Cheek Masterclass

Dermal fillers are frequently used in the correction of scarring, wrinkles and other depressions in the skin. They are a form of hyaluronic acid, a substance naturally found in the body, and can be injected into the skin to improve aesthetics. They are generally made of several types of synthetic, man-made and natural substances. For anyone suffering from problems such as wrinkles, folds or depressions in the skin, dermal fillers may be the best solution to improve appearance. The procedure is quick, often taking just 30 minutes or less to complete, and many people experience no pain at all and minimum side-effects.

The use of dermal fillers dates to the early 1890s which should instil confidence in new users. This was when doctors discovered that fat taken from part of a patient’s body could provide a more youthful look when injected back into the face or arms. This is a trend which has remained popular, even in today’s medical field, as many doctors still extract fat from parts of the patient’s body and use it elsewhere for beneficial results to aesthetic and medical conditions.

So, what exactly was used in the early days? Doctors in the mid-1900s were using paraffin and silicone as filler to improve skin aesthetics. However, this form of filler had its shortcoming and there were widespread reports that these kinds of fillers were unsafe to use on human skin. Following this, scientists began to explore alternatives, and in 1980 doctors discovered a type of naturally occurring filler material in the skin of cows known as collagen. Upon further scientific tests and trials doctors established that the material would be safe for use on human beings and that this could effectively replace fat as a filler substance. This was used until the development of a human derived collagen.

Collagen became the new material to use with no risk to human safety. The American Society for Aesthetic Surgery confirmed that injections of collagen came out number thirteen as the most commonly conducted aesthetics procedure in the USA. In 2008 there were more than 58,000 reported treatments throughout the year. 49.6 per cent of these applications used bovine-derived products and 50.4 per cent human-derived collagen products. The extended use of hyaluronic acid dermal fillers which are man-made can perhaps explain a decrease in the use of human-derived collagen. These kinds of fillers (hyaluronic acid) have recently shown signs of beating collagen into almost third place.

There was a decrease in the use of collagen fillers by about 12.8 percent in 2008 when a total of 1.26 million treatments were recorded worldwide. Calcium hydroxyapatite alone currently accounts for slightly less than 123,000 treatment cases, which reflects an increase of around 3 per cent since 2007. Polymethyl methacrylate was approved by the US Food and Drug Administration and shows usage as being approximately 11,000 treatments in 2008, which is a remarkable decrease of about 10.6 percent from 2007.

Additionally, there has been a huge increase in the use of these materials in the UK. These treatments are safe and inexpensive, which goes some way to explain why many people are making the decision to undergo treatment. It is thought that people are looking for a product which is not expensive but still provides quality, reliable results.

Dates in history

1893 – German (Franz Neuber) used autogolus tissue that was harvested from the arms to correct depressed facial tissue.

1900s – After the invention of the syringe, chemical agents were used. The first injectable started being used in facial augmentation (Paraffin) (Negatives – migration and inflamed nodules)

1909 – Autogenous fats were reported to be used to correct the malar and chin area.

1934 – Researchers Karl Meyer and John Palmer found that the main function of HA and that it maintains the skin volume and hydration.

1940 – 1940s to the 1950s it emerged silicone highly refined and was being using as a dermal implant. After abuse and adverse effects the cosmetic agent was banned in 1992.

1945 – Paraffin and Silicone were being used in Japan to make women look more westernised.

1960 – Silicone was used in Nevada for unregulated breast enhancements

1970 – Various animal collagens had been researched and deemed safe to be used on humans. Collagen injections and implants were introduced in 1981 the FDA approved Zyderm.

This was the first FDA approved wrinkle filler. Zyderm and Zyplast were made of purified cow skin.

1970s – 1980s – Liposuction Emerged

1980 – Development of additional fillers started. Each one had positive attributes but ultimately failed due to immunologic cost, ease-of-use problems. Injectable collagen remained the only commercial filler option for more than 20 years.

1900s – Hyaluronic acid started to be used for joint pain, treating wound and eye surgery.

1996 – Hyaluronic Acid was used for facial tissue augmentation in Europe.

2003 – FDA approved the first hyaluronic acid dermal filler (Restylane). Easy to use, longer lasting results and does not require allergy testing.

2004 – Porcine based Collagen (pig tendons) launched in Europe in 2005.

2005 onwards – A multitude of products have since been developed for soft tissue augmentation. HA is the most frequently used in the states.

How do dermal fillers work?

The fundamental working principle of dermal fillers is that they have a ‘plumping’ effect. This simply implies that they will plump-up the area which has received the injection, levelling it with other parts of the skin and making it look plumped out, even and no longer sunken. Ultimately, different fillers may achieve this goal in slightly different ways, but the result is that the skin will look plump and firm, young and refreshed.

The treatment is successful by taking advantage of the basic roles and functions of the skin, which can also help in fully understanding the procedure. The human skin is made up of two layers, namely the epidermis and the dermis. The outermost layer is the epidermis and its main function is to serve as protection against the effects of the environment and other components. It controls water loss from tissues and cells, thus serving as a barrier to the outside environment.

The dermis layer is right below the epidermis and constitutes the skin’s structural elements, such as nerves, hair follicles and blood vessels. The growth of cells and blood vessels is enhanced through a framework provided by a network of fibres that is formed by protein.

The major component of the dermis is collagen which gives the skin its firm elasticity and strength, offering fundamental support to the skin. As one grows old the ageing process causes the upper layer (the epidermis) to gradually become thin and provides less protection to the dermis layer. In addition, collagen production in the body slows down considerably as the existing collagen becomes ineffective.

This then causes wrinkles, folds, depressions and other forms of skin abnormalities associated with old age. It is at this point that dermal fillers become necessary to reduce the consequences of the deteriorating epidermis and weakened collagen. Dermal fillers technically work as replenishment for the natural collagen which has been rendered less effective by the ageing process. They both compliment & work as replacement for collagen and, depending on the quality of the system used, impressive results can be achieved.

The general working principle is similar for all dermal fillers, but may vary slightly from one type to another. Dermal fillers are usually designed to treat one area specifically, such as the lips. Often, various dermal fillers are marketed under a similar name with each treating a different area of the body or providing a different level of treatment.