Soft tissue fillers, also known as dermal fillers or injectable fillers, are substances injected into the skin to restore lost volume, smooth out wrinkles and folds, and enhance facial contours. They have become a cornerstone of non-surgical facial rejuvenation, offering a minimally invasive way to address age-related changes in the face.
Facial aging is characterised by a gradual loss of subcutaneous fat, a process that contributes significantly to volume depletion in key areas such as the cheeks, temples, and under the eyes. This volume loss leads to the descent and flattening of facial structures, resulting in the formation of wrinkles and folds (e.g., nasolabial folds, marionette lines), the appearance of hollows (e.g., under-eye troughs), and a less defined jawline. Additionally, the skin itself loses collagen and elastin, further exacerbating the appearance of fine lines and wrinkles.
Soft tissue fillers work by physically occupying space beneath the skin, thereby restoring lost volume and providing support to overlying tissues. When injected into specific areas, they can plump up sunken cheeks, fill in deep wrinkles and folds, smooth out fine lines, enhance lip volume, and improve the contour of the jawline and chin. The immediate effect is a more youthful and refreshed appearance, with softened lines and improved facial symmetry.
A variety of soft tissue fillers are available, each with its own composition, properties, and longevity. These can be broadly categorised into temporary, semi-permanent, and permanent fillers, although the trend favours the use of temporary and semi-permanent options due to their safety profile and the evolving nature of facial aesthetics.
Hyaluronic acid (HA) fillers are among the most popular temporary fillers . HA is a naturally occurring substance in the skin that helps retain moisture and provides volume . These fillers are biocompatible and offer a smooth, natural-looking result. They are also reversible with an enzyme called hyaluronidase, which can dissolve the filler if needed . HA fillers come in various formulations with different particle sizes and viscosities, making them suitable for treating a wide range of concerns, from fine lines to deep folds and volume augmentation. Their longevity typically ranges from 6 to 18 months, depending on the product and the area injected.
Another type of temporary filler is injectable collagen . These fillers are made from purified bovine or human collagen and were among the earliest dermal fillers used . However, they have become less popular due to their shorter duration of effect (typically 3-4 months) and the risk of allergic reactions, often requiring pre-treatment skin testing.
Calcium hydroxylapatite (CaHA) is a semi-permanent filler. It consists of microscopic calcium phosphate particles suspended in a gel carrier. Once injected, the gel provides immediate volume, and over time, the CaHA particles stimulate the body to produce its own collagen. This dual mechanism results in longer-lasting effects, typically around 12-18 months. CaHA fillers are often used for deeper lines and folds and for restoring volume in the cheeks and temples.
Poly-L-lactic acid (PLLA) is another semi-permanent filler that works primarily by stimulating collagen production. It is injected in a series of treatments, and the results develop gradually over several months as new collagen is formed. PLLA is particularly useful for restoring overall facial volume and improving the appearance of deeper wrinkles. The effects can last for up to two years or more.
Permanent fillers, such as polymethylmethacrylate (PMMA) microspheres suspended in collagen gel, offer long-lasting results. However, their use is associated with a higher risk of complications, including nodule formation and difficulty in correcting any adverse effects, making them less favoured by many practitioners.
The injection technique for soft tissue fillers is crucial for achieving optimal and natural-looking results. Practitioners use various techniques, including linear threading (injecting the filler as the needle is withdrawn), serial puncture (making multiple small injections), and droplet technique (injecting small boluses of filler). The depth of injection also varies depending on the type of filler used and the area being treated, ranging from the superficial dermis for fine lines to the deep subcutaneous tissue or supraperiosteal plane for volume restoration.
Potential risks and complications associated with soft tissue fillers include injection-related issues such as bruising, swelling, redness, and pain at the injection site. These are usually temporary and resolve within a few days. More serious but less common complications can include infection, allergic reactions, nodule formation, vascular occlusion (which can lead to skin necrosis), and filler migration. Choosing an experienced and qualified practitioner who has a thorough understanding of facial anatomy and injection techniques is essential to minimise these risks. In conclusion, soft tissue fillers are a valuable tool in combating facial aging by restoring lost volume and smoothing out wrinkles and folds. The variety of available fillers allows for tailored treatments to address individual concerns and achieve natural-looking rejuvenation. While generally safe, it is crucial for patients to be aware of the potential risks and to choose a skilled practitioner for their filler treatments.