Dermal Fillers

Dermal Fillers go by many names; Fillers, Facial Fillers, Injectable Fillers – essentially they are all the same thing. And that thing is a very broad category of products that can be very different to one another. Now that I’ve made it look complicated, let’s take a step back to review what exactly a filler is.

A filler fills. It’s as easy as that – although where it fills and how it fills are the more difficult questions! A filler can either be permanent or non-permanent – that is they either get absorbed over time or they last for life.

Dermal Fillers

Permanent Vs Non-Permanent Dermal Fillers – Table courtesy Wollina and Goldman (Fillers in the improvement of acne scars).

The current thinking is that non-permanent dermal fillers such as Hyaluronic acid based fillers are the safest to use. As they are not permanent, if you don’t like the result, it will eventually go away. Also, in special circumstances if the dermal filler needs to be removed, it can be dissolved using an injectable enzyme. So for the most part, most doctors today use Hyaluronic Acid based dermal fillers.

And what is Hyaluronic Acid you may ask? Hyaluronic acid is a carbohydrate that is found naturally in our skin. It is a water holding molecule (so it hydrates) and fills the spaces between our collagen and elastin fibers in the dermis of our skin.

Dermal Fillers

Hyaluronic acid is a molecule made up of N-acetyl glucosamine and Glucuronic acid. It provides hydration to the deeper layers of the skin. Image: source unknown.

Initially dermal fillers were used to fill the lines associated with facial aging. So doctors would typically inject the lower face (nasolabial folds and marionette line). This would reduce the visibility of the lines but it never dealt with the cause of the line – which is facial fat loss.

Dermal Fillers

Over the decades our faces lose fat from the fat pads in our cheeks. Image source: unknown.

The current thinking is that instead of injecting the lines in the lower part of the face, we inject the cheeks first – to replace the fat that has been lost. What happens when we do this is that the cheeks are lifted and the lines under the eye, between the nose and mouth and below the mouth are all reduced. If then the person still has lines in these areas, the second treatment would be to directly inject these lines – although most of the time this is unnecessary as the client looks and feels rejuvenated.

The type of Hyaluronic Acid dermal filler we use depends on where we inject it and how deep we inject it. All filler brands have a variety of different fillers within their brand – from the thick gel-like ones to the thin silk-like ones, each has its use. The thicker gels tend to be used for deep injections in the cheeks – they provide the “foundations”. The thinner silk-like ones are injected more superficially – they are like the “curtains”. Foundations of a house provide support and generally last a long time – cheek fillers lift the cheeks (support) and last longer than thin fillers. The curtains of a house get blown around in the wind (thin fillers can easily be moved by the injector) and are usually changed frequently (thin fillers only last around 9 months to a year).

Dermal FIllers

The size of the Hyaluronic Acid particle influences whether it’s a thick or thin filler. As seen above, large sized particles like Restylane Sub Q are thick fillers, which are injected deep. Small sized particles like Restylane Touch are thin fillers and are injected superficially. Image courtesy Galderma.

All of the above is just a very small introduction into the world of Dermal Fillers. There are so many more things to know! At the end of the day, one thing stands true: For the most part, it is the injector that you should be concerned with and not the dermal filler choice!


–  Dr Wade



Contact us today if you would like to know more about dermal filler treatments in Somerset West, Green Point or Camps Bay, Cape Town. Let us know if you would like toschedule a consultation to discuss the various aesthetic treatments we offer. Dr Wade practices in Green Point, Camps Bay and Somerset West, Cape Town.

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Botox  | Dermal Fillers | Chemical Peels | Micro-needling (Dermapen) | Filorga Mesotherapy

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