Australasian Dentist Magazine Nov Dec 2021

Category 94 AustrAlAsiAn Dentist What are dermal fillers? Dermal fillers are an aesthetic based gel that is injected into an area to enhance or reshape it. they are specifically made for the enhancement of your features, the reduction of folds and/or wrinkles. typically in Australia, Dermal fillers are made of Hyaluronic acid. Hyaluronic acid (HA) is found in our skin and is a naturally occurring sugar chain that gives our skin plumpness and attracts water to the skin, creating hydration. the HA in dermal filler is made in a laboratory, and are not animal derived (nAsHA). in our skin do change over time, as our body modifies or breaks it down with enzymes as part of our metabolic processes. Over time, this can lead to sagging of the skin and folds that never used to be there. What types of different fillers are there and what is the difference between them? there are many types of filler and many brands available on the Australian market. As mentioned the most common type is made of HA. Within this class of dermal filler there are many different thicknesses. thicker fillers are highly cross-linked or chemically woven together. this makes the filler very firm to touch, but also stable over a long period of time as it takes longer for your body to wear it down. the thicker fillers are best used for enhancement of bone like structures. For example, this type of filler can be used to replicate or enhance the cheekbones, the jawline and similar areas. thinner fillers are used for a much softer type of tissue. typically this might be used in the under eye area or lips where a soft result is desirable. using a filler that is hard in these areas would just not look right, and would show up as lumps and bumps. thin types of fillers do not last quite as long as the thicker type, but are best suited to delicate areas. How long do dermal fillers last? HA levels naturally turns over in our skin at a rapid rate, so when a HA filler is made in a laboratory, it undergoes a process to stabilise it so that it lasts much longer than our innate HA. One of the great advantages of dermal filler treatment is that the effects are long lasting but not permanent. thicker fillers can last for around 12-24 months. this varies according to the filler brand, as each has their own unique structure or cross-linking signature. When you have dermal filler, your metabolism will also dictate the turnover. Highly fit people will break down filler more quickly than less fit people. Other factors include “wear and tear”. What i mean by this is that we use our lips every day to speak and laugh and eat. this high traffic area will wear down filler fast, whereas if the same filler were placed in the cheek will last longer as the cheek doesn’t move quite as much. Can fillers make the skin sag? improperly placed filler or too much filler can add weight to the face, where we just don’t want it. An area that often gets over- treated can be the under-eye area, the jowl area along the jaw line and also the nasolabial folds – the lines that start at the corner of your mouth and run down under the cheeks. if a little too much filler is used in these areas, particularly if the skin is thin and stretchy, the filler will weigh the skin down and create more folds as the skin stretches to accommodate the filler. A great cosmetic injector should be able to recognise this, and avoid treating these areas or direct the patient to undertake supportive skin treatments first. it is really unfortunate when i see a new client who has had a previous bad experience with filler. invariably this is because the filler has been placed inappropriately or far too much filler has been used by their last cosmetic injector. Dermal filler can be a brilliant treatment that looks natural and enhances the features. it is a real shame when the confidence of a client is lost. What should a patient know before getting dermal fillers? Dermal fillers are a medical procedure and should be treated as such. Dentists should always undertake a full dental examination and, this of course, will be done as a face-to-face consultation. this gives us a huge advantage over chain clinics that often ‘dial-in’ a consult before treatments for their clients. We have an established relationship that we can work with, and plan treatment for our patients appropriately. Dermal filler should be undertaken as part of a full dento-facial treatment plan, where we would first consider the teeth and occlusion, along with the skeletal relationship of the patient. During theconsultation, after assessing the dental and skeletal relationships, if it is determined that dermal filler treatment would benefit the patient you should discuss the procedure process, the risks, the alternatives (including referral) and also the likely results. For a patient, it is also important that they know who the injector is and the qualifications that they hold. the patient should also have a firm understanding of the maintenance required, as well as the financial costs involved, just like we would explain What to say when patients ask you about dermal fillers – the dentist perspective By Dr Giulia D’Anna, BDsc, MrACDs, Grad. Dip. Derm. th Cert iV tAe, Grad. Cert laser liniCal Dr Giulia D’Anna