Plumping up a sagging face with fillers

The most common dermal fillers are made of hyaluronic acid, which can also be found naturally in our body. — AFP

Day by day, time can pass by quickly as we age every second, minute and hour.

However, aside from the natural progression of time, other factors can also cause us to age.

Work stress, genetic predisposition, smoking and health conditions are just a few of the reasons behind accelerated ageing.

Conversely, there are a lucky few who seem to age slower and perpetually look young with a “baby face”.

A significant contributor to this youthful-looking skin is collagen.

Collagen is an important structural molecule in our body.

It makes up a total of 25% to 30% of our body protein content.

It is present in most of the tissues in our body, including the skin, tendons, ligaments, bone and gut.

In our skin, collagen provides elasticity, helps stimulate cell growth and maintains its good texture.

As we age, our body produces less collagen.

As a result, we lose skin firmness and mass,

Another important cause of ageing is photoageing.

Exposure to sunlight 10 to 30 minutes a day, a few times a week is important for vitamin D production in our body.

ALSO READ: Malaysians still have low levels of vitamin D despite abundance of sunlight

However, the sun emits ultraviolet A (UVA) and ultraviolet B (UVB) rays that damage our skin-deep structures, including our collagen fibres.

This causes premature skin ageing to occur.

Photoageing also further worsens skin pigmentation issues such as melasma (dark patches or spots) or freckles.

UV rays are highly emitted from 11am to 4pm.

Loss of volume

Ageing causes loss of volume throughout our whole body, particularly the face.

Human body volume is contributed by muscles and fats.

A teenager or young adult usually has good volume, but this tends to decrease as we grow older.

Fat loss, bone loss and broken-down collagen contributes to volume loss.

Our face has a lot of superficial and deep fat pads, which are like cushions.

Similar to our sofas, as time passes by, the cushion softens and changes shape.

The fat pads go through atrophy (breakdown of fat cells) as we age.

As these facial “cushions” break down, the facial volume and support also reduces.

This then leads to sagging skin.

Significant fat loss can occur all over our face, especially at our temples (temporal area), under the eye (tear trough), the side of our face (preauricular) and chin (mandibular area).

Bone loss also contributes to volume loss.

We tend to lose mineral density and bone mass over time.

Our skull is like a framework. As this framework shrinks, our facial structure also changes and leads to loss of facial volume.

Most common filler

This is where dermal fillers can play a role.

These gel-like substances are injected under the skin to temporarily restore facial volume and help contour the face.

They can last 12 to 18 months depending on the type of dermal filler used and the person’s lifestyle.

There are many types of dermal fillers in the market.

They can be made of hyaluronic acid, calcium hydroxyapatite, polymethylmethacrylate (PMMA), poly-L-lactic acid (PLLA) or poly-D, L-lactic acid (PDLLA).

Hyaluronic acid dermal fillers are the most widely used in the world today.

This is as hyaluronic acid is naturally found in most tissues in our body.

It is also non-allergenic and its effects can be reversed.

The dermal filler acts like a cushion to support our facial structures that have lost volume and elasticity over time.

The hyaluronic acid is also attracted to and binds to water molecules in our body, keeping the skin hydrated and firm, as well as looking fresher.

Hyaluronic acid dermal fillers can be injected into certain layers of the skin to achieve specific results, e.g. to treat deep smile lines (nasolabial folds), acne scars or depressed cheeks, or to change lip shape.

Common areas of treatment are the temples, brow, malar fat pads, tear troughs, cheeks, nasolabial folds, chin, jawline, nose and lips.

If the results are not satisfactory, the filler can be dissolved with the enzyme hyaluronidase, which breaks down hyaluronic acid.

Other common fillers

Calcium hydroxyapatite is found naturally in human bones.

Fillers made from calcium hydroxyapatite are biosynthetically produced and give very natural-looking results.

They can help reduce moderate to severe facial wrinkles and folds, such as the nasolabial folds.

Contouring of the jawline can also be done.

Calcium hydroxyapatite fillers generally last 12 to 15 months.

PLLA and PDLLA are also commonly-used fillers.

These are collagen bio-stimulators, meaning that they stimulate your own skin to produce more collagen.

Both types of fillers can generally last one to two years.

As time passes by, they are broken down to water and carbon dioxide by your own body.

For the best natural results, the collagen stimulation needs to occur over a few months.

Meanwhile, PMMA fillers contain bovine collagen.

They also stimulate your skin to produce collagen.

Due to the presence of bovine collagen, a skin allergic test is required at least two to four weeks before the procedure to detect any allergy to bovine products.

PMMA fillers can last up to five years.

See a trained professional

Injecting dermal fillers require skill and precision.

Aesthetic doctors undergo proper training and certification before injecting fillers.

Many complications can happen if the injection is not done properly.

The procedure must be done in an aseptic technique, meaning in a clean, sterilised environment with proper sterilised equipment.

Complications such as injection site bacterial infection can occur if safety precautions are not taken.

Nodules or granuloma (tissue swelling) can occur if the fillers are injected in the wrong plane.

The worst complication that can happen is when a filler is injected into a blood vessel, of which our face has many.

This can lead to skin necrosis (death), and also blindness.

Some people go to beauticians to get their dermal filler injections.

The main reason for this is because of the cheaper prices.

However, beauticians are actually not legally allowed to do invasive procedures, i.e. anything that penetrates or pierces the skin, including giving injections.

They are also not trained in the anatomy of the face and are not qualified to treat any potential complications that may arise from the injection.

Only qualified medical professionals, such as aesthetic doctors, can perform such procedures.

Remember, safety and quality are more important than anything else.

Dr Kenneth Wong Chen Fei is a general practitioner (GP) certified in aesthetic medicine. For more information, email [e-mail]. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.