What Doctors Don’t Tell You about the Long-Term Effects of Using Facial Dermal Fillers

The Merriam-Webster dictionary defines beauty as “the quality or aggregate of qualities in a person or thing that gives pleasure to the senses or pleasurably exalts the mind or spirit”. Everyone wants to be attractive and pleasing to look at. In our society today, people turn to various ways and methods to ‘up’ beauty. While some try to do a new hairstyle, get a new wardrobe or invest in some expensive jewelry, others resort to cosmetic surgeries. Surgical procedures like a butt lift, cheek lift, breast augmentation, or even the less invasive ones like injectable fillers are the order of the day. Without a doubt, Botox and fillers have completely revolutionized the way people look. Over-the-counter skincare products can only do so much in terms of decreasing wrinkles and providing smoother, younger-looking skin. This is why some people use dermal fillers.

Lip Filler Before After

Lip Filler Before After

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What are fillers?

Fillers, otherwise known as dermal fillers, are injectibles that smoothen out wrinkles on the face. They are gel-like compounds that are injected beneath the skin to improve facial features, smooth out wrinkles, and restore lost volume. People are looking for procedures to reduce the appearance of crow’s feet as well as to bulk up their lips, hands, and cheeks. Because dermal fillers provide the rejuvenating and enhancing cosmetic advantages previously only possible with surgery, but at a cheaper cost and with little to no recovery time, their popularity has increased dramatically in recent years. According to statistics from the American Society of Plastic Surgeons, the number of filler operations alone performed in the United States increased dramatically from 1.8 million in 2010 to 2.6 million in 2016.

Types of fillers

Fillers are made from different kinds of materials. They are categorized into temporary, semi-permanent, or permanent depending on how long a filler stays in tissue. They can also be classified as biodegradable and non-biodegradable. The composition of the product is also significant. They are:

  1. Hyaluronic acid: Also known as HA is a naturally occurring chemical found in both animals and humans, it also has hydrophilic properties. Because of this, HA filler materials can significantly enhance soft tissue following injection. HA is a short-term injectable filler that can last up to nine months or more. Most HA products are synthetic.
  2. Collagen: Collagen constitutes 70-80% of the human dermis. Dermal collagen decreases and fragments with aging. Collagen fillers can be human, bovine, or porcine in origin.
  3. Fat injection (autologous): Small amounts of fat are removed from places like the thigh, stomach, and buttocks, purified, and then inserted under the skin of the face. Stretching the skin, this technique can assist to reduce the appearance of wrinkles.
  4. Poly-L lactic Acid (Sculptra): This is a biodegradable, non-toxic synthetic substance that is injected beneath the skin to replace lost facial fat. Also known as PLLA, it increases collagen production and has been approved as a cosmetic treatment for specific skin problems in HIV patients.
  5. Calcium Hydroxylapatite (Radiesse): Composed of the elements that give bone its strength and texture. The product is mixed with water or an aqueous gel solution which is then injected beneath the skin to give it volume.

How long do fillers last?

Like every other thing in this world, fillers carry out their function for only a while. This causes people to keep going back for more. The length of time lasted is determined by factors such as the type of filler used and where it is injected or administered. They have a lifespan ranging from 6 to 18 months to 2 to 5 years. A lot of factors can affect the longevity of these fillers like; the location of the filler in the face, the quantity of filler injected, and how long it takes for the body to metabolize it. However, at the midpoint of the filler’s expected lifespan, you’ll notice a reduction in volume. This is why regular ‘touch-ups’ are important to maintain the ‘look’.

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What happens when fillers wear off?

Dermal fillers can be used for more than only aging concerns. Dermal fillers have grown popular for a variety of reasons. They can help plump lips, improve the look of scars, and enhance shallow facial features, to mention a few benefits. Dermal fillers are not permanent and degrade in the skin over time. The skin is elastic so it naturally goes back to its original shape. This means that in the months following lip fillers, the lips will gradually lose volume until returning to their previous shape. The same is true for face fillers.

How are fillers administered?

Dermal fillers can be obtained at your doctor’s clinic. This service can also be provided in a medical spa or beautician’s office. Only certified personnel are allowed to administer the injections.

The steps are:

  1. Facial assessment and mapping
  2. Sterilizing
  3. Anesthetizing
  4. Administration of the injection
  5. Clean-up and recovery

The injection site, as well as the surrounding skin, should be thoroughly cleansed with antiseptics. Anesthesia is essential for both technical advantage and patient comfort. There are various injection techniques when it comes to filer application. They are; serial puncture, depot, fanning, fern, cone, cross-hatching, and linear threading technique. The injection technique used is determined by the indication, its location, the filler substance, the needle size, and the injector’s experience.

Are fillers a boon or a misfortune?

Skin, fat, muscle, and bone make up our faces’ four main structural elements. Many of the visual indications of aging are caused by volume loss in these structures as we age. A lot of people turn to fillers to rescue the situation. While these fillers can restore a more youthful look by reducing wrinkles and replacing lost volume, there is a danger of both short-term and long-term problems with any of these fillers. Common risks include:

  1. Bruising and scarring
  2. Pain
  3. Tenderness
  4. Itching
  5. Rash
  6. Lumpy appearance under the skin
  7. Infection
  8. Blocked vessels
  9. Allergic reactions
  10. Skin discoloration

According to the American Academy of Dermatology, the most prevalent side effects that occur due to the administration of dermal fillers are redness, tenderness, bruising, and swelling.

The quantity and variety of adverse events will rise with expanded indications and treatment options. Although the majority of adverse responses are minor and temporary, more severe adverse events might happen and leave patients with long-lasting or permanent functional and aesthetically debilitating deficiencies. While some symptoms start soon after treatment, others take longer to manifest. The muscles in the face, head, and neck may weaken over time if dermal fillers are used often. Unfavorable effects on swallowing, voice cord function, and eye movements, including double vision, can result from these adverse effects.

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Fillers may cause serious long-term adverse effects

A study was carried out by a group of scientists to discover the delayed immune-mediated adverse effects due to the administration of polyalkylimide dermal fillers. Immune system activity is a major mediator of many negative medication responses. Patients with intermediate or delayed adverse effects due to dermal fillers were referred by a group of clinical immunologists. The phrase “intermediate adverse effects” refers to those that start to manifest 1 to 12 months following the injection of fillers. It involves one more of the following symptoms:

  1. Angioedema
  2. Swollen or tender nodules with or without discharge of pus or filler material
  3. Edema
  4. Hardening of the skin also known as skin induration

The systemic manifestations are:

  1. Fever
  2. Xerostomia
  3. Dry eyes
  4. Arthritis
  5. Skin lesions

For the delayed adverse effect, they begin 12 months after the injection manifesting the same symptoms as the intermediate adverse effects.

25 patients were used for the study and were evaluated during the clinical manifestations of these symptoms. 8 of these patients were excluded from the study because they got a second opinion. The assessment involved chest radiographs, blood tests, and other major investigations. On clinical examination, it was observed that between the PAI implantation and the onset of symptoms, there was a latency period of 13.4 months. On inspection of the granulomatous lesion, the administered PAI seemed to be the likely cause. Facial angioedema, skin induration and swelling, and multiple inflammatory tender nodules were noticed. In 6 patients, systemic manifestations were observed. 1 patient had a diagnosis of Sicca syndrome, the patient had dry eyes as one of the symptoms. On laboratory result evaluation, 12 of the 17 had abnormal parameters. The study above shows that the use of fillers even on a short-term basis causes serious adverse effects.

A review was carried out by another group of scientists. Here, the long-term adverse effects associated with the use of hyaluronic acid(HA) dermal fillers were evaluated. It is a mucopolysaccharide that is negatively charged. Hyaluronic acid is produced mainly by fibroblasts in the extracellular matrix(ECM). The dermal ECM contains a significant amount of HA, which plays a key role in the development of a durable, compressible ground substance. Hyaluronic acid functions as a tissue hydro regulator, and also functions in anti-inflammation and immunosuppression. In aging skin, there is a steady decrease in hyaluronic acid content. The decrease presents as reduced elasticity, turgidity, and wrinkling. Hyaluronic acid dermal fillers are also commonly used for scar repair and lip enhancement. Restylane and Hylaform are brands of hyaluronic acid fillers.

The review (Friedman et al 2002) of all complaints of Restylane-related adverse events submitted to the manufacturer in 1999 and 2000, representing an estimated 306,000 treated patients, revealed one adverse event for every 650 to 1800 persons treated. These reactions were mostly localized hypersensitivity reactions. Furthermore, recurrent herpes labialis occurs in a small number of individuals after lip augmentation with a hyaluronic acid filler. This review exposed the inconsistencies that arise in using hyaluronic dermal fillers.

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Too many dermal fillers in your face

Dermal fillers have become a household name because of the popularity they have gained over the years. Everyone uses dermal fillers and many people believe it is a risk-free procedure due to its noninvasive nature. In the wrong hands, a lot of things can go sideways. Too much of it could be administered and it could also be administered in the wrong places. When too much filler is applied, the line between looking natural and seeming plastic is quickly crossed. The following conditions may emerge if you use too many fillers:

  1. Witch’s chin: Resembles that of a witch, literally. Here the chin looks really sharp and pointed due to excess filler in the chin, hence the ‘witch look’.
  2. Avatar’s nose: Here the nasofrontal angle (the angle between the brow and the nose) is destroyed, resulting in a nose bridge that is exceptionally high and broad, akin to the aliens in the film ‘Avatar’.
  3. Pillow face or chipmunk cheeks: The cheeks and eyelids look really puffy and unnatural. Just like a pillow, the entire mid-face bulges outwards and the eyes recede.
  4. Filler fatigue: The application of fillers causes some space beneath the skin to be occupied, eventually causing the skin in that area to be stretched. As a cause of excessive filler application, the skin becomes extra stretched leading to the development of bran-like pockets which are not so cool to look at. This may necessitate the administration of more filler in subsequent procedures, resulting in a never-ending cycle of filling and absorbing.
  5. Bulging forehead: this look can be extremely nasty, and leaves your head looking overly round like a watermelon. The natural contours are lost and this can be a little bit embarrassing.
  6. Bony Cheeks: This results in excessively protruding cheekbones making the cheeks look so out of proportion.
  7. Puffy lips: Here you see extremely puffy lips that don’t look good.

Fillers can stretch out the tissues beneath the skin over time, essentially speeding up the aging process. This leaves a trail of saggy skin behind and more visits to the doctor’s office to get a refill.

Do fillers migrate?

While we worry about the fact that too many fillers can make the face look like a disaster, we also have to worry about the fact that dermal fillers could migrate to an unintended area causing a greater disaster. Filler migration is the process by which dermal filler spreads or “migrates” to another location beyond the injection site. This majorly happens with lip fillers but is also associated with other areas. It can be seen as lumps and ridges around the lower lid of the eye and a shelf-like appearance around the upper lip border. It can be caused by inexperienced doctors, the administration of too many fillers, or the accelerated breakdown of fillers.

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Other long-term effects of dermal fillers

Since the advent of fillers, people don’t look the same anymore. Body alteration is growing more common in our society, and it is becoming considered normal and the new standard of beauty. In as much as these procedures enhance beauty, long-term use can make the face even age more and cause skin sagging or stretching. In addition to stretching the skin, excessive usage of fillers can cause long-term harm such as lip wrinkling, disruption of the connection of the facial fat pads, and some degree of irregularity and aging of the skin. The physical health risks listed above cannot be overemphasized. It also poses a significant risk to mental health.

More effective methods?

Due to the adverse side effects that occur as a result of using dermal fillers, face lifting sounds like a better alternative to avoid all the chemical reactions. Face lifting, also known as rhytidectomy, is a facial rejuvenation surgery in which the human skin is stretched to make the patient look younger by dividing the subcutaneous layers and using various suturing procedures. A facelift is popularly regarded as the gold standard therapy for total facial rejuvenation. But is it?

Due to its invasive nature, there are a lot of complications involved here. They are: abscess formation, skin necrosis, nerve damage, scar hypertrophy, hyperpigmentation, hematoma, infection, thromboembolism, fluid accumulation, and others too numerous to mention

A facelift is not permanent and does not last forever. According to research, 21% of facelifts relapse five and a half years following surgery. The procedure can lead to distorted earlobes, also if too much skin is removed, the face may appear drawn back or frightened.

In addition, facelifts are generally expensive. Concrete reasons point more and more to why doing a facelift isn’t an option to be considered.

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‘Aging gracefully’ could be the best solution

Our dream is to age like a fine wine. Yes, you can see all the fine lines and wrinkles but guess what, that’s perfectly okay. Our world today has got us thinking that every ‘beauty problem’ can be solved with a poke here and a poke there. It is far more than simply smoothing fine lines and boosting volume to look younger and fresher. Improving skin quality, skin tone, and skin health can all help your look. Here are some tricks that can keep you looking up to date:

  1. Exercising
  2. Healthy eating
  3. Using sunscreen
  4. Staying hydrated
  5. Staying away from smoking
  6. Drinking less alcohol

Maintaining a great relationship with your skin puts you on the road to achieving that youthful look. Lifestyle is very important. Getting enough sleep and drinking enough water can go a long way. Avoiding smoking, alcohol and caffeinated drinks prevent the skin from drying out. Being kind to your skin by wearing sunscreen regularly goes a very long way. Regular exercise reduces your risk of ailments such as heart disease and cancer and allows you to stay mobile for longer. Eating more vegetables and staying away from processed and oily foods can keep you healthy.

Conclusion

In our world today, there is this pressure to look a certain way. Most of us unconsciously adopt society’s beauty standards as our concept of beauty. We see ourselves trying to keep up with these standards. The word ‘filler’ could just be the most popular beauty word in the world. Fillers have become a popular aesthetic therapy for a variety of facial issues. As shown above, the use of dermal fillers could pose a threat to our health on a long-term basis. Natural methods have proven to be complication-free and free of doctors’ appointments. Fillers could come in handy as a quick solution to enhance beauty but they aren’t really necessary. You look good just the way you are.

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References

Cosmetic skin fillers rise in popularity, and complications | CNN

Dermal fillers in aesthetics: an overview of adverse events and treatment approaches – PMC (nih.gov)

Dermal Fillers: Types, Indications, and Complications – ScienceDirect

Dermal Fillers: Tips to Achieve Successful Outcomes – PMC (nih.gov)

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