Dermal Fillers: Do's and Dont's

Fillers are an armamentarium in the anti-ageing treatment. Though ageing is a generalized phenomenon, the process of ageing does not occur uniformly in all areas of the face. The subcutaneous fat of the face is not a single uniform layer but is compartmentalized.[ 2 – 4 ] Each individual compartment ages at a different pace in the same individual. Hence correction of the ageing face needs correction of these individual compartments separately.

There are a host of fillers now available in India. It is imperative to know about these fillers, their constituents, particles per mg, cross-linking, monophasic or biphasic nature, presence of any additive like lignocaine, and their shelf life before and after opening the filler.

There are various methods of injecting the filler. Most popular is the linear threading method, either retrograde or antegrade. It is advisable that the beginners start with this technique than other methods like the depot or fern method which can be associated with lumps, if given inappropriately.

Initially, practice fillers under the direct supervision of a trained practitioner. It is better to practice fillers initially on people whom you personally know than on your patients. Do not venture into non-FDA approved indications. Anticipating any adverse effects, recognizing them promptly and institution of early rescue measures is as important as knowing fillers and administering them. When something is beyond your expertise, do not hesitate to take opinion of seniors.

Nowadays there are various opportunities to acquire knowledge regarding fillers. Theoretical knowledge can be acquired through textbooks, internet or journals.[ 5 ] Practical knowledge is best acquired by hands-on workshops or by working with seniors who are already practicing fillers. Workshops are conducted by national forums like Indian Association of Dermatologists, Venereologists and Leprologists (IADVL), Association of Cutaneous Surgeons of India (ACSI),[ 6 ] Indian Academy of Aesthetic Dermatology (IAAD)[ 7 ] and American Association of Aesthetic Medicine and Surgery (AAAMS);[ 8 ] training centres like KT Medical Aesthetic Training Centre,[ 9 ] Intraderm Ltd[ 10 ] and companies manufacturing fillers like Anteis[ 11 ] and which market fillers like Coherent Medical Systems.[ 12 ]

Know about the approval status of the filler

Fillers are considered as a medical device and hence there is a quality check conducted by various approval bodies in various parts of the world for their use. These approvals assert the authenticity and safety of products. Marketing of products is also easy if they have the certification by the appropriate bodies of that particular country. In Europe, Conformité Européenne (CE) marking is given for products complying with the laid standards.[13] In USA, an approval by Food and Drug Administration (FDA) is mandatory. The status of approval by FDA for any filler is widely accepted in most non-European countries and can be obtained online from the FDA's official website.[14]

Cost is a major issue in our country and this paves way for use of substandard materials to fulfill the patients' desire. New fillers from China,[15,16] Korea,[17] Syria,[18] Ukraine[19] and many other places are being introduced into the market, and in many instances full knowledge about the safety and approval status may be difficult to ascertain. Hence, dermatologists should restrain from using lesser known products. In such instances, the responsibility of treating physicians increases. It is important to note here the recommendation from the dermatosurgery taskforce guidelines of IADVL:[20]

Controlled data for the longevity of the filler materials published by the manufacturing company may not always be available. Both this and the fact that individual results may vary should be explained to the patient.

“Fillers from different countries are available in India and many of these may not have received approval from the drug authorities. It may not be always possible to use only FDA-approved fillers in our country. Controlled data for the longevity of the filler materials published by the manufacturing company may not always be available. Both this and the fact that individual results may vary should be explained to the patient. In view of these facts, full information about the filler and its approval status should be sought from the distributor, to satisfy oneself with full knowledge about the filler substance. Moreover, every country has its own approval systems and this should be taken into consideration.”