Dermal Filler The Art Of Facial Rejuvenation

Dr Mark Morunga

 About Dermal Fillers-Hyalronic Acid Gel Filler​

• Around the eyes – reduce the appearance of tired and sullen looking eyes, reduce the black circles on your eyes, address the tired appearance caused by the ageing process.
  
• Cheeks – recreate the volume of a youthful cheek, reduce the appearance of the ageing process, create stronger defined cheekbones, address volume loss or sagging cheeks.
• Nose – shape or correct mis-shapen noses.
• Temples – hollow temples are a tell-tale sign of ageing and treating this volume loss can produce a subtle but beautiful face-lift type result. Filling the temple area is also a popular treatment for creating balance and symmetry in the face.
• Naso-labial Folds – reducing the line/fold from the nose to the corners of the mouth.
• Jowls/Chin – reducing the jowling of skin at the jaw, softening the appearance of lines/fold from the corners of the mouth to the jaw, shaping the chin or creating structure/balance/symmetry, beautifying the face by addressing the nose-to-chin angle.
• Marionette lines – the radiating lines from the corners of the mouth. Sometimes referred to as smile lines. These delicate fine lines can often exaggerate the ageing process. This subtle treatment can literally take years off your appearance!

Why Use Dermal Fillers

1 Understanding Where Wrinkles Form Your skin consists of two layers known as the epidermis and the dermis. The epidermis, or outer layer of the skin, acts as the skin’s primary defense against the environment. The dermis, or innermost layer of the skin, is composed primarily of connective tissue and provides the skin with a support network. Most facial wrinkles and deeper nasolabial folds occur within the dermal layer of the skin.

2 Our Skin’s Natural Moisturizer Hyaluronic acid (HA) is a naturally occurring molecule. Much like a sponge, its primary function is to bind and absorb water, which creates volume in the face. In this way, Hyaluronic acid can be thought of as the body’s internal moisturizer. But, as we age, HA diminishes, which contributes to the presence of lines and folds. Juvederm ® injectable gel works to correct this by restoring hyaluronic acid in your skin, helping to diminish wrinkles and nasolabial folds.

3 Experiencing Rejuvenation Juvederm® dermal filler is a nonsurgical, physician-administered treatment for nasolabial folds and other facial wrinkles. Using a fine needle, your healthcare professional eases Juvederm® under the skin to fill the soft tissue of the dermis. This adds volume and diminishes the appearance of wrinkles and nasolabial folds instantly.

While there are a variety of hyaluronic acid fillers, Juvederm® is uniquely formulated. A next generation HA filler, Juvederm ® uses a manufacturing process called HYLACROSS™ technology. HYLACROSS™ gives Juvederm® its special smooth-gel structure that holds up over time.

Health and Safety Information

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Juvederm® Safety Considerations
With any cosmetic treatment, safety is the first concern. As always, it’s important to consult with your doctor before deciding on a wrinkle treatment. Because Juvederm® injectable gel is a non-surgical, in-office treatment, most patients experience minimal recovery and downtime.
Juvederm ® and Juvederm ® XC Side Effects Juvederm ® XC injectable gel is generally well tolerated. Most side effects are mild to moderate in nature and their duration is short lasting (7 days or less). The most common side effects include, but are not limited to, temporary injection site reactions such as redness, pain/tenderness, firmness, swelling, lumps/bumps, bruising, itching, and discoloration. As with all skin injection procedures, there is a risk of infection.
Hyaluronic acid fillers are generally biocompatible, which means allergy skin testing is not required prior to treatment.


Allergies If you're considering treatment with Juvederm® injectable gel, your healthcare professional should ask about your medical history to determine if you are an appropriate candidate for treatment. Juvederm ® injectable gel for facial wrinkles and folds should not be used in patients who have:

• Severe allergies marked by a history of anaphylaxis or history or presence of multiple severe allergies
• A history of allergies to gram-positive bacterial proteins
• Juvederm ® should not be used in patients with a history of allergies to lidocaine.

 
Post-treatment Considerations Your healthcare professional will tell you what to expect following treatment with Juvederm ® injectable gel. You should ask your healthcare professional when makeup may be applied after your treatment.
You should avoid the following for at least 24 hours after treatment:

• Strenuous exercise
• Consumption of alcoholic beverages
• Extended exposure to sun or heat

Exposure to any of the above may cause temporary redness, swelling, and/or itching at the injection sites. If there is swelling, you may need to place an ice pack over the swollen area

Other Considerations In addition, you and your healthcare professional should discuss the following important treatment considerations in order to help avoid unsatisfactory results and complications when using Juvederm ® injectable gel:

Persons of Color Juvederm® is the first FDA approved hyaluronic acid dermal filler with demonstrated safety and effectiveness in persons of color.

• Patients who are using substances that can prolong bleeding, such as aspirin or ibuprofen, as with any injection, may experience increased bruising or bleeding at the injection site. You should inform your healthcare professional before treatment if you are using these types of substances.
• If laser treatment, chemical peeling, or any other procedure based on active dermal response is considered after treatment with Juvederm ® injectable gel, there is a possible risk of an inflammatory reaction at the treatment site.
• Juvederm ® injectable gel should be used with caution in patients on immunosuppressive therapy, or therapy used to decrease the body's immune response, as there may be an increased risk of infection.
• The safety of Juvederm ® injectable gel for use during pregnancy, in breastfeeding females, or in patients under 18 years has not been established.
  


• The safety of Juvederm ® injectable gel hyaluronic acid dermal filler in patients with a history of excessive scarring (eg, hypertrophic scarring and keloid formations) and pigmentation disorders has not been studied.
• Your healthcare professional should also warn you that the safety and effectiveness of Juvederm ® injectable gel for the treatment of areas other than facial lines and facial folds (such as lips) have not been established in controlled clinical studies. Allergan New Zealand Limited, Auckland.
  

Restylane® is a gel containing hyaluronic acid an lidocaine that is injected by a healthcare professional into or below the skin to smooth facial wrinkles and enhance lips by restoring volume and fullness. 

• Do not inject into blood vessels as this may lead to a lack of blood supply to the skin and ulceration and scarring.  Do not use in patients with known hypersensitivity to lidocaine o to amide-type local anaesthetics.  Restylane should not be used in or near sites where there are active skin disease, inflammation or infection, or where a permanent implant has been placed.
• Do not use in patients with bleeding disorders or in those who are taking thrombolytics or anticoagulants and caution when using in patient taking other medicines which prolong bleeding times. 
• Use with caution when treating facial areas with limited soft tissue support of cover such as the periorbital area.  Treatment benefits are instant, do not affect facial expression and result usually last 6-12 months.  Ongoing treatments are needed to maintain best results.
• After a Restylane treatment, patient may experience some degree of redness, swelling, pain or tenderness, itching and/or bruising which may only last a few day.  Inflammatory reactions may occur up to 2-4 weeks after treatment in rare cases. 
• Other adverse effects may include allergy, infection granuloma formation, persistent discolouration at the injection site, and ulceration of the skin.  Exposure to excessive sunlight or extreme cold should be avoided until redness or swelling has resolved.
• Use with caution before or after laser treatment or chemical peel.  Restylane has not been tested in pregnant or breast-feeding women.  Galderma, Auckland.  Distributed by Healthcare Logistics, Auckland.
  

In New Zealand Dermal Fillers are categorized as Medical Devices and have WAND Notification status.