Procedure

Dermal Filler Injection

search

Dermal Filler Injection, Dermal Filler, Collagen Filler, Cosmoplast, Hyaluronic Acid Filler, Restylane, Perlane, Juvederm, Calcium Hydroxylapatite Filler, Radiesse, Poly-L-lactic Acid Filler, Sculptra

  • See Also
  1. Skin Cosmetic Procedure
  2. Botulinum Toxin Injection
  • Indications
  1. Lip enhancement
  2. Facial Wrinkles and folds in lower two thirds of face
    1. Nosolabial folds (old FDA approved use)
    2. Oral commissures
    3. Marionette lines (long vertical lines around the chin)
  • Mechanism
  1. Injectable substances that increase soft-tissue volume for 3-24 months
  • Dosing
  1. Injection of 1-2 ml into Dermis
  2. One treatment per 3 to 24 months (depending on filler injected)
  • Medications
  1. Collagen Filler (original filler introduced in the 1980s)
    1. Collagen derived from animals, and dissolves over time
    2. Increased risk of local and Allergic Reactions (largely replaced in U.S. by other products)
    3. Products
      1. Cosmoplast (Allergan Inc) lasts 3-4 months
  2. Hyaluronic Acid Filler (most commonly used as of 2024)
    1. Retains moisture and is reversible
    2. Products
      1. Restylane and Perlane (Medicis Aesthetics) each last 6-9 months
      2. Juvederm (Allergan Inc) lasts 9-12 months
  3. Calcium Hydroxylapatite Filler
    1. Mineral is similar in composition to bone
      1. Stimulates local Collagen production
    2. Products
      1. Radiesse (Bioform Medical Inc) lasts 12-18 months
  4. Poly-L-Lactic Acid (Polylactic Acid) Filler
    1. Biodegradable synthetic product used for deep Wrinkles
    2. Products
      1. Sculptra (Dermik Lab) lasts 12-24 months
  5. Polymethacrylate (or polymethylmethacrylate, PMMA)
    1. Polymer Filler is hard, stiff and brittle, and permanently retained within skin
    2. Similar products are used in plexiglas or lucite
    3. Used for nasolabial folds ("smile lines")
    4. Products
      1. Bellafill (composite with bovine Collagen)
  • Adverse Effects
  1. Local, mild, transient effects
    1. Ecchymosis
    2. Local edema
  2. Vascular Injection (serious)
    1. Tissue Necrosis
      1. Occurs when filler is injected into skin vessels
    2. Blindness
      1. Occurs with filler injection into periocular vessels
  3. Infections
    1. Cellulitis or wound abscess
    2. HSV Outbreak
  • Efficacy
  1. Advantages
    1. Results are immediate
  2. Disadvantages
    1. Swelling and Bruising after the procedure
    2. Very operator dependent with the best outcomes with the most experienced clinicians
  • Management
  • Wounds containing Filler
  1. Indications
    1. Patient presents for wound management (e.g. Laceration) to a region containing filler
  2. Filler effects on open wounds
    1. Leakage of filler is non-toxic
    2. Filler does not interact with Local Anesthetic, but may limit Anesthetic volume injected
    3. Inquire about the type of filler used and when it was placed
      1. Avoid massage of wounds with recent filler placement, or with botox injection
  3. Wound Repair technique
    1. Irrigate wounds as normally performed to prevent infection
  4. Prophylactic Antibiotic indications
    1. Prophylactic Antibiotics are not typically recommended
    2. Antibiotics may considered if they would be used in non-filler patients
  5. Disposition
    1. Follow-up with plastic surgeon who originally placed the filler
    2. Expect scarring in the region of the wound
  • References
  1. Lin and Salim (2024) Dermal Filler, EM:Rap, 10/14/2024, accessed 10/31/2024
  2. Small (2009) Am Fam Physician 80(11): 1231-8 [PubMed]
  3. Wise (2006) Facial Plast Surg 22(2):140-6 [PubMed]