remodelling, where the key concerns are profile, contour and symmetry. Benefits of Aliaxin® SR •Remodelling of the face •Replenished facial fullness •Natural and well-defined facial contours •Allows homogeneous diffusion in the tissue and extended areas of the face •Stable •Long lasting Fillers in Dubai - AQUASHINE BTX AQUASHINE BTX is an innovative anti-ageing hyaluronic acid filler with biomimetic peptides. Aquashine BTX is ideal to correct moderate to severe facial wrinkles and folds and to restore the shape of the face. This product is an ideal solution for mature skin and is designed for face and tissue remodelling. Results from using AQUASHINE BTX can last for up to 12 months. Benefits of Aquashine BR: • Correction of moderate to severe wrinkles and folds • Face and tissue remodelling • Restores the shape of the face Fillers in Dubai - AQUALYX® AQUALYX® is an injectable, gel-based aqueous solution, a non-surgical reduction of stubborn fat under the skin. Aqueous solution with a microgelatinous base, modulating and favoring the action of external ultrasound waves for the non-surgical in the treatment of localized adiposity. This is a form of injection lipolysis, lipotherapy or intralipotherapy. It is marketed for aqualysis or aquaplasty treatment as a means of body contouring. Clinical data shows that the application of AQUALYX is effective and safe, leading to an increase in contoured appearance. Characteristics AQUALYX was developed to treat localised pockets of fat underneath the surface of the skin. It can be used to treat fat pockets on the back, chin, stomach, underneath the buttocks, hips, thighs and knees. It can also be used to treat pseudo-gynaecomastia, the development of fatty tissue around the nipple, resulting in a breast-like appearance in men (due to weight gain rather than the growth of actual breast tissue as seen in genuine male gynaecomastia). This is sometimes referred to as Motolese`s Solution. AQUALYX was developed by Professor Pasquale Motolese, president of the Italian Society of Aesthetics and Medicine and was first introduced in 2009. Manufactured by the Italian firm Marllor, it was first launched in the UK in 2013 and is distributed in the UK by Healthxchange Pharmacy. What is AQUALYX? AQUALYX is an aqueous compound solution, with slow-release sugar that reduces the biological half-life of the solution, minimising side effects. The ingredients are a polymer from phospate buffered saline, agarose, sodium deoxycholate, water for injection purposes (87%). The buffer system within AQUALYX ensures that the 12alfa-dihydroxy-5beta-24oico cholanic acid sodium salt is delivered to the target area. Deoxycholic acid has been used in various fields of human medicine since its discovery. Present also in the human body, deoxycholic acid is used in the emulsification of fats for the absorption in the intestine. How does it work? The solution is injected into the treatment area whereby the 12alfa-dihydroxy-5beta-24-oico cholanic acid sodium salt of AQUALYX alters the surface tension of the fat cell membrane and increases the permeability of the membrane. An ultrasound device is then applied over the surface of the skin in the targeted area and this causes the movement of liquids both inside and outside the fat cells. The fat cells start to balloon and break up, leading to the drainage of micro droplets of fatty liquid into the body, which is then metabolised through the lymphatic system and excreted. What happens during treatment? One AQUALYX treatment typically consists of two injection sites. A local anaesthetic, lidocaine, will usually be administered before the treatment commences. The practitioner may prefer however to add the lidocaine anaesthetic to the AQUALYX solution so that the two are injected together. Either method should minimise discomfort during the procedure. The practitioner will use an ultrasound device in conjunction with the AQUALYX injections to assist in the dissipation of the fat cells. Treatment regime: the time taken for a treatment session will depend upon the size of the area and indication being treated. Treatment can take between 30 - 60 minutes per treatment and you will typically require 2 - 8 treatments, 4 weeks apart. Some people may see significant results after 1 or 2 sessions. Treatment for fat pockets underneath the neck and chin, for example, may require 1 - 3 treatments of 2 - 3 injections, while treatment for fat pockets on the hips and thighs may require 8 treatments. Fillers in Dubai - BCN ADIPO BCN ADIPO claims to improve the appearance of cellulite and localised fat on the surface of the skin. It has been developed to combat cellulite and restore firmness of the skin, and can be used on the face to improve aesthetic conditions such as the visibility of double chins. How does Adipo work? Adipo is an anti-cellulite cocktail that contains L-carnitine and caffeine, which work in combination to mobilise accumulated fat, releasing it so that it can be burned by the metabolic system. Caffeine is useful in improving the circulation as well as tightening and toning the skin to ultimately reduce the appearance of cellulite. Who should not use Adipo? It is not recommended for use on individuals suffering from cardiac disorders or stomach ulcers. It should not be used during pregnancy and breastfeeding. It should not be used in conjunction with any product containing yohimbine. Fillers in Dubai - Belotero® Lip Contour Lidocaine Belotero® Lip Contour Lidocaine is an injectable hyaluronic filler that treats lip contour, mid oral commissures and gives optimal volume and definition for patient specific results. This filler is designed to define the outline of the lip for a more youthful appearance. Characteristics Belotero® Lip Contour is used for lip augmentation, giving enhancement to the upper and lower lip. Lip Contour also contains 0.3% lidocaine to reduce the pain during treatment. Benefits of Belotero Volume: •Increased lip volume for a natural appearance •Balance the lip shape •Enhanced curves and contours •Reduced drooping and fuller shape •Long-lasting results Fillers in Dubai - Belotero® Intense Belotero® Intense contains the second highest concentration of hyaluronic acid at 25.5mg/ml which works to restore and significantly increase the volume of face skin tissue. This makes it suitable for filling in deeper lines and wrinkles including nasolabial folds, marionette lines, corners of the mouth and the chin. This filler also suitable for lip augmentation and deep oral commissures. Characteristics Belotero® Intense is very malleable therefore it adapts to your facial contours easily and has a natural, smooth finish once administered. This filler is designed to be injected into the deep dermis. Intense has a good resistance to degradation, but is fully biodegradable and hypoallergenic once used. This product can minimise the skin irregularities to give you a excellent result. Benefits of Belotero Intense •Excellent tissue integration •Corrects fine to deep lines •Optimal filling capacity •Creates facial volume Fillers in Dubai - Belotero® Soft Belotero® Soft is formulated for superficial injections to correct fine lines and wrinkles as well as lip enhancement. This is also suitable for the correction of facial atrophic scars. Belotero Soft is optimised for deep skin rehydration due to its excellent cohesivity and its water binding capacity and needs to be injected into the superficial to mid-dermis by a legally approved practitioner. Characteristics Belotero® products are designed for you to tailor an aesthetic solution for every patient depending on the skin’s structural and functional needs. The different formulations can be used individually or in combination. Benefits of Belotero Soft •Excellent cohesivity and water binding capacity •Corrects fine lines and wrinkles •Deep skin rehydration •Indicated for fine lines such as crow’s feet and perioral lines Fillers in Dubai - Belotero® Balance Belotero® Balance is a prescription injection that is approved to temporarily smooth out and fill in moderate to severe nasolabial folds. This is a sterile, non-pyrogenic, viscoelastic, colourless, transparent gel of crosslinked sodium hyaluronate of non-animal origin, in a physiological phosphate buffer. Characteristics Belotero® Balance is an injectable filler designed to increase the volume of skin tissue. This filler enables moderate volume enhancement of the desired area and fills all types of wrinkles and corrects scars. Balance integrates seamlessly into the skin, allowing for immediate and smooth correction of medium to deep lines in the superficial and mid dermis. Benefits of Belotero Balance •Correction of medium to deep facial lines •Volumizing effect •Optimal skin integration Fillers in Dubai - Belotero® Volume Belotero® Volume is an injectable gel filler designed to add support to the overlying skin and to restore volume. This can be used to replace lost volume and smooth unwanted wrinkles in different areas (cheeks, cheekbones, chin and temples). Characteristics Belotero® Volume has an excellent malleability that makes it ideal for modelling and restoring facial volume. This treatment can be used to reverse the effects of ageing by replacing the lost volume in your face. The powerful volumizing effect and high plasticity help replace lost tissue and rebuild facial contours, resulting in a natural-looking appearance. Benefits of Belotero Volume •Restores lost facial volume •Smoothes out wrinkles •Optimal modelling capacity Fillers in Dubai - Belotero® Hydro Belotero® Hydro is specifically designed for deep rehydration treatment and skin rejuvenation. The recommended injection sites for skin rejuvenation with Belotero Hydro are the face, neck, décolletage and back of the hands. Characteristics Belotero® Hydro can used to restore skin radiance and elasticity. This is the perfect solution to lasting moisturised skin. Hydro is uniquely developed and formulated to enhance skin hydration. Belotero Hydro consists of sodium hyaluronate gel (of non-animal origin) in a physiological phosphate-citrate buffer. Benefits of Belotero Hydro •Deep skin hydration •Restores skin radiance and skin elasticity •Skin rejuvenation •Treatment areas: Face, neck, décolletage and back of the hands Fillers in Dubai - Cingal Cingal provides the benefit of a cross-linked hyaluronic acid and a fast acting steroid to effectively treat the symptoms associated with osteoarthritis. It is the first and only approved viscosupplement that combines Anika’s pioneering cross-linked hyaluronic acid formulation of Monovisc with a well-established and approved steroid to treat inflammation and provide additional short term pain relief. Benefits of Cingal: The addition of steroid provides fast and short term pain relief within the first few days of injection Hyaluronic acid viscosupplement provides long lasting pain relief which may last up to 6 months Convenient single injection treatment Contains a highly concentrated and non-animal based hyaluronic acid Has a record of strong safety profile in both initial injection as well as repeat injections Who should not use Cingal? It is not advisable for the following to use Cingal: individuals with a known hypersensitivity to hyaluronic acid or to preparations containing triamcinolone hexacetonide, individuals with infections or skin diseases around the proposed injection site. Associated Side Effects: Common side effects may include pain, swelling, heat, itching, bruising or redness around the injection site. Reactions are generally mild and should not last long.

Although wrinkles can signify wisdom, or at least some level of maturity, there is no question that newly born infants also have wrinkles. The real concern that most of us have is that certain types of wrinkling are associated with the aging process. In our current “pop” culture, people do not view aging positively. Generally, the treatment of normal skin aging that does not result in a functional abnormality is termed “cosmetic.” Most cosmetic procedures are not covered by health insurance. Many products and procedures promise to reduce wrinkles. Some do little or nothing (like the products that claim they reduce “the appearance of fine lines,” which means that they don’t reduce the lines themselves). Others can achieve a fair amount of success. Although all of our skin ages, sun exposure dramatically enhances the rate at which this occurs. Changes brought on by sun damage (photoaging) include dry skin (really roughness), sagginess, skin growths like keratoses, lentigos (“liver spots”), and wrinkles. Just compare the skin on the face and neck of a poorly pigmented farmer to the skin of his buttocks. Most wrinkles associated with aging appear on the parts of the body where sun exposure is greatest. These sites are the face, neck, the backs of the hands, and the tops of the forearms. Wrinkles come in two categories: fine surface lines and deep furrows related to muscular contraction. Some deep furrows are anatomical in nature and have little to do with aging. Generally, it is only the aging wrinkles that really bother people. There are two basic approaches to the amelioration of these signs of aging: prevention and treatment. Topical wrinkle treatments are, in general, much more effective for fine lines. Deeper creases may require more invasive techniques, such injection of fillers, local muscle paralysis, or plastic surgery. There is a special form of wrinkling called “cellulite” that produces a “cottage cheese-like” appearance to the skin. Cellulite most commonly appears in the hips and buttocks of women and is due to fat deposition in certain anatomical areas in the dermis. What are risk factors and causes of wrinkles? Smoking Degree of natural skin pigmentation (more is better) Sun and ultraviolet exposure Heredity (some families wrinkle more) The loss of subcutaneous fat on a person’s body (people with more subcutaneous fat have fewer wrinkles) Some of these factors are beyond our control. The main preventive measures we can take are to minimize sun exposure and not smoke. These measures can, at best, delay wrinkles. Sun protection factor SPF numbers on sunscreen labels refer to protection against UVB radiation (the “sunburn rays”). Higher SPF numbers (50) are better at protecting the skin than lower numbers. Broad-spectrum sunscreens offer protection against UVB and UVA radiation (longer-wave ultraviolet light). UVA rays are abundant in sunlight and produced by tanning salon light bulbs; they may not cause immediate sunburn but do produce aging and an increase skin cancer risk over time. (Sorry, but there is no such thing as a “safe tan.”) Sunscreens that block UVA indicate this on the label and contain ingredients such as Parsol, Mexoryl, and benzophenones. Procedural options Glycolic acid peels: These superficial peels can make a very slight difference in the intensity of fine wrinkles. Deeper peels: These peels use ingredients like salicylic acid and trichloroacetic acid and penetrate somewhat deeper into the skin. Deeper peels do a better job of smoothing fine lines. The deeper the peel, however, the greater the risk of side effects such as long-lasting pigment changes (changes in the color of the skin) and scarring. Such peels may require anesthesia. Mild sedation helps ease short-term but intense discomfort. Microdermabrasion: This refers to “sanding the skin” with a machine containing silica or aluminum crystals; many estheticians offer this service, usually in “packages” of six or seven sessions. Microdermabrasion does not change skin anatomy, though it may make the face feel smoother. Cosmetic products marketed as “home microdermabrasion” are just mild exfoliants -- harmless but not likely to produce any meaningful change in wrinkles. Dermabrasion: This is a true surgical procedure, often performed under general anesthesia. The treating physician uses a rotating instrument to sand the skin down. Depending a great deal on the skill and experience of the operator, dermabrasion can result in excellent improvement but can also produce significant side effects, including scarring and permanent changes in skin color. Laser resurfacing: Using instruments such as the carbon dioxide and erbium lasers, physicians can achieve results similar to those of dermabrasion with greater reliability and precision. A medical professionals passes the laser several times over the area to be treated until the damage reaches the middle of the dermis, the skin’s second layer. This helps stimulate the body’s natural collagen synthesis (production), which plumps up sagging skin and wrinkles. Some dermatologists perform laser resurfacing under “conscious sedation,” in which the patient remains awake and receives intravenous medications to calm and ease pain. Doctors combine this sedation with the application of topical anesthetic creams such as EMLA, as well as injections of local anesthetics like lidocaine. Patients may need to repeat procedures to maximize improvement. Skin takes a long time to heal (weeks to months) after resurfacing. In addition, this procedure, like dermabrasion, can cause permanent pigment changes and scarring. Fractional resurfacing: Newer lasers work through a modification of traditional laser resurfacing. Treatments affect not the whole skin but instead only evenly spaced spots surrounded by undamaged skin. Healing is much faster than traditional resurfacing, with less “downtime” afterward. Patients may need several treatments to achieve full benefit. Non-ablative laser resurfacing: Newer lasers attempt to stimulate collagen synthesis under the skin without damaging the epidermis. Studies and clinical experience suggest that such procedures can improve fine wrinkles, though not as much as laser resurfacing. Several treatments may be necessary. These procedures are almost painless and there is little or no redness, peeling, or downtime afterward. Heat and radiofrequency: Another variation of noninvasive facial rejuvenation is to heat tissue using radiofrequency devices and infrared light sources. Techniques are still in development, but results to date suggest that such treatments are safe and can produce visible and lasting improvement, though not as much as surgical techniques like facelifts (rhytidectomy). Cosmetic surgery: Surgical facelifts, brow lifts, and similar operations can be very helpful for selected patients. Thread lift: In this procedure, a barbed, medical professionals insert a stiff thread into facial skin in the appropriate direction and the tissue is pulled to catch on the barbs, producing a lifted appearance. Whether or not the effect is sustained is controversial, but there is no doubt that in the short term there can be a modest cosmetic benefit using only a local anesthetic associated with minimal downtime. Botox: Injection of botulinum toxin, the muscle poison, can paralyze facial muscles that produce the “frown lines” on the forehead, fine lines around the eyes, and other wrinkles. Improvement lasts several months, and patients must have repeated injections to sustain improvement. Dermal Fillers: Medical professionals inject fillers into the skin to increase volume and flatten wrinkles and folds. In the past, the most popular filler was collagen. More recently, health care professionals use new filler substances such as hyaluronic acid (Restylane, Juvederm) and calcium hydroxylapatite (Radiesse), lactic acid (Sculptra), and autologous fat transplants because their effects can last six to nine months or even longer. Anyone considering any of the cosmetic procedures should be sure to consult doctors who have experience in one or several of these techniques. Patients should fully inform themselves about the risks and potential benefits of the procedure they are considering before going forward.

It can be painful if the procedure is carried out by injector who is not as skilled. Generally, basic dermal filler procedures require no anaesthetic as the dermal filler contains local anaesthetic. It is simple and straight-forward, involving a few tiny injections directly into the skin, and takes between 15-30 minutes. Make-up can be applied immediately after the procedure and you can go straight back to work. Result can be seen immediately. Optimal results can be maintained over a long period of time through regular repeated treatments. The procedure varies from person to person depending on your requirements and the severity of the wrinkles that are being treated, in addition to the particular dermal filler being administered. Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. The ever-expanding range of dermal filler products for aesthetic soft tissue augmentation is of benefit for patients and physicians, but as indications and the number of procedures performed increase, the number of complications will likely also increase. Objective: To describe potential adverse events associated with dermal fillers and to provide structured and clear guidance on their treatment and avoidance. Methods: Reports of dermal filler complications in the medical literature were reviewed and, based on the publications retrieved and the authors’ extensive experience, recommendations for avoiding and managing complications are provided. Results: Different dermal fillers have widely varying properties, associated risks, and injection requirements. All dermal fillers have the potential to cause complications. Most are related to volume and technique, though some are associated with the material itself. The majority of adverse reactions are mild and transient, such as bruising and trauma-related edema. Serious adverse events are rare, and most are avoidable with proper planning and technique. Conclusion: For optimum outcomes, aesthetic physicians should have a detailed understanding of facial anatomy; the individual characteristics of available fillers; their indications, contraindi- cations, benefits, and drawbacks; and ways to prevent and avoid potential complications. Keywords: aesthetic medicine, complications Introduction The popularity of dermal fillers has grown rapidly in recent years because they offer the rejuvenative and enhancing aesthetic improvements previously only achievable with surgery, but at lower cost and with limited-to-no recovery time. According to data from the American Society for Aesthetic Plastic Surgery (ASAPS), more than 1.6 million dermal filler treatments were performed in 2011, making them the second most popular nonsurgical cosmetic procedure performed in the USA after neuromodulators; the latter procedure is frequently performed in concert with dermal filler injections.1 As public awareness and acceptance of dermal fillers grows, so does the size of the market, with an estimated 160 products currently available worldwide from more than 50 companies. Their main indications are the filling of rhytides and folds, and correction of soft tissue loss due to disease or age.2 Increasingly, fillers are used for volume replace- ment and enhancement procedures,3 including cheek and chin augmentation, tear trough correction, nose reshaping, midfacial volumization, lip enhancement, hand rejuvenation, and the correction of facial asymmetry. As the indications and the number of procedures performed increase, the number of complications will likely also increase. Understanding the different characteristics, capabilities, injection techniques, risks, and limitations of available fillers is essential for injectors to reduce the risk of complications, improve patient outcomes, and care for patients who have experienced adverse events. This requires expert familiarity with the properties and potential complications of a wide range of products, including those that are not available in the injector’s country of practice, as patients may present with adverse reactions to fillers that were injected abroad. Particularly important is how the incidence of local adverse events following treatment is related to the injection tech- nique versus the chemical composition of the dermal filler.4 This review will provide physicians with a background to the etiology of filler-related complications, and structured and clear guidance on their treatment and avoidance. Categories of dermal filler Several methods of categorizing dermal fillers exist, but for a discussion of dermal filler complications it is perhaps most useful to categorize in terms of biodegradable (moderate and long duration) versus nonbiodegradable fillers, and in terms of particulate versus nonparticulate fillers (Table 1). Moderate duration biodegradable fillers, such as collagen and the hyaluronic acid (HA) fillers, are reabsorbed by the body quite quickly, so their cosmetic effects are relatively short-lived. HA derivatives are the most widely used biode- gradable fillers in both Europe and the USA,1,5 and generally have effects lasting 6–18 months depending on the source and extent of cross-linking and concentration and particle size of each product.6 HAs are linear polymeric dimers of N-acetyl glucosamine and glucuronic acid, which differ in the proprietary methods used to cross-link their dimers, their degree and method of chain cross-linking, the uniformity and size of their particles, and their concentration. These char- acteristics all have a significant impact on the clinical effect of these products. Increased cross-linking and concentration increase the viscosity and elasticity as well as the resistance to degradation by native hyaluronidase. The hydrophilic nature of HA means that the more concentrated and/or large particle products will tend to absorb more water, and thus produce more tissue swelling after injection. HA products are also characterized by the size of their microspheres. Biphasic fillers, such as Restylane®, Perlane®, and Macrolane® (all Q-MED, Uppsala, Sweden), contain a range of microsphere sizes. Monophasic HA products, such as Juvederm® (Aller- gan, Irvine, CA, USA), Belotero® (Merz Pharmaceuticals GmbH, Frankfurt, Germany), Teosyal® (Clarion Medical Technologies, Cambridge, ON, Canada), Prevelle Silk® (Mentor Worldwide LLC, Santa Barbara, CA, USA), and VariodermTM (Adoderm, Langenfeld, Germany), contain homogeneous microspheres and are the preferred HA of most other companies. The different HAs have varying degrees of hardness (G’), which will influence their suitability for a particular procedure. In general, the greater the G’ of the product, the deeper it should be injected. It should be noted that while more concentrated products with a greater degree of cross-linking have a longer duration of effect, they also increase reactivity in the body and thus the risk of inflam- mation and granuloma formation. Fillers with biodegradable particles that stimulate the body to produce its own collagen have a longer duration of effect; such products include calcium hydroxylapatite (CaHA; Radiesse®; Merz Pharmaceuticals GmbH) and poly-L-lactic acid (PLLA; Sculptra®; Valeant, West Laval, QC, Canada). CaHA consists of synthetic CaHA microspheres suspended in a carrier gel. Injection provides immediate visual improve- ment with long-term deposition of new collagen surrounding the microspheres, which contributes to an average duration of effect of around 15 months.7 PLLA is a synthetic polymer that provides soft tissue augmentation through stimulation of an inflammatory tissue response with subsequent collagen deposition.8 Each injection session with PLLA produces a gradual treatment effect and limited correction. Three injection sessions are generally required, but once the final correction is achieved, results last up to 2 years. The nonbiodegradable fillers provoke a foreign body reaction that stimulates a fibroblastic deposition of collagen around the nonabsorbable microspheres.9 Products in this cat- egory include polymethylmethacrylate (PMMA; Artecoll®; Rofil Medical International B.V., Breda, the Netherlands), the polyacrylamide hydrogel Aquamid® (Contura International, Soeborg, Denmark), and Silikon® 1000 (Alcon Laboratories, Inc., Fort Worth, TX, USA), a medical-grade pure form of silicone. PMMA consists of 80% bovine dermal collagen plus 20% PMMA microspheres. The collagen vehicle is degraded within 1–3 months, leaving the microspheres encapsulated by a fine fibrous capsule. Aquamid® is a hydrophilic polyacryl- amide gel composed of 97.5% sterile water bound to 2.5% cross-linked acrylamide polymer. A continuous exchange of fluid occurs between the hydrogel and surrounding tissue, which becomes Dermal fillers in aesthetics: adverse events and treatment approaches Table 1 Characteristics of commonly used fillers and their indications Human collagen Human collagen Purified bovine collagen with 0.3% lidocaine Purified bovine collagen with 0.3% lidocaine Specific uses Creases, wrinkles, scars and lip enhancement; 100,000 particles per mL. Smaller gel particle size (vs Restylane) used to correct thin superficial lines; 500,000 particles per mL. Deeper dermal filler with a larger gel particle size (compared to Restylane) used to fill deeper creases and more prominent facial lines; 10,000 particles per mL. Medium-depth facial lines. Contouring and volumizing facial wrinkles and folds. Juvederm Ultra 2 erases moderate lines (around lips, eyes). Juvederm Ultra 3 smooths wrinkles between nose and corner of mouth. Juvederm Ultra 4 is for severe folds and lines and for facial contouring. Juvederm Ultra XC is formulated with lidocaine. More highly cross-linked formulation for generalized facial volume enhancement and correcting deeper folds and wrinkles. Very high viscosity gel for restoring lost facial volume; eg, in cheeks. For fine superficial folds, including crow’s feet and perioral lines. For moderate to deep folds and lip contouring. For deep folds and lip and volume augmentation. Range of products for superficial lines to deep creases. Highly cross-linked. For superficial wrinkles such as perioral lines and rhytides. For moderate to deep wrinkles; for example, moderate nasolabial folds. For moderate to deep wrinkles (eg, deep nasolabial folds). For facial contouring (eg, cheeks and chin). Teosyal® range consists of different formulations which restore face volume and repair cutaneous depressions. Fine lines (around the nose, mouth, and frown area) and acne scars. Deeper lines and furrows. Zyderm 1 used for fine lines, wrinkles, and shallow scars. Zyderm 2 used for moderate lines, wrinkles, and scars. Deeper lines, wrinkles, and scars. Duration of results 6 months on average, with retreatment every 6–9 months As above As above Average treatment lasts about 4 months Lasts 1 year Lasts up to 18 months Lasts 12–18 months Lasts up to 12 months Lasts up to 12 months Lasts up to 12 months Lasts 6–16 months Lasts 6–12 months Lasts 6–12 months Lasts 6–12 months Lasts 6–12 months Lasts 6–9 months Lasts 3 months Lasts 3 months Lasts 3 months Lasts 3 months. The collagen fillers are not available in the United States (Continued) 297 Restylane Restylane Fine lines/Restylane Touch Restylane Perlane Captique Juvederm Ultra (2, 3, and 4) and Juvederm Ultra XC Juvederm Ultra Plus and Juvederm Ultra Plus XC Juvederm voluma Belotero Soft Belotero Basic Belotero Intense varioderm Emervel Touch emervel Classic emervel Deep emervel volume Teosyal range (Deep Lines, Global Action, Ultra Deep, First Lines, Meso, Touch Up, Ultimate) Cosmoderm Cosmoplast Zyderm Zyplast Q-Med/Medicis Q-Med/Medicis Q-Med/Medicis Genzyme/Inamed/ AllerganMentor Inamed/Allergan Inamed/Allergan Inamed/Allergan Merz Pharmaceuticals Merz Pharmaceuticals Merz Pharmaceuticals Adoderm GmbH/ Medical Aesthetics group Galderma Galderma Galderma Galderma Lifestyle Aesthetics Inamed corporation Inamed corporation Inamed corporation Inamed corporation Clinical, Cosmetic and Investigational Dermatology 2013:6 submit your manuscript | www.dovepress.com Dovepress Funt and Pavicic Dovepress Table 1 (Continued) Brand name Manufacturer Key component Biodegradable collagen stimulator products Specific uses Duration of results Lasts 1-2 years, effects develop gradually At least 1 year; average 12–15 months 1 year, but may be permanent At least 5 years Sculptra Radiesse Dermik aesthetic Merz Pharmaceuticals Poly-L-lactic acid Calcium hydroxyl-lapatite microspheres suspended in a carrier gel Contains PMMA enclosed in a solution of 3.5% collagen and 0.3% lidocaine 97.5% sterile water and 2.5% polyacrylamide Addresses lines and wrinkles and adds volume. Moderate to severe facial folds and wrinkles. Deeper wrinkles: collagen is absorbed, leaving PMMA to stimulate new collagen. Facial volume restoration and contouring. Nonbiodegradable products Artecoll Aquamid Rofil medical Contura Abbreviations: HA, hyaluronic acid; PMMA, polymethylmethacrylate microspheres; vs, versus. Dermal filler complications: avoidance and treatment All dermal fillers have the potential to cause bruising (Figure 1). Bruising is observed more frequently after injec- tion into the dermal and immediate subdermal planes using fanning and threading techniques.11 Less bruising is seen when materials are injected using the depot technique at the preperiosteal level. Bruising is treated with cold compresses after the procedure and vitamin K cream.12 For persistent staining, treatment with pulsed dye light (Vbeam® ; Syneron Candela, Irvine, CA, USA) or potassium titanyl phosphate (KTP) lasers may be effective; the light emitted from these is more precisely absorbed by hemoglobin than other colors. A number of steps can be taken to minimize bruising, including avoiding all blood-thinning medications starting 1 week prior to the procedure (aspirin, warfarin, dipyrida- mole, clopidogrel, nonsteroidal anti-inflammatory drugs [NSAIDs], fish oil, vitamin E supplements, St John’s Wort, garlic tablets, gingko biloba, and ginseng).13 Patients should be advised to stay out of the sun as long as bruising persists, and vigorous exercise should be avoided for the first 24 hours to avoid raising blood pressure. Fillers that incorporate lido- caine and epinephrine (adrenaline) may reduce the amount of postinjection bruising; the former improves the comfort of injection while the latter inhibits activation of eosinophils that play a role in bruising and cause vasoconstriction as the procedure proceeds. The patient’s head should be elevated throughout the procedure and remain so for 24 hours. Bruising can be further limited by use of the smallest gauge needle that can deliver the filler, a slow injection technique with small aliquots of product, use of blunt cannulas,14 and limiting the number of transcutaneous puncture sites. edema Short-term post-traumatic edema Some transient swelling in the immediate postprocedural period is normal and occurs with all dermal fillers. This type of edema occurs very shortly after injection and is related to injection volume and technique. Treatment and avoidance is as for bruising. The majority of cases of postinjection, trauma-related edema dissipate within 1 week. Antibody-mediated edema (angioedema) Dermal fillers are essentially foreign bodies, and some patients may develop hypersensitivity to injected products due to an immunoglobulin E (IgE)-mediated immune response (Type I hypersensitivity reaction). This may occur after initial or repeated exposure. IgE stimulates Clinical, Cosmetic and Investigational Dermatology 2013:6 298 submit your manuscript | www.dovepress.com Dovepress Dovepress Table 2 Types of dermal filler complication by onset of adverse Dermal fillers in aesthetics: adverse events and treatment approaches Figure 1 Bruising may be immediate or worsen over 3 days. closely monitored to make sure the edema is not a result of an infectious etiology. Rapidly progressing angioedema is treated as a medical emergency because of the risk of airway obstruction. Chronic angioedema refers to episodes that last more than 6 weeks. These cases are often difficult to treat and have a variable response to medication. Table S1 highlights the treatment steps recommended. Each step is added to the previous one if an inadequate response is obtained. Edema should be controlled with the smallest dose of oral steroids that is effective. One of the authors (DF) has had success in reducing the steroid dose with concurrent use of the leukot- riene receptor antagonist montelukast (Singulair® 10 mg per day [Merck & Co., Inc., Whitehouse Station, NJ, USA]). This agent binds with high affinity and specificity to the cysteinyl leukotriene binding sites. Nonantibody-mediated (delayed) edema Delayed hypersensitivity reactions are characterized by induration, erythema, and edema, and are mediated by T lymphocytes rather than antibodies. They typically occur 1 day after injection, but may be seen as late as several weeks after injection and may persist for many months.16,17 Delayed hypersensitivity reactions are nonresponsive to antihistamines. The allergen should be removed (Table S1). In the case of HA, this will involve treatment with hyaluronidase. Other fillers may require treatment with steroids until the filler resorbs, laser treatment, and/or extrusion.18 Excision is a last resort. event Early events (occurring up to several days post-treatment) Injection site reactions Erythema edema Pain/tenderness Bruising Itching Infection Erythema edema Pain/tenderness Acne papule formation Nodule/abscess Hypersensitivity Erythema edema Pain/tenderness Nonfluctuant nodules Lumps, asymmetries, contour irregularities caused by technique and placement errors Skin discoloration Redness Whiteness Hyperpigmentation Local tissue necrosis caused by vascular occlusion Delayed events (occurring from weeks to years post-treatment) Infection (atypical; eg, mycobacterial) Erythema edema Pain/tenderness Nodule/abscess Systemic responses to infection Biofilm Foreign body granuloma Varying from subclinical histologic changes to disfiguring nodules Migration of implant material Immune reactions Local and site of injection and generalized hyaluronidase treatment should be given to patients injected with HAs. The incidence of malar edema can be reduced by proper patient and filler selection, limiting filler volume, and by placing filler material deep to the malar septum at the immediate preperiosteal level.19 The authors strongly recom- mend the use of an HA when treating the infraorbital hollow so that hyaluronidase may be used to dissolve the material if adverse events occur. A filler of low elasticity and viscosity is preferred, as this limits lymphatic compression. In addi- tion, a filler may be placed at the immediate subcutaneous level superficial to the area prone to lymphatic obstruction. A material such as Belotero® Balance or Soft that does not cause a Tyndall effect when injected superficially should be used in small quantities. Superficial injection, if properly placed and limited in volume, should not result in malar edema. Persistent malar edema should be distinguished from overcorrection. Skin discoloration Erythema Immediately after injection, some skin redness is normal (Figure 5). If erythema persists for more than a few days, a hypersensitivity reaction is likely. Treatments for rosacea may be effective, including oral tetracycline or isotretinoin. A medium-strength topical steroid is advocated for persistent erythema. Long-term use of high-potency steroids should be avoided, as they may cause atrophy and telangiectasias. Lasers can be effective for the treatment of telangiectasias and erythema (for details of laser treatment, see Bruising section). Vitamin K cream is useful in accelerating resolu- tion of erythema in addition to facial bruising.22 Patients with rosacea have a higher risk of developing postinjection erythema and should be warned of this prior to beginning the procedure. a bleaching agent such as topical hydroquinone (2%–8%) and Retin-A (tretinoin) combined with daily full-spectrum sunscreen application. Chemical peels may also be used to treat resistant postinflammatory hyperpigmentation. If unsuccessful, the next step is treatment with IPL, a pulsed dye laser or fractional laser; the low fluence Q-switched Nd:YAG 1,064 nm laser is also effective. Current lasers have limited use in the treatment of Fitzpatrick skin types IV–VI, but the long wavelength Nd:YAG laser allows darker skin to be treated without disrupting natural skin color, and IPL systems can treat Fitzpatrick skin types I–IV. Limiting the number of skin punctures during the injection process by using the linear threading or fanning technique or injecting at the preperiosteal level may reduce postinjection erythema and therefore postinflammatory hyperpigmentation. Dyspigmentation When particulate HA fillers are inappropriately implanted into the superficial dermis or epidermis, a bluish hue may occur as a result of the Tyndall effect (scattering of light by particles in suspension). Blue light waves have a higher frequency than red and are more easily scattered, so that when a ray of light hits the skin’s surface, it is reflected in many different directions, with blue becoming the prominent color that emerges. This effect can occur with all particulate HA fillers, but does not appear to be caused by Belotero®, a monophasic polydensified nonparticulate gel.25 The more superficial the placement of material, the longer the duration of the discoloration. Hyaluronidase should be the initial approach to treatment. For HAs that are less susceptible to hyaluronidase because of a high degree of cross-linking or large particle size, multiple treatments may be necessary. As a last resort, dyspigmentation can be treated by nicking the skin with a small-gauge needle (30 gauge) or surgical scalpel (#11 blade) and expressing Abscess formation is a rare complication occurring any time from 1 week to several years after treatment; it may persist for weeks, and periodically recur for months. Abscesses should be treated with incision, drainage, and antibiotics. Cultures should be obtained. Treatment should then be tailored to the obtained sensitivity reports.28 Midfacial and periorbital infection can in rare cases result in intracerebral complications. Herpetic outbreak Dermal filler injections can lead to reactivation of herpes virus infections (Figure 7). If the treatment is targeting the lips or mouth area and the individual has a history of cold sores, prophylactic treatment with valaciclovir (500 mg twice daily [bid] for 3–5 days) can be started prior to injection to reduce the likelihood of this occurring. If the patient has not received prophylactic treatment, but infection is recognized early, valaciclovir at a dose of 2 g bid for 1 day should be given. If suprainfection occurs, the patient should be treated with appropriate antibiotics. The majority of herpetic recur- rences occur in the perioral area, nasal mucosa, and mucosa of the hard palate. Shingles after injection is very rare. When a blistering reaction occurs outside of the areas of recurrent herpes simplex virus infection (lip skin and vermillion, nasal mucosa, and mucosa of hard palate), vascular compromise should be seriously considered. Figure 7 Dermal filler injection leading to herpes virus reactivation. Clinical, Cosmetic and Investigational Dermatology 2013:6 Nodular masses Nodules are frequently observed after soft tissue augmentation. As they can arise from a number of causes, investigation may be required to establish a diagnosis. Visible material is more common in areas of thinner skin. Nodules must be categorized as inflammatory or noninflammatory. Noninflammatory nodules When too much material accumulates in an area as a result of poor technique (overcorrection, too superficial placement of a filler, or use of a filler for an incorrect indication such as intramuscular placement in a sphincteric muscle; Fig- ure 8), a noninflammatory nodule may result that is palpable and may be visible. Such implant nodules form isolated lumps in the area of injection that do not grow, and which are well defined from the surrounding tissue. They appear early after the procedure and should be differentiated from foreign body granulomas, or biofilms, which are a result of an inflammatory reaction around the product or site of infection and occur later. Poor filler placement and the use of particulate fillers (eg, PMMA, CaHA) in highly mobile areas such as the lips can cause delayed-onset noninflam- matory nodules.29 Implant nodules are one of the most common adverse events following dermal filler procedures,33 but their inci- dence can be reduced by taking care to avoid too superfi- cial placement of filler, selecting the appropriate filler for the tissue site, massaging after injection to ensure even distribution and smoothness, and avoiding intramuscular injection. Inflammatory nodules Biofilms Biofilms are widespread in nature and consist of densely packed communities of bacteria that surround themselves with secreted polymers. When a material is injected into the skin or subcutaneous tissue, it can become coated with bacteria and form a biofilm. These complex collections of bacteria secrete a protective and adhesive matrix that allows them to irreversibly adhere to a living structure or inert surface, where they give rise to a low-grade chronic infection that is resistant to antibiotics.34,35 A mature biofilm will release individual free-swimming bacteria in the tissues. Many bacterial species form biofilms, and as biofilms progress they become more antibiotic and culture resistant. When activated, for example by trauma from a further dermal filler procedure, the biofilm can cause a local infection, a systemic infection, or a granulomatous or inflammatory response. Distinguishing inflammation due to a bacterial biofilm from a low-grade hypersensitivity reaction is difficult. Furthermore, these infections are difficult to treat, and so the focus should be on prevention. If a red, indurated area appears at any time after treatment, regardless of duration, a biofilm should be suspected.36,37 Persistent infla estylane®. 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Taylor SC, Burgess CM, Callender VD. Safety of nonanimal sta- bilized hyaluronic acid dermal fillers in patients with skin of color: a randomized, evaluator-blinded comparative trial. Dermatol Surg. 2009;35 Suppl 2:1653–1660. 24. Heath CR, Taylor SC. Fillers in the skin of color population. J Drugs Dermatol. 2011;10(5):494–498. 25. Pavicic T. Efficacy and tolerability of a new monophasic, double- crosslinked hyaluronic acid filler for correction of deep lines and wrinkles. J Drugs Dermatol. 2011;10(2):134–139. 26. Hirsch RJ, Narurkar V, Carruthers J. Management of injected hyaluronic acid induced Tyndall effects. Lasers Surg Med. 2006; 38(3):202–204. 27. Douse-Dean T, Jacob CI. Fast and easy treatment for reduction of the Tyndall effect secondary to cosmetic use of hyaluronic acid. J Drugs Dermatol. 2008;7(3):281–283. 28. Rousso JJ, Pitman MJ. Enterococcus faecalis complicating dermal filler injection: a case of virulent facial abscesses. Dermatol Surg. 2010; 36(10):1638–1641. 29. Sclafani AP, Fagien S. Treatment of injectable soft tissue filler complications. Dermatol Surg. 2009;35(Suppl 2):1672–1680. 30. Voigts R, Devore DP, Grazer JM. Dispersion of calcium hydroxylapatite accumulations in the skin: animal studies and clinical practices. Dermatol Surg. 2010;36(Suppl s1):798–803. Clinical, Cosmetic and Investigational Dermatology 2013:6 31. Vrcek IM, Malouf P, Gilliland GD. A novel solution for superficially placed calcium hydroxylapatite (Radiesse) in the inferior eyelid. Orbit. 2012;31(6):431–432. 32. Reddy KK, Brauer JA, Anolik R, et al. Calcium hydroxylapatite nodule resolution after fractional carbon dioxide laser therapy. Arch Dermatol. 2012;148(5):634–636. 33. Heinz BC, Ladhoff U, Kahl Ch, Rzany B, von Mallek D. [Survey of incidents associated with injectable dermal fillers reported to the German Medical Devices Vigilance System]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008;51(7):787–792. German. 34. Christensen LH. Host tissue interaction, fate, and risks of degrad- able and nondegradable gel fillers. Dermatol Surg. 2009;35 Suppl 2: 1612–1619. 35. Monheit GD, Rohrich RJ. The nature of long-term fillers and the risk of complications. Dermatol Surg. 2009;35 Suppl 2:1598–1604. 36. NarinsRS,ColemanWP,GlogauRG.Recommendationsandtreatment options for nodules and other filler complications. Dermatol Surg. 2009;35 Suppl 2:1667–1671. 37. Dayan SH, Arkins JP, Brindise R. Soft tissue fillers and biofilms. Facial Plast Surg. 2011;27(1):23–28. 38. Bjarnsholt T, Tolker-Nielsen T, Givskov M, Janssen M, Christensen LH. Detection of bacteria by fluorescence in situ hybridization in culture-negative soft tissue filler lesions. Dermatol Surg. 2009;35 Suppl 2:1620–1624. 39. Grippaudo FR, Pacilio M, Di Girolamo M, Dierckx RA, Signore A. Radiolabelled white blood cell scintigraphy in the work-up of dermal filler complications. Eur J Nucl Med Mol Imaging. 2013;40(3): 418–425. 40. 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Avoidance Differential diagnosis Ice or cold compresses Persistent Edema Oral or injected antihistamines Oral or intravenous corticosteroids Nonsedating antihistamines Sedating antihistamines Oral corticosteroids and/ or immunosuppressants Antibody-mediated

Today’s dermal fillers have come a long way since the first-generation of collagen injections. Advanced injection techniques, coupled with the use of micro-cannula (blunt needle) and improved product safety means that significant side effects are extremely uncommon but may include: Injection-related reactions: these reactions may include redness at the injection site immediately after the treatment. Bruising: occasionally bruising can occur. However the use of micro-cannula (blunt needle) dramatically reduces the risk of bruising. Contour irregularities can and do occasionally occur. Massaging can usually smooth out any ‘lumpiness’ however if persistent the filler can be easily and rapidly dissolved. Infection – as with all injections, this procedure carries a risk of infection. The syringe is sterile and standard precautions associated with injectable materials are taken. Necrosis – one of the worst possible complications of dermal filler. Fortunately, this is extremely rare. It happens when the dermal filler is accidentally injected into a blood vessel and it subsequently blocks the blood supply to the skin/tissue in that area. Blindness – This is a very rare complication. There have been approximately 100 cases in the world and is caused by injecting dermal filler into blood vessel which has a connection with the artery which supplies blood and oxygen to the eye. There is no treatment so far for this that has been successful.

After your treatment we will again go through with you any after care advice in order to maximise your treatment benefits and avoid any undesirable side effects. You can resume normal activities, drive yourself home or return to work immediately after the treatment. As with any type of injection there may be some slight redness immediately afterwards. Camouflage make up may be applied. The results directly after the treatment should therefore not be seen as the final results. This is because over the following 2 weeks the results will gradually improve. For 2 weeks after the treatment you are advised to avoid extreme heat (sun bed or sunbathing) or intense cold.

Typical areas that can be treated are: Nasolabial lines or folds, which run from each corner of the nose to the corner of the mouth. Smile lines appearing on the cheeks. Lip plumping is an extremely popular request by growing number of women purely looking to enhance their natural appearance, as opposed to an anti-ageing solution. Cheek Volumising can create improved definition of the face that is lost over the years through the ageing process, giving sunken or flat cheeks. As we get older our facial bones shrink causing skin folds to appear. Building up our cheek bones using dermal fillers such as Juvéderm or Sculptra is an effective way of combating these imperfections. Deep forehead wrinkles, frown and crow’s feet can be treated using dermal fillers, however many patients with fine wrinkles are best treated using Botox. Wrinkled hands are often the most likely visible sign of ageing and difficult to conceal. Juvéderm Hydrate revitalises hands for a more youthful appearance. Juvéderm Hydrate is not a dermal filler or volumiser, but a treatment specifically designed to improve skin hydration and elasticity in the face, neck, décolletage, and hands. It effectively replenishes depleted levels of hyaluronic acid in the skin to restore a natural, healthy glow.

Filler How long it lasts Collagen 2 to 3 months (often longer when treating scar) Hyaluronic acid gel 4 to 12 months Calcium hydroxylapatite 6 months to 1 year Poly-L-lactic acid 1 to 3 years Fat taken from your body 1 to 3 years (often longer when treating a scar) PMMA (polymethylmethacrylate) Permanent

Dermal fillers are FDA approved to last a certain amount of time. It is important to know what area the FDA indication and approval is for. For example, most of the older generation fillers such as Juvederm® or Restylane®, were given FDA approval for treatment of the nasolabial folds. However, most injectors use fillers for other areas of the face, and that is considered off-label injecting, due to the fact the filler is being injected into an area that was not studied in the clinical trials. Some fillers have multiple indications for different areas of the face. The reason it’s important to know the area of the face that received the FDA approval, is because that particular area of the face is the area that was studied in the clinical trials. For example, if a filler is FDA approved to last up to 1 year in the nasolabial folds, its important to look at how many syringes were injected in order for it to last 1 year, and the area of the face the filler was injected into. Because we talk and move our mouths multiple times a day, typically filler around the mouth or in the lips doesn’t last as long as filler in the upper face. Most hyaluronic acid fillers are FDA approved to last up to 1 year with optimal correction. (Optimal correction means placing the right amount of syringes into a certain area and not under correcting the area). Non-hyaluronic acid fillers are more permanent and tend to last longer. Some non-hyaluronic acid fillers are FDA approved to last 3-5 years with optimal correction. However, it is important to note that long term fillers come with more potential side effects and long term complications.

There are many different fillers that are FDA approved and with all the new technology related to non-invasive aesthetics, the field is constantly changing and improving. With these improvements, there seems to be a new dermal filler on the market every 3-6 months. It can be a daunting process to keep up with them all. However, each filler has a different molecule size, as well as make-up. Although they look similar in consistency in the syringe, when placed under a microscope, it is easy to see the granular changes, as well as the molecular size changes related to each filler. Depending on the area being injected, as well as the results that are desired by the patient, Dr. Vigo can choose the appropriate filler for you. He uses many different fillers to achieve the result that is best for the patient. For example, when injecting the cheeks or the jawline, a larger molecular filler is required in order to replace volume in those areas. However, around the mouth for perioral lines, he uses a soft, small molecule filler to give the patient a reduction in lines without causing the mouth to have a “blown up” or overdone appearance.

The most common side effects after dermal filler treatment is swelling and bruising. Typically swelling lasts for about 72 hours and bruising can be present for up to a week typically. In order to have less bruising before your dermal filler appointment, we suggest taking the herbal drug Arnica Montana prior to treatment as well as a few days after treatment. It is also important to avoid anti-inflammatory drugs such as ibuprofen, advil, etc. Some herbal vitamins also can thin the blood and should be discontinued prior to treatment. It’s important to discuss this with Dr. Vigo at your consult in order to avoid as much bruising as possible.