This is a very popular cosmetic treatment and over the past two decades it has revolutionised the treatment of wrinkles and volume loss.
Dermal fillers can be injected in a deeper fashion to restore volume in areas that have begun to droop and hollow. Typical areas where this is the case are:
- Nose to mouth lines (nasolabial)
- Marionette lines
- Temple hollowing
Lips and around the mouth (perioral)
Dermal fillers are also used to volumise the lips. This is one of the most popular uses of dermal fillers. It is also important to understand that fillers aren’t just used to give young women full lips. They can also be used to restore the anatomical changes seen in older lips and as a result provide excellent rejuvenation of lips that have lost volume, definition and structure through the ageing process.
Hyaluronic acid is a safe and versatile tool in the treatment of facial ageing when used by an experienced and knowledgeable medical professional. Misconceptions about filler are unfortunately common due to the way that they are often portrayed in the media.
Lower density (softer) HA fillers are used sometimes within the skin to help with the treatment of fine lines and wrinkles. Major creases are best treated through appropriate deeper volume restoration with higher density fillers. Although fine lines can be visibly improved with low density HA fillers, treatments such as fully ablative CO2 laser resurfacing provide a more powerful and permanent way of dealing with fine wrinkles around the mouth and the eyes. The advantage of treatment with Dr Hussein is that he is an expert in all aspects of cosmetic dermatology and as a result will be able to provide the most appropriate treatment whether it be filler, laser resurfacing or something else.
Tear trough Correction
This is a technically complex area of the face that must be treated by someone who has significant expertise in assessing and treating the area. Multiple problems can lead to ageing around the eye. Hereditary factors, dermatochalasis (skin laxity), fat pad prolapse, muscle weakening, hypermelanosis, age related bone remodelling and vascular changes can all combine in varying quantities to age the area around the eye.
If treatment of the tear trough is appropriate (it may be that fully ablative CO2 laser tightening or surgical blepharoplasty with fat reduction may be more appropriate) then it should be performed by someone with comprehensive anatomical knowledge of the area and a significant amount of case experience. Please refer to Dr Hussein’s video lecture below for a better understanding of this complex area.
Nasal correction with filler (Non-surgical rhinoplasty)
Nasal and peri-nasal injection with filler has become a very popular in the last decade. The nose is an anatomically complex region and unfortunately the incidence of potentially dangerous complications is highest here compared to any other region on the face. Blockage of blood vessels causing skin necrosis and blindness are two of the most severe complications of filler injection that can arise in injections of the nose.
Due to the lower two thirds of the nose being soft and cartilaginous in structure HA fillers have significantly low success in changing structural nasal anatomy.
Nasal corrections that CAN be achieved to a reasonable degree with HA filler are as follows:
- Dorsal hump softening/saddle shape deformity (but at the cost of flattening of the nasal-frontal angle which can then look odd).
- Dorsal columns can be adjusted giving the illusion of a straighter nose.
- Softening of a bulbous nose tip through widening and increasing the height of the nasal dorsum.
Nasal corrections that CANNOT be achieved effectively or to any significant degree with filler are as follows:
- Correction of lateral (sideways) deviation of the nose or septal deviation
- Lifting of the nasal tip or upward rotation of the tip
- Increasing the height of a flat radix (sharpening and height increase for those with a flatter nose)
Any changes are relatively short lived and each time this process is repeated (which by nature has to be every 6 months) the cumulative risk of severe complications arises. The best advice when it comes to nasal correction is to seek a safer and more long-term surgical solution in the hands of an experienced plastic surgeon.
A high risk of complications will be encountered if fillers are used in the treatment of patients who have undergone previous nasal surgery (rhinoplasty) and should only be performed by plastic or ENT surgeons with significant rhinoplasty experience.
Dr Hussein performs over 800 cases of Hyaluronic Acid Dermal Filler injections a year and has done so for over a decade. He is a UK advisor on complications management and also teaches as an Honorary Clinical Lecturer at Queen Mary University of London. He also runs numerous courses for medical professionals training them in facial anatomy and filler injection techniques.
If you are a professional interested in training with Dr Hussein please look at the H&H Aesthetic training courses website.
With Hyaluronic acid filler duration multiple factors can affect duration. Smoking, exercise, UV exposure, ambient temperature, subsequent treatment with lasers and radiofrequency are just a selection of common factors that can speed up the breakdown of Hyaluronic acid fillers.
The average duration of common HA filler injections are listed below. These are the average times between repeat treatments:
- Cheeks = 12 months
- Nasolabial Lines = 12 months
- Marionette Lines = 12 months
- Tear Trough = 18-24 months
- Lips (volume) = 4-6 months
- Lips (definition/perioral lines/ageing) = 12 months
Hyaluronic Acid Fillers are a safe and versatile product that can be used for great effect when used in the right hands.
Unfortunately Hyaluronic Acid Dermal Fillers are classified as medical devices in the UK. They are not classified as Prescription ONLY MEDICATION (POM).
As such technically anybody can administer a dermal filler in the UK. The overwhelming majority of medical professionals in the UK believe that this should not be the case. Understanding how to use a dermal filler safely and effectively requires a in depth understanding of the anatomy of the face. In particular the blood supply of the face must be well understood as it is possible to block important blood vessels with fillers.
Complications of Hyaluronic Acid Dermal Fillers include:
- Temporary redness and swelling (all cases)
- Bruising – 1 in 10 cases
- Granuloma/Nodule formation – 1 in 1000 cases
- Blood vessel blockage (resulting in skin necrosis and scar if not urgently treated) – 1in 1000 cases
- Blindness (migration of filler from arteries around the nose and frown area to the central retinal artery) – 1 in 10000 cases (high risk areas are Nasal injection and Glabella injection)
- Infection/biofilm – 1 in 2000 cases (if appropriate technique and preparation agents used)
Fillers that are administered by untrained individuals can cause necrosis (death of skin) that results in irreversible scarring. Fillers administered into blood vessels have also been found in post mortem studies in the blood vessels of the lung:
This would have got into the circulation via injection of large amounts of filler into large veins of the face.
Untrained individuals such as beauty therapists who undertake these procedures have insufficient understanding of anatomy. Complications can arise even in treatments performed by medical professionals.
Doctors performing these procedures understand how to manage these complications. Having a procedure like this performed with a medically trained professional such as a Doctor means that there is recourse to safe management if a problem arises. You can also be reassured that Doctors carry adequate insurance cover to carry out these procedures. This is because this is a registration requirement for the GMC. Untrained individuals who do not have to have a licence to practice via a professional regulator like the GMC may not have adequate insurance cover.
Complication Management by Dr Hussein
It is unfortunate that many hyaluronic acid filler injections that have been performed by non- medical professionals result in sub-optimal outcomes and complications. It is often that Dr Hussein is approached by clients who have had a sub-optimal outcome or have experienced a complication from treatment by another practitioner. A common scenario is that when the client has tried to contact the original practitioner regarding the complication or suboptimal outcome it has been difficult to get in touch. Often they are unable to get in touch with the practitioner or they are told that nothing can be done and they should wait for ‘things to wear off’.
In the first instance Dr Hussein does not like to undertake corrections of another practitioner’s work. He firmly believes that sub-optimal outcomes management, corrective work and complications management should be undertaken by the original practitioner. This allows the original practitioner an opportunity to assess his/her own work and optimise the outcome. This will be an important learning experience for the original practitioner and also will be free of charge to the client.
In exceptional cases Dr Hussein may agree to assess and manage complications. Where urgent intervention is required for example. If Dr Hussein agrees to undertake this work then there will be a consultation charge and a fee for remedial work.
It goes without saying that Dr Hussein would manage any sub-optimal outcome or complication arising from his own work free of charge.
Costs of remedial work from outcomes related to other practitioners
- Consultation & assessment: £150
- Letter to original practitioner: £125
- Cost of hyalase dissolving procedure: £250
- Pulsed Dye Laser to speed resolution of Bruising: £335
- Cost of remedial work: charged according to filler products used
- Cost of steroid injections for treatment of late onset nodules: £150
DR HUSSEIN CASE GALLERY
Dermal Fillers – Jawline
Dermal Fillers – Cheek
Hyalase Tutorial pt.1
Hyalase Tutorial pt.2
Hyalase Tutorial pt.3
Dermal Fillers – Aspiration Tutorial
Dermal Fillers – Temporal Fossa Full
Dermal Fillers – Tear Trough
Cost is based on the type of filler used. In general filler is charged on a syringe by syringe basis. Each syringe contains 1ml of HA filler. The higher the density of the filler the higher the cost of the vial. Prices of the Allergan JuvedermTM range per vial are listed below:
- Juvederm Volbella 1ml: £410
- Juvederm Volift 1ml: £440
- Juvederm Voluma 1ml: £460
- A typical tear trough correction may require 1ml of Juvederm Volift OR Volbella
- A typical cheek and nasolabial correction may require 2-3mls of Voluma
- An average lip volumisation will require 1ml of Juvederm Volift
- A peri-oral line and lip restructuring for age related changes will require 1ml Juvederm Volift AND 1ml Juvederm Volbella