Dermal fillers are an accepted and popular method of treating unwanted facial lines. A number of different products exist for this purpose, most claiming to be better than the next! The commonest filler used in my practice is Restylane. This is made from non-animal hyaluronic acid and is in the form of a clear gel which smoothes wrinkles and folds. The gel binds water within the wrinkle or fold, and as the gel breaks down, water takes its place. The treatment is used for lines on the forehead, between the eyebrows, around the eyes, in the lines around the mouth and to add volume to the lips. The effect of Restylane lasts up to six months but this may be less in areas of excess muscle activity (eg the lips).
The clear gel is injected into the skin in small amounts with a very thin needle. A local anaesthetic cream may be applied to the treatment area 30 minutes to numb the area. For very sensitive areas, such as the lips, a local anaesthetic injection is given under the lips (similar to that given by your dentist). I use lignocaine (xylocaine) injection which acts as a nerve block to numb the treatment areas. Please mention any allergies to lignocaine or any previous problems with dental injections. On occasions I will advice you to massage the area treated but full advice on aftercare will be provided at the time of your treatment.
Some common injection related reactions might occur such as swelling, redness, pain, itching, discoloration and tenderness at the implant site. Other types of reactions are very rare, but about 1 in 2,000 treated patients have experienced localised reactions thought to be due to hypersensitivity. These have usually consisted of swelling at the implant site, sometimes affecting the surrounding tissues.
Redness, tenderness and rarely acne-like reactions have also been reported. These reactions have either started a few days after injection or after a delay of 2-4 weeks and have been described as mild to moderate and are self-limiting.
Although Restylane has not been shown to have any serious complications, it is advisable to avoid treatment if you are pregnant or breastfeeding.
Depending on the site of treatment, I also use other hyaluronic acid based products related to Restylane. These include Perlane and SubQ where more bulk filling is required, or Evolence. These tend to last longer – approximately 9 months. Where even more bulk is required, eg in very sunken cheeks, I use a permanent filler called BioAlcamid.
Please do not hesitate to ask any questions about these treatments both before and after injection.
Botulinum toxin therapy is now an accepted and popular method of treating unwanted facial lines. The drug is the by-product of a bacterium called C.Botulinum and acts by causing nerve weakness at the site of the injections. This nerve weakness causes a long lasting relaxation of the facial and forehead muscles which, by being overactive, cause lines to appear on the overlying skin. It usually takes few days for the effect of the injections to become apparent. The treatment may be used for lines on the forehead, around the eyes or between the eyebrows.
No anaesthetic is required. Using a very fine needle, small amounts of Botulinum toxin are placed into the muscles responsible for the lines that are bothering you. Numerous small injections may be required. There are usually no visible after effects from the injections, although occasionally temporary swelling of bruising may occur.
You should not massage the area injected in the first six to eight hours as this may allow the drug to spread to the eyebrow and eyelid muscles. It will help if you can avoid lying down during this period and you should try to exercise the muscle areas treated.
Although the dose of toxin used has not been shown to have any serious complications, you should not have this treatment if you fall into one of the following groups:
- Pregnant of breastfeeding
- Patients with neurological or muscular diseases (eg Multiple Sclerosis)
- Patients taking aminoglycoside antibiotics
- Patients allergic to Botulinum Toxin
Temporary muscle weakness around the eyes may occur in approximately one in one hundred patients treated. In some cases this may cause noticeable double vision or drooping of the eyelid. These problems resolve spontaneously but may take several weeks to get better completely.
It is not uncommon to have a mild headache for up to 48 hours after the treatment. Paracetamol or other simple painkillers can be used if required. If you have any concerns following the treatment please do not hesitate to contact Mr Neil Solomons
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