Patient Information - Dermal Filler 

When considering treatment with dermal fillers I want you to have a safe treatment.  There are some potential risks that are either unavoidable or out of your control but the following information should allow you to know what to expect and provides you with the information you need to know before going ahead with dermal filler treatment.

What are dermal fillers?  
Dermal fillers are natural or synthetic gels that are injected into the skin to volumise, lift and improve the appearance of lines. The vast majority of dermal fillers are completely biodegradable and temporary however there are some permanent fillers available as well. Although the idea of a more permanent filler may seem more appealing to a patient, they are generally associated with more complications and longer term problems and rarely used in practice. In the UK, there are over 160 brands available on the market and the vast majority consist of hyaluronic acid although other products are also used including calcium hydroxyapatite, polycaprolactone, poly-L-lactic acid and agarose gel.  At DC Aesthetics I only use biodegradable fillers made of hyaluronic acid. 
 
What is hyaluronic acid?  
Hyaluronic acid is a naturally occurring sugar chain molecule found in all skin and soft tissues throughout the body, identical across species. It attracts and binds water in the skin, providing volume and hydration, but also ‘cushioning’ and supporting collagen and elastin fibres and providing a medium, or carrier, for chemical messages between the cells.  Dermal fillers are manufactured, usually through fermentation and cross linking with proteins to produce a clear, sterile gel for injection into the skin. Not all hyaluronic acids are the same and legitimate brands are not available for general sale on the internet and should only be administered by trained clinicians.  Each brand has a range of ‘tissue tailored’ products indicated for different areas and depths of injection. One size does not fit all.  
 
How does it work?  
Dermal fillers are injected directly into the skin to provide instant correction.  

Does it hurt?  
Many dermal fillers contain local anaesthetic to provide pain relief during the procedure although some practitioners may apply a topical anaesthetic cream or ice prior to treatment to numb the skin.  
The procedure may be uncomfortable but is not usually painful. Certain areas, such as the lips, are more sensitive.

 
Treatment areas  

•  To correct or enhance facial contours; cheeks, temples, jawline, nose, chin

•  To define, correct or enhance lips

•  To soften and correct facial wrinkles or folds

•  To improve the tone, texture and hydration of the skin   

 
Checklist  

• Do not feel pressured to make any quick decisions.  

• Do be honest about your medical history; in particular any previous facial surgery as this may alter the anatomy under the skin.  

• Any medications you are taking, particularly any medications that may impair your immune system such as steroids.  

• Any current illness or long-term conditions that you have.  

• Any recent or planned dental treatments (this may affect the anatomy, or may increase your risk of post treatment infection).  

• Do be honest about your expectations  

• Do listen to the practitioner's explanation of possible risks, side effects and complications, previous positive experience does not indicate protection or immunity from the risks described.  

• Do not schedule your treatment when you have an important event or holiday/trip planned within 4 weeks. Bruising and swelling can take time to settle and may be prolonged or worsened with exposure to heat and the sun. Vigorous exercise should be avoided for 48 hours or until any initial side effect settle. Should you have a problem, your practitioner will need to see you in order to provide corrective treatment or advise you.  

 

Before treatment  

• All make up will need to be removed prior to treatment, attend ‘fresh faced’ if possible. Contamination with makeup can cause infection.  

• Taking the following within 72 hours of treatment may increase your risk of bruising – Alcohol, Aspirin, Ibuprofen, St. John’s Wort, Gingko Biloba.  

• Do cancel if you are at all unwell, even coughs and colds can increase your risk of post treatment complications.  

• Reschedule if you think you have or are developing a cold sore. Treatment around the mouth can trigger or spread cold sore infections. If you are prone to developing cold sores then it is important to inform your practitioner as they may wish to prescribe some prophylactic medication.  

• Do contact the clinic to discuss any illness or new medicines prior to attending.   

 

After treatment  
Most people are able to continue with normal activities. Some will have some redness, pin- prick marks, swelling (particularly following a lip treatment) which should settle within a few days. Cold packs may be advised to help alleviate swelling and arnica may be recommended to reduce bruising. Your practitioner will provide you with aftercare advice.  
Bruising and swelling may be more apparent the next day and can take up to 14 days to disappear. Tenderness should settle within 48 hours.  
After treatment it is expected that you will see an improvement straight away although due to initial swelling, the product may feel hard or lumpy or asymmetrical immediately afterwards. The final results are best judged at a 2-week review appointment. Depending on the product used and the area treated, results may last from 4 months to in excess of a year.  

• Make-up should not be worn for 12 hours’ and the skin should be kept clean, with normal cleansing. Do not use cleansing wipes which may irritate the skin.  

• Avoid extremes of heat or cold, vigorous exercise and massage (unless specifically asked to do so) on the day of treatment.  

• Avoid sun bathing and extremes of heat for 14 days as this has been shown to increase and prolong swelling.  

 
Things to look out for  
Please contact your practitioner if redness, tenderness or swelling worsens after 3 days, rather than settling. Though some tenderness is to be expected, pain is not and should be reported. If the skin appears dusky or mottled, blisters appear, the skin is becoming hot or red or the area is becoming painful, contact your practitioner immediately.  
If you suffer any of the following symptoms, which may indicate a serious allergic reaction, seek immediate medical attention:  

• Itching

• Rash

• Red itchy welts

• Wheezing

• Difficulty swallowing  

• Asthma symptoms  

• Dizziness

• Feeling faint  

 
If you are at all concerned about symptoms you were not expecting or any that concern you, you should contact the practitioner who treated you and make an appointment to be seen.  
If you wish to see someone else, contact your practitioner and ask for a copy of your treatment record and or a referral letter. This detailed information will be important if another practitioner is going to safely help or advise you.  
If you suffer any adverse reactions or a poor cosmetic result, it may be that correction is not possible and you will be advised to wait until the dermal filler has been broken down by the body.  
 Is it safe?  
All treatments carry a degree of risk. All risks and complications will be discussed with you at consultation and prior to any treatment being agreed.  Dermal fillers should be administered by a healthcare professional with specialist training. Adverse events are uncommon, usually occur within a few days of treatment and are expected to be temporary, usually resolving spontaneously within weeks.  Your practitioner will provide aftercare advice designed to minimise risk and promote speedy recovery from any expected side effects.  
 
Side effects include, but are not limited to:  
Redness - Swelling - Bruising - Itching - Tenderness - Asymmetry - Lumps  
 
Am I suitable for treatment?  
Your practitioner will take a detailed medical history and an assessment of your needs and expectations to ensure this is an appropriate treatment for you. This must be a nurse, doctor, dentist or prescribing pharmacist with specialised training, qualified to prescribe.  

• Dermal fillers cannot be used in pregnant or breast feeding women.  

• Not suitable if you are currently taking certain medicines, particularly drugs that affect the immune system.  

• If you have previously experienced adverse reactions to dermal fillers or local anaesthetic.  

• Treatment is not recommended if you are suffering from any skin infection in or near the treatment area or are unwell in any way (even a cold).  

• Not suitable for patients with bleeding problems.  

• If you are taking any medicines which affect bleeding, such as aspirin or warfarin.  

• If you are currently or have recently completed a course of Roaccutane (acne treatment) in the last 18