Common questions about dermal filler treatments

When starting out injecting dermal fillers, there are many questions that can arise which can leave you struggling for answers – What are dermal fillers? Can hyaluronic acid gels move? Should I massage dermal filler after injecting? Can I use dermal fillers to treat scarring and acne scars?

In this blog, Dr Tim Pearce answers these common questions posed by aesthetic clinicians about dermal filler treatments.

Dr Tim Pearce provides a range of eLearning courses, aimed at medical professionals, including a series of detailed videos on the processes and techniques required for aesthetic treatments including dermal fillers. They are designed to provide valuable support to build confidence for those who have attended a face-to-face and hands-on practical training course.

How do dermal fillers work?

Dermal fillers are injectable products that add volume to your skin. At one end of the spectrum, saline can be used as a very temporary dermal filler, and at the other end, using your own fat is considered a dermal filler option. Most dermal fillers currently in use in aesthetic medical practice are hyaluronic acid-based dermal fillers, with a few exceptions.

Contrary to the name, dermal fillers are not simply for filling; they can shape, contour, and add detail. In the right hands, there is a lot of artistry in the results you can achieve when using a good dermal filler product for facial aesthetic treatments.

The great thing about hyaluronic acid-based dermal fillers, notes Dr Tim is that they are a copy of something that is already present in our skin, therefore they work to emulate a natural component of the skin.

As well as making them long-lasting, the manufacturers of dermal filler products have varied some of the properties of the hyaluronic acid gel which allows injectors to create more shape or volume or use the gel to treat a crease or create definition. The thickness and properties of the dermal filler gels vary – some working to smooth the surface of the skin and others to provide structure underneath the tissue to increase prominence. These properties lend themselves well to making patients look and feel more beautiful by creating shape and enhancing the angles on the face, replacing volume that has been lost in the fat pads, and adding detail by defining outlines like the vermilion border of the lips; the aim being to remove shadows, add structure, and create a more harmonious and youthful look.

Can dermal filler move after treatment?

When the dermal filler – a long chain sugar molecule of hyaluronic acid – is injected into the tissue, the molecules will start to tangle up with the existing molecules within the skin – collagen, elastin, and glycosaminoglycans – within the first few hours after placement and the gel begins to move less easily within the tissue as it integrates.

It can still move, within reason, and a small lump can be easily resolved with careful massage if a patient returns for a review after two weeks, for example. The filler is still mobile, but not actively moving. However, the exception is in those first few hours when you want to avoid too much touching or pressure on the treated area. For post-treatment advice given to patients, Dr Tim would urge caution for up to 48 hours with some products. Patients should avoid putting unnecessary pressure on the treated area to help it integrate into the tissue and stay where it has been placed for longer.

However, ultrasound studies have shown that dermal filler can still be present and slightly diffused from the location where it was originally placed, even several years after treatment. Therefore, the answer to the question, can dermal filler move, must be yes, and it is important to educate patients that diffusion over time is possible.

Another contributor to dermal filler product movement is facial movement. In areas of lots of movement, particularly the lips, you can see small collections or lumps of product at the oral commissures due to repetitive movement from mastication or chewing.

Do you need to massage dermal filler?

Dr Tim explains that you do not have to massage dermal fillers after completing the procedure. For most types of dermal filler, if it feels okay once you have finished injecting and you cannot see any lumps or bumps, you can leave it alone; even small imperfections will usually integrate within the first two or three weeks as things settle, therefore, there is no requirement to massage.

However, if you do decide to massage after the placement of dermal filler, there are some important considerations, particularly in relation to anatomy to avoid making matters worse or creating problems. As a general rule, the goal should be to remove lumps or bumps, whilst trying not to alter the position of the dermal filler.

For example, a common complaint is the presence of a lump in the lip. If you can feel a lump in the lip, Dr Tim’s advice is to apply a small amount of pressure to it, gradually increasing the pressure until you feel the lump ease underneath your fingers, then stop. His golden rule is that it is all about smoothing it, not moving it. Conversely, patients sometimes get oedema after a lip procedure. It can look like dermal filler lumps but is puffiness and swelling. This is not going to respond to massage and massage should be avoided in favour of waiting.

Similarly, Dr Tim urges caution with massaging dermal filler into areas that will make the aesthetic result worse. For example, if you massage a cheek treatment straight after the procedure, and do so towards the eye, you risk causing puffiness underneath the eye due to the hydrophilic nature of the product in this delicate area. Therefore, another golden rule is always massage away from the eyes and away from the lips or hold the area whilst massaging to preserve volume and avoid flattening the shape you have created which would lose or soften the aesthetic result.

Remember to educate your patients, advising them to keep poking and prodding to the bare minimum so they do not inadvertently massage away the results and make that mistake too.

Can dermal fillers improve acne scars and other types of scarring?

The simple answer is, yes, says Dr Tim. There are many ways that you can improve an acne scar, or indeed other scars, using dermal fillers. Firstly, you must establish the kind of scar you are dealing with because different types of scars require different treatment approaches and not all can be resolved well with dermal filler.

If an acne scar is attached to the dermis, the deeper facial plane, as is common with ‘ice pick’ type scars, then it will require subcision to release the fibres. If the scarring simply creates an indentation in the dermis, placement of a small amount of dermal filler underneath it will push it up, raising the indentation and removing and softening the shadow.

Longer scars can be troublesome, especially if they are near a crease or facial movement. If there is a crease caused by skin bunching upon facial movement because it is next to tougher scar tissue, it is possible to strengthen the area slightly with carefully placed dermal filler, which in turn will improve the appearance of the scar.

It is a good idea to properly assess a scar to determine whether it is the type of scar that can be improved with dermal filler, before attempting to treat it. Palpating with your fingers can tell you a lot. For example. if you can pull a scar apart, that might indicate that it is a crease. If you can push underneath a scar, and see it fade slightly, that might indicate that it can be raised with filler gel. Often, when treating patients for other indications, if there is a little of the product left in the syringe and they have expressed concern about a scar, such as an acne scar, a small amount of dermal filler can work well and achieve satisfying results.

For extra top tips to support practical hands-on training, take a look at Dr Tim’s eLearning dermal fillers foundation course which is designed to provide the core knowledge and skills required to safely and effectively treat the face with dermal fillers. Why not combine it with Dr Tim’s advanced eLearning course on dermal filler complications mastery designed to help practitioners understand, diagnose, treat and avoid complications with dermal fillers.

You can find Dr Tim Pearce on Instagram if you have any common questions about medical aesthetic treatments, or wish to comment on any top tips you are going to implement; he loves to hear from you all.

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Dermal Filler eLearning Courses

If you want to increase your knowledge about safe and effective dermal filler injectable treatments, Dr Tim Pearce offers a series of fabulous courses. The foundation level is a popular starting point, with many delegates continuing to complications courses focused around safety, including how to minimise the risk and how to handle things if the worst occurs:

• Dermal Fillers Foundation Course
• Dermal Filler Complications Mastery

Both give CPD and certificates on completion and are highly rated by our delegates.

In addition, browse our FREE downloadable resources.

Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.