Dermal fillers are minimally invasive mainstay cosmetic treatments used to help return the appearance of volume and youth to ageing skin. Volume deficiency, scars, wrinkles, lip augmentation (plumping), facial sculpting and contouring are common facial concerns targeted by dermal fillers.
This guide will tell you everything you need to know about them: how they work, the choices of products on the market, and their possible side effects on your body and skin.
What are dermal fillers?
Before starting on dermal fillers, we need a brief understanding of how the face changes as we age. Over time, the thickness and elasticity of our skin decreases, and our faces loses fat. Soft tissues sag, facial muscles weaken, and the outermost layer of skin wrinkles.
Enter fillers. Dermal fillers help restore lost volume to your face and add lift.
Types of dermal fillers
The classifications of dermal fillers vary according to their properties. Fillers are categorized based on their biodegradability, how long it takes before the filling substance is absorbed by the body, and the duration of a treatment’s effect.
Early attempts to use fillers for facial rejuvenation relied on dermal fat or collagen fillers. However, the effectiveness of fat as a filling agent was risky as a number of variables were involved. These included the method and type of fat harvested, both of which could cause inconsistent absorption rates by the body. There could also be significant side effects including prolonged swelling, internal bruising and cause infections. Bovine (cattle) collagen, the first collage filler used, also had limited success due to its short duration of effect (3-4 months) and potential risk of allergic reaction.
Human-based collagen has since been developed but demand for collagen remains low compared to more effective filling agents.
These are fillers that provide temporary or semi-permanent effects as they gradually degrade and get absorbed by the body. Common biodegradable fillers are collagen, hyaluronic acid, calcium hydroxyapatite and poly-L-lactic acid.
Naturally present in our skin and connective tissues, hyaluronic acid is a key structural component that stabilizes cellular structures and binds collagen and elastic fibers. Hyaluronic acid remains as the most widely used dermal filler due to its ease of use, safety and minimal side effects.
When hyaluronic acid is injected into the skin, it combines with the natural hyaluronic acid found in our body. Due to its hygroscopic nature (ability to absorb water from surroundings), hyaluronic acid binds to water quickly, creating volume that lasts for 6 to 12 months before degrading into the body. It also induces new collagen formation, a desirable quality as our bodies gradually stop producing collagen in our late twenties.
Poly-L-lactic acid (PLLA)
A synthetic, biodegradable polymer of the alpha-hydroxyl-acid family (natural acids found in food), poly-L-lactic acid (PLLA) is another common filling agent. Its safe profile enables PLLA to be actively used in other medical applications such as in dissolvable stiches or soft tissue implants.
PLLA triggers mild inflammation to promote the formation of collagen and tissue fibers. The accumulation of collagen creates volume at the site of injection. Over time, PLLA breaks down into lactic acid and is metabolized to carbon dioxide or incorporated into glucose molecules.
Calcium hydroxylapatite (CaHA)
CaHA is a synthetic compound with a chemical structure that resembles a component found in our bones and teeth. Treatment with CaHA is safe and will not cause allergic reactions. When injected into skin tissues, our body gradually absorbs CaHA, inducing new collagen to be produced. Such an effect typically lasts about 15 months or longer.
CaHA breaks down into calcium and phosphate ions before finally being excreted by the body.
Injecting silicone into the face adds volume directly and immediately and also triggers collagen production that adds to the effect. Silicone is favoured for its stable chemical structure, ease of use, low cost, and long-lasting effects. As a non-biodegradable filler, silicone stays in your body once it is injected.
However, the use of silicon in cosmetic treatments is controversial due to its potential to cause long-term complications such as abnormal swelling, blindness or nerve damage. Issues can also arise from poor injection technique, the amount of silicone used and differences in silicone grades. For these reasons, it is strongly recommended you get your fillers done only by a trained dermatologist.
Warnings and alternatives
Administered professionally and with the proper technique and expertise, a dermal filler comes with minimal side effects. However, with many different rejuvenation treatments available, it’s important you consult a trusted dermatologist for a professional assessment before commencing treatment.
For those who prefer plumping effects without an injection, go for Dr TWL’s Hyaluronic Acid serum. As a skincare ingredient, hyaluronic acid draws moisture from its surroundings and keeps the skin well-hydrated; it is able to hold over 1,000 times its own weight in water. This gives a desirable plumping effect and improves fine lines and wrinkles without the needles.
© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.
Meet with Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr Teo, call us at +65 6355 0522, or email firstname.lastname@example.org. Alternatively, you may fill up our contact form here.
Any detailed research you may have done about the skin would have returned you with the term ‘skin barrier’, or in scientific terms the ‘stratum corneum barrier’. You may be aware of how important the skin barrier’s function can affect the condition of the skin, but how exactly does the skin barrier work?
Skin hydration and the stratum corneum barrier has been active areas of study for many years. Yet, consumers are only beginning to get their interest piqued about the skin barrier, largely due to many marketing techniques. Before you commit to any product or treatment that promises to ‘repair’ the skin barrier, have a read on what these terms and processes mean.
The stratum corneum barrier
The skin barrier prevents foreign material from entering the human body. But it does more than just that. It also prevents water loss and serves as a shield against environmental factors. The barrier works to maintain the body’s homeostasis (or stable equilibrium) level. The loss of water from the body through evaporation from the surface of the skin is common, thus a need to keep our corneocytes hydrated.
Corneocytes are the cells found in the stratum cornum layer, that is the outermost layer of the epidermis. These cells are formed through cornification, where the skin cells develop tough protective layers or structures, creating a physical barrier for the skin. When deprived of water, dry skin may be more prone to crack open at stress.
The environment’s humidity also affects the corneocytes. As the level of humidity can vary, corneocytes get their source of hydration from the body, in order to maintain equilibrium with the environment. This may explain why our skin feels drier in winter. The skin battles harsh winds, depleting the skin’s moisture layers.
Skin hydration is an important factor when considering how to attain healthy skin. We look at the stratum corneum’s water content when analyzing skin hydration, with healthy skin containing more than 10 per cent water.
A mixture of water-soluble compounds called natural moisturizing factor (NMF) have been found to affect water content levels. The arrangement of lipids (fats) in the stratum corneum is also important, as it serves as an effective barrier to the passage of water through the layer. A poor arrangement can lead to transepidermal water loss (TEWL). TEWL is essentially when water diffuses and evaporates from the skin surface. Even though this is a natural process, excess TEWL is undesirable as it can lead to many unwanted skin conditions.
TEWL and Moisturizers
TEWL has been one of the most commonly used methods in the skin care industry to measure skin hydration as it directly correlates with skin barrier dysfunction. Healthy skin would score a low TEWL value as it would mean less water loss.
In the same vein, most moisturizers are put to the test by using TEWL values. A good moisturizer should help decrease TEWL. Moisturizers have remained as a ‘staple’ in basic skincare. Yet, not many may fully understand its function, thus some are unable to choose a suitable moisturizer for their skin needs. An effective moisturizer should protect the skin by stimulating and augmenting its natural barrier function, whilst catering to the skin’s requirement for moisture. Environmental attacks on the skin are also shielded with a proper moisturizer which can slow down skin ageing.
What happens if the water content of the stratum cornum falls below a desirable level? Normal desquamation is not able to take place, that is the shedding of the outermost skin layer. With insufficient hydration, skin cells will adhere to one another and accumulate on the surface layer. Visible changes associated with this phenomenon include dryness, roughness, scaling and flaking.
Certain cosmetic ingredients have become a cult favourite in recent years by targeting the stratum cornum water content, such as glycerol (also known as glycerin) and hyaluronic acid.
This ingredient exists in the stratum cornum as a natural endogenous humectant. It has shown that changes in the stratum cornum’s water content correlate with the glycerol content in the layer. Such results have driven the development of glycerol-containing moisturizers. Check the ingredient list of your moisturizer, this star ingredient should appear in any effective moisturizer.
Though it is known as a major component of the dermis (deeper layer of the skin), hyaluronic acid is also found present in the outermost layer. It plays an important role in regulating the skin barrier function and hydration. Although the skin care industry may recognize hyaluronic acid as a powerful humectant (attracts water to hydrate the skin), this molecule also participates in cellular functions. Hyaluronic acid influences cell-cell interactions that lead to normal structure of the skin barrier.
Though the mechanisms for skin hydration remain complex, a simple understanding about the skin structure and function is crucial when looking for an appropriate product or treatment. With these complex terms tackled, you are now one step closer to understanding your skin and its needs. If your current skincare routine does not yield desired results, you can consider cosmeceuticals as the alternative. A combination of ‘cosmetics’ and ‘pharmaceuticals’, cosmeceuticals are products with bioactive ingredients that can bring pharmaceutical effects to the skin barrier and health.
© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.
Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email email@example.com. Alternatively, you may fill up our contact form here.