When we discuss dermal fillers at consultation, there can often be a general feeling of “I wish it lasted for longer”. Patients are usually so delighted with the results that we are often asked if there are any fillers around that last a lot longer or are even permanent.
The answer to this is yes – there are quite a few permanent fillers available, none of which we use, or would ever consider using, at our clinic. The majority of practitioners, including most Plastic Surgeons, will never consider treating with a permanent dermal filler, for the very reasons outlined in this shocking article from The Daily Mail.
At our Droitwich Aesthetic and Laser Clinic, we only use temporary hyaluronic acid (HA) dermal fillers that have FDA approval. This means that they have undergone rigorous clinical trials and are considered safe and effective to use – two of the household names for example are Juvederm and Restylane. These products typically last around 6-9 months when injected into the dermis, although some of the newer fillers, such as Juvederm Volift / Volbella can last around 12-16 months.
Whilst it may be disappointing when the great effects start to wear off, the beauty of these products is that they ARE temporary, and if you aren’t happy with the outcome of treatment, or if there is a problem after the treatment, they degrade in the skin and disappear.
One of the problems with permanent fillers is that they cannot accommodate for the continuing ageing process. There have been incidences where a permanent filler is placed in the cheeks for example, and as the skin continues to sag and lose elasticity, the permanent filler can appear to be in the “wrong” area. It hasn’t moved, or migrated, simply the shape of the face and bone structures has altered over time and the filler is now not sitting where we would want it to. Temporay HA fillers can be adjusted each time you have treatment to allow for the natural ageing process.
There is also a well-documented risk of Biofilm occurring with permanent fillers. This is where a low-grade infection of bacterial growth forms over the filler implant and causes problems with repeated inflammation and infection. This can be tricky to treat in the long term, and the fact that the filler is permanent means that the problem is permanent. This image is an actress who was left with long term infections after cheek augmentation with a permanent dermal filler.
Probably the most serious problems occur with silicone based permanent fillers, and this is the problem in the case of the patient in this article. Initially, the results of the treatment with silicone are good and the patient is very happy with the treatment, and also pleased in the knowledge that they no longer have to spend money having temporary HA fillers done. So far….so good.
However, over time, water is drawn to the silicone though the body’s own natural immune response and inflammatory cascade. This results in the treated areas getting larger, excessive swelling and consequent deformity of the treated area. If the silicone was placed in the lips, they can swell to huge disproportionate size. Extra tissue can form in the mouth and can affect speech. This can happen many years after the intial treatment.
If this happens, the only option to remove the permanent filler is surgery, but often this is years after the filler was placed, and it will have merged with natural tissues and be difficult, if not impossible, to excise. This was the unfortunate situation Lesley Ash found herself in after having permanent silicone injections to her lips some years ago.
The message to take home is any problems with permanent fillers are permanent! Whilst it may seem to be a cost effective solution in the short term, evidence shows us that permanent fillers can cause misery and be extremely costly to improve. If you don’t like the results, basically you are stuck with it.