THE DEBATE

Two aesthetic medicine practitioners share their views on dermal fillers with Shriyal Sethumadhavan.

Shriyal Sethumadhavan

Dr Madhuri Agarwal, Dermatologist and Founder & Medical Director, Yavana Aesthetics Clinic in India

“The effects of temporary fillers are easier to reverse.”

“Dermal filler is a quick and simple procedure that provides instant results with a minimal amount of discomfort and downtime. It is administered via tiny injections and the results are visible instantly. The natural soft tissue gel is completely safe and encourages the skin to produce more collagen (biostimulator) to restore a youthful appearance. Dermal fillers can last anywhere between six to eighteen months, depending on the type of filler material used and the area where it is injected. There are temporary fillers that stay in the tissue for less than a year, semi-permanent fillers stay for up to one to two years, and permanent fillers are substances that remain in the tissue for more than two years. The dermal filler effects are reversed naturally over a period as a biological part of tissue degradation.

In the past decade, temporary fillers have grown diverse in portfolio and formulations as they are preferred by physicians in comparison to the more permanent fillers. The effects of temporary fillers are easier to reverse.

There are situations, where the person is dissatisfied with the results of dermal fillers or the physician plans to reverse the results of previously injected fillers. Hyaluronidase is utilised to dissolve the effects of dermal fillers. Hyaluronidase can be used only in cases of temporary dermal fillers. It is injected as per recommended protocols in the dermal filler site and the effects of the fillers are reversed rapidly. In case of permanent dermal fillers, attempt to reverse the effects are usually via surgical excision mode.”

Dr Sonia Tekchandani, Consultant Dermatologist, Tender Skin International-India and UAE

“Hyaluronidase is injected into the skin to dissolve the filler.”

“An increasing number of soft-tissue fillers have been introduced to the market. By length of time, they remain in the tissue and by product composition:

• Temporary (6 to 18 months): Hyaluronic acid (HA)

• Semipermanent (12 to 24 months): Poly-L-lactic acid, calciumhydroxylapatite

• Permanent (more than two years): Polymethyl methacrylate, and polyacrylamide gel 

Temporary fillers are most often used for cosmetic purposes and there is a logical explanation for this choice. Ageing is a dynamic process, making it inadvisable to permanently correct a defect at a specific point in time. More than 85 per cent of dermal filler procedures are performed with Hyaluronic acid due to its natural origin, excellent safety profile, ease of injection, and the good results achieved. The pros of temporary dermal fillers include: They are minimally invasive and biodegradable; require minimal recovery time and have limited side-effects; and because it is not permanent, you can test out how the fillers will affect your look before deciding if you want to apply it permanently.

The cons of permanent dermal fillers include: Limited usage due to viscosity and inability to be absorbed by the body; removal treatments exist but are difficult and complex and it needs to be surgically corrected; and there are no guarantees that you will be satisfied with the long-term results.

In cases where dermal fillers have produced an undesired result, a reversal agent called Hyaluronidase is injected into the skin to dissolve the filler. Hyaluronidase is a naturally occurring enzyme that catalyses the dissolution of the filler, i.e., it works to break down Hyaluronic acid, supporting its rapid and constant turnover. It is important to note that for fillers with ingredients, other than hyaluronic acid, there are no reversal agents and can be removed only surgically.”