Dermal Fillers - Facial and Lip Enhancements

If you are considering having a dermal filler treatment, we recommend that you read the following information. This will help you to be fully prepared and know what questions to ask. Although dermal fillers are classed as a medical device and do not require a prescription, we recommend that you chose a prescribing practitioner because if something does go wrong, you may need a prescription item to be able to correct this. i.e, If you require your filler to be dissolved the medication for this is Hyaluronidase which requires a prescription. Tres Beaux Aesthetics is a nurse led clinic run by a Registered Nurse.

Prior to treatment you should have a face to face consultation with your treating practitioner and be offered a cooling off period before returning for treatment, so that you have time to consider your decision carefully based on the information you have been provided with.

WHAT IS DERMAL FILLER?

Dermal filler injections are administered using a small needle, a cannula or both. Dermal fillers usually come packaged in a box that contains sterile needles, product labels, and pre loaded syringe that should be opened in its sterile packaging in front of you at the beginning of the treatment. The product label will include the name of the product, batch number and expiry date. This will be documented on your treatment records and should be provided to you on request. The syringe will contain clear gel like substance, which consists of a water-based carrier gel, non animal hyaluronic acid, and may contain lidocaine, which is a local anaesthetic to make the treatment more comfortable. Hyaluronic acid is naturally occurring substance, which is a major component of our skin and has a function in wound repair, hydration, and cell to cell communication. One of the main characteristics of hyaluronic acid is that it effectively binds water like a sponge, which is why it is an effective tissue filler.

Dermal fillers work by boosting the skin’s supply of hyaluronic acid, dermal fillers revitalise and add volume to the skin, instantly diminishing the appearance of lines and wrinkles, and giving a natural softer look. Dermal fillers are a soft injectable gel consisting of stabilized, non-animal hyaluronic acid. The gel is tissue-friendly and closely resembles the hyaluronic acid that exists naturally in the body. It is long-lasting but not permanent.

There are over 60 different brands of filler available within the U.K and many more worldwide, but some have better safety profiles than others. Individual brands differ in the properties of the filler, including particle size, concentration and cross linking which effects their resistance to degradation (how long the filler will last), elasticity and volumising effect. Most brands will have several products in their range to enable treating different areas, ranging from softer fillers to treat fine lines and lips to firmer fillers to provide contour and shape. Popular dermal filler brands such as Restylane, Juvederm, Teosyal, Intraline, EPTQ, Amalian, and others can smooth out folds and wrinkles, add volume to the lips, and contour facial features that have lost their fullness due to ageing, sun exposure, illness, etc. Facial rejuvenation can be carried out with minimal complications. The products produce a natural volume under the wrinkle, which is lifted up and smoothed out. The results can often be seen immediately. Treating wrinkles with these dermal fillers is fast and safe and leaves no scars or other traces on the face.

What areas can be treated?

Dermal fillers can be used in most areas of the face and sone areas of the body, including neck, décolletage, backs of hands and genital areas. Technique is important and practitioners generally classify treatments as basic, intermediate or advanced.

ENSURE YOUR PRACTITIONER IS APPROPRIATELY TRAINED AND EXPERIENCED IN THE AREA YOU WOULD LIKE TREATING.

Commonly treated areas include:

• Nasolabial folds (nose to mouth lines

• Upper and lower cheeks

• Oral Commissures (corners of the mouth)

• Marionette liners (lines below the mouth corners)

• Lips - Classic Look, Natural Look, Russian Lips, Key & Pin Hole Lip Fillers

• Tear trough (hollowness beneath the eyes)

• Smokers lines (area above and below the lip)

• Jawline

• Jowls

• Chin

• Liquid Rhinoplasty (Nose reshaping)

• Temples

How does it work?

During normal ageing, the fat compartments of the face lose volume and the ligaments holding them in place become weaker leading to a sagging appearance. Hyaluronic acid and dermal fillers are extremely ‘hydrophilic” or water loving. When they are injected, they boost the skins volume, so the area becomes revitalised and volumised. By placing the dermal filler in specific anatomical positions this can also create a lifting effect. Adding volume helps to address issues such as volume loss, laxity and sagging of the skin, having a positive effect on lines and wrinkles. They can also be injected directly beneath the lines to help soften and improve them.

Hyaluronic acid dermal fillers are injected using a small. needle, a cannula or both and creates an instant filling out effect. Your practitioner should discuss what areas you would like treating and specific risks based on the treatment area., product used and your medical history. Most syringes contain 1ml of hyaluronic acid and often more than one is syringe is required to produce the desired result. This may be performed at the same time or at a later treatment session which should be discussed during your consultation.

Is it Painful?

Most dermal filler injections contain a small amount of lidocaine, which is a local anaesthetic to help reduce any pain experienced during the procedure. Even with the addition of local anaesthetic, it ids not a pain free treatment and it will depend on the injection technique, whether a cannula or needle is used and the individuals pain tolerance.

In some circumstances, a topical anaesthetic such as LMX4 or Emla , may be used to provide additional pain relief, particularly when treating sensitive areas such as the lips. This will be applied to the skin and left on for 20-40 minutes to take effect.

Once the anaesthetic has worn off, there may be some tenderness which is expected, but you should not experience a significant degree of pain. If you are experiencing considerable pain after the treatment you must contact your practitioner as this could indicate that you are developing a complication.

Is it safe?

Hyaluronic acid is a naturally occurring substance present in the skin and the product itself is considered very safe when it has been purchased from a reputable pharmacy or supplier. Counterfeit products have been found in general circulation which do carry a much higher risk of adverse events, so it is important to seek a practitioner who can demonstrate the source of the product. Tres Beaux Aesthetics uses the following suppliers: Medfx pharmacy, St Helens Pharmacy, Fox Pharmacy, Acre Pharmacy and Teleta Pharma.

Side effects may be more likely due to the following factors:

Patient Factors: condition of the skin, age, certain medical conditions, certain medications

Practitioner Factors: Training and years of experience, number of procedures performed.

Products/Brand

There are numerous brands of filler on the market today with an extensive price range. The top big 3 leading market brands are Juvederm, (Allergan), Teosyal (Teoxane), Restylane (Galderma). These brand have been around for many years and have been rigorously tested and meet FDA and CE approval. The FDA’s ( The united States food and Drug Agency) approval is based on the review of data collected from controlled clinical studies that have evaluated the safe and effective use of the wrinkle fillers when injected into specified areas of the facial tissues and the hands. These premium fillers are usually at the top end of the price range. Many other fillers are also available on the market that are often at a lower price range. These have not usually met FDA approval but must be CE approved to be licensed in the UK. Gold standard is to use FDA approved devices however that doesn’t mean that a non FDA approved filler is not safe it just means that it as not been through the same rigorous testing. These include fillers such as, Revolax, EPTQ, Intraline, Amalian and many others.

What is the difference between fillers and which should you choose?

Some fillers are very hydrophilic and soak in fluid like a sponge. These fillers are very good for areas such as cheeks, chin and jawline where a lot of volume is required. For very superficial lines and wrinkles a softer thinner filler is required that has high spreadability and will not be seen under the skin. For lips its all a matter of personal preference. For a natural more defined look a better option is the more premium brands that are less likely to migrate from the lip to the surrounding area. For those that want a full pouty lip shape then a filler with more viscosity is required. However, the thicker the filler and the more times they are treated the higher the risk of the lips becoming overfilled and migrating, resulting in a loss of shape and definition. Not everyone experiences filler migration even after several treatments using the thickest filler however some body types will have migration just from the smallest amount of filler if it is the wrong product for their body type. For further information and before deciding on the brand of filler that suits you please discuss this at consultation. It is sometimes helpful to show a photo of the desired size as an indication of what you regard as small or large. Your lips are individual to you and it is not possible to recreate a shape that someone else has however it is useful in determining what size is desired.

Possible adverse effects include:

Pain: you may experience some minor tenderness or discomfort post treatment. If you have more pain than expected, it is important to contact the clinic immediately as this may indicate a complication, such as vascular occlusion. Lip are more sensitive than other areas of the face and even if you have had fillers in other areas previously, you are likely to experience a degree of pain during the procedure. You may also experience some discomfort post-treatment.

Redness: This is normal and usually resolves quickly. If the treatment area becomes red a few days after treatment, particularly if heat is present, this may indicate an infection and you need to contact the clinic straight away.

Swelling: some swelling or oedema is normal after treatment and may be worse the following morning after the procedure. However persistent swelling should be reported to your practitioner as there may be treatment to help relieve this.

Bruising: As the procedure involves injections in the skin, bruising is a common finding. This can be anything from a small mark on the skin to extensive bruising which extends beyond the area treated and can take up to 2 weeks to resolve. Rarely bruising can lead to permanent staining of the skin. Lips are extremely vascular and therefore have a higher risk of bruising which can potential be seen on the skin around the mouth.

Infection: your treatment should be conducted in an appropriate clinical environment. Your practitioner should adhere to infection control protocols and you should receive appropriate aftercare advice to lessen the risk. Infection develops asa warm red, swollen area over the area that has been injected a few days after your treatment. If this occurs, make sure you contact the clinic for review as soon as possible.

Herpes (cold sores): Treatment around the lips can exacerbate an outbreak of herpes, which may be worse than a normal outbreak and may require treatment from your practitioner. Tres Beaux Aesthetics recommends that preventative medication is required for certain treatments in people who are prone to cold sores. It is important that this is discussed as part of your medical history.

Lumps: It is normal to have some lumps and bumps straight after procedure and these are usually caused by trauma and inflammation around the needle site. These usually resolve after a few days when the filler starts to soften and the skin start to heal. Other types of Lumps may be present immediately after treatment due to product misplacement or migration of the product or may appear several weeks or months later in some cases. Lumps may appear as soft swellings or hard nodules. They sometimes appear after acute illness, such as dental or sinus infection, or with exposure to excessive sunlight. If you develop lump, it is recommended that you contact the clinic for a face to face review.

Vascular Occlusion: This is rare but serious complication from dermal filler injections. In this situation, your blood supply has been compromised by filler that has caused a blockage or obstruction of normal blood flow. If this is not correctly managed, the skin and tissue supplied by the blood vessel does not receive sufficient oxygen and can result in tissue loss, scaring and secondary infections. A vascular occlusion will normally cause severe pain, irregular change of colour in the areas treated and poor capillary refit (a test that will be performed by your practitioner to see if the blood supply has been compromised). It will often appear immediately during treatment or soon afterwards and once this has been identified, your practitioner should have the necessary products at hand to effectively manage this. The most vascular occlusion occur because of lip filler injections. Tres Beaux Aesthetics is fully stocked with reversal medications at all times.

Blindness: This is an extremely rare and devastating complication that can occur with dermal filler treatments. There are certain areas of the face that pose a higher risk if they are injected, (Nose, and in-between the eyes) although it can occur from any facial dermal filler procedure. This should be discussed during your consultation with your practitioner, because if blindness occurs, it is likely to be permanent. There are approximately 350 cases worldwide.

Stroke: Another extremely rare, but documented complication of dermal fillers.

Dermal Filler Procedure

1. This product is administered via a syringe, or injection, into the areas of the face sought to be filled with the hyaluronic acid to eliminate or reduce wrinkles and folds.

2. An anaesthetic, numbing medicine used to reduce the discomfort of the injection, may or may not be used.

3. The treatment site(s) is washed first with an anaesthetic cleaning solution.

4. Dermal fillers are clear transparent gels that is injected under your skin into the tissues.of your face using a thin gauge needle.

5.The depth of injection(s) will depend on the depth of the wrinkle(s) and its location(s).

6. Multiple injections might be made depending on the site, depth of wrinkle and technique used

7. Following each injection, the injector should gently massage the correction site to conform the contour of the surrounding tissues.

8.If the treated area is swollen directly after the injection, ice may be applied on the site for a short period.

9. After the first treatment, additional treatments of dermal fillers may be necessary to achieve the desired level of correction.

Periodic enhancement injections help to sustain the desired level of correction

Risks/Discomfort

1 .Although a very thin needle is used, common injection-related reactions could occur. These include: some initial swelling, pain, itching, discolouration, bruising, or tenderness at the injection site. You could experience increased bruising or bleeding at the injection site if you are using substance that reduce blood clotting such as aspirin or other non-steroidal anti-inflammatory drugs such as ibuprofen.

2. These reactions generally lessen or disappear within a few days but may last for a week or longer.

3. As with all injections, this procedure carries the risk of infection. The syringe is sterile and standard precautions associated with injectable materials have been taken.

4. Some visible lumps may occur temporarily following the injection.

5. Some patients may experience additional swelling or tenderness at the injection site and rare occasions, pustules might form.

6. Dermal fillers should not be used in patients who have experienced this hypersensitivity, those with severe allergies, and should not be used in areas with active inflammation or infections (e.g., cysts, pimples, rashes or hives

7. Dermal fillers should not be used in areas other than the tissues of the face, Neck, Decolletage and back of hands.

8. If you are considering laser treatment, chemical peeling or any other procedure based on skin response after dermal filler treatment, or you have recently had such treatments and the skin has not healed completely, there is a possible risk risk of inflammatory reaction at the implant site.

9. Please allow at least 2 weeks before Vaccinations and 3 weeks after vaccinations for dermal filler treatments. There have been a small number of reported cases of swelling in the areas of filler placement after the Covid Jab. This is thought to be the body’s immune response and most cases resolved without treatment. You must ensure that you are at least 2 weeks clear of any symptoms if you have had Covid 19 or any other Flu like illnesses.

10. Most patients are pleased with the results of dermal filler use. However, like any cosmetic procedure, there is no guarantee that youwill be completely satisfied. There is no guarantee that wrinkles and folds will disappear completely, or that you will not require additional treatment to achieve the results you seek. while the effects of dermal fillers use can last longer than comparable treatments, the procedure is still temporary. Additional treatments will be required periodically, generally within 4-6 months to one year, involving additional injections for the effect to continue.

11. After treatment, you should minimise exposure of the treated area to excessive sun or UV lamp exposure and extreme cold weather until ant initial swelling or redness has gone away.

Benefits

Dermal fillers have been shown to be safe and effective when compared to collagen skin implants and related products to fill wrinkles, lines and folds in the skin on the face. Its effect, once the optimal location and pattern of cosmetic use is established, can last 6 months or longer without the need for re-administration.

Alternatives

This is strictly a voluntary cosmetic procedure. No treatment is necessary or required. Other alternative treatments which vary in sensitivity effect and duration include; animal- derived collagen filler products, dermal fillers derived from patients own fat tissues, synthetic plastic permanent implants, or Botulinium toxin that can paralyse muscles that cause wrinkles.

Cost/Payment

A quote will be given and the cost of treatment will be billed to you individually. Since most uses of dermal fillers are considered cosmetic, they are generally not reimbursable by government or private health care insurers.

Dermal Fillers After Care

You have undergone a dermal filler treatment where hyaluronic acid has been placed in your skin. You may have some swelling, redness and bruising which should subside within the next 3-14 days. A Cold compress should be applied to reduce swelling and arnica tablets/gel or vitamin K oxide cream can be used to reduce bruising.

Do’s & Donts

It is advisable that you do not touch the area or apply make-up for at least 6 hours following treatment to reduce the risk of infection. If you need to touch then apply hand sanitizer to hands before contact with lips. Avoid kissing (humans and animals). Paracetamol can be taken for any discomfort. Avoid aspirin and ibuprofen as this could increase bruising. For 48 hours you should avoid exposure to U.V and extreme heat i.e. sauna, steam, sunbed, direct sunlight, very hot showers, strenuous exercise etc, as this may increase discomfort and swelling. Avoid hot food and drinks for the first few hours. Use high protection UVA filter cream on lips if using sunbeds or travelling to hot countries. Lips are more sensitive to UVA and increase risk of swelling, burning and infection.

• Avoid extreme cold, including ice that is directly applied to the skin. If necessary you can apply a cool compress to the area to reduce any discomfort or swelling.

• Be careful when eating straight after lip fillers to avoid biting your lip.

• You should avoid facial massages or skin resurfacing until the area has fully healed.

How soon will I see results and how long will it last?

You should see the results immediately, although final results will become clear once any swelling has subsided. Our most common used filler is EPTQ, Intraline and Teosyal which last 6-9 months on average. However each person will metabolise the filler at different rates. Some people hold H.A filler longer than others depending on how much of the protein Hyalaise is present in the body. The protein Hyalaise breaks H.A filler down and is absorbed naturally by the body. It is therefore necessary for some clients to require regular top ups to maintain the desired result.

When to seek urgent review

Allergy or infections can occur but are thankfully extremely uncommon. If you get a painful or itchy bump or swelling near an injection site please contact Tres Beaux Aesthetics immediately for review.

When immediate help could be required

Pending Necrosis though extremely rare needs immediate attention to prevent scarring. It is caused by filler or swelling disrupting the usual blood supply causing discolouration (pale/white or dusky coloured area) usually associated with pain within the first few hours after treatment. Higher risk areas are the forehead or frown area, and the corner of the nose. It can occur in many different places however it requires an immediate return to Tres Beaux Aesthetics or if after hours to A&E.

Anaphylaxis: Though rare in the extreme, immediately after your treatment, if you were to start to feel generally unwell and develop swelling and redness around the face, I am trained to recognise and deal with anaphylaxis in clinic. If you are no longer at the clinic 999 should be called for urgent ambulance explaining your concern is anaphylaxis

Clinic Policy

• All clients must be over the age of 18

• Children are strictly not allowed in the clinic

• No food/drinks/smoking is allowed in the clinic due to hygiene reasons.