As our faces age, they lose volume due to shrinking fat pads and some loss of bone. Fillers can help replace some of this volume. For good results, an excellent knowledge of anatomy is required; this is important for safety too.
We are professional and experienced clinicians based in a busy dermatology department so you can feel confident in our expertise. Fillers can be helpful for wrinkles and creases in the lower half of the face, particularly the crease running down from each side of the nose to the corners of the mouth. We use the naturally occurring hyaluronic acid, which is the main ingredient in mucus, as it has a good safety profile and is gradually reabsorbed.
How do fillers work?
Restylane is a brand name of a synthetic form of hyaluronic acid. This substance is identical in all species and tissue types, unlike collagen which differs between man and animals. Hyaluronic acid is present in all living organisms. It is a simple organic chemical that forms into long threads. These tangle together and act like a sponge. It is the main ingredient in mucus after water. In the skin, it creates volume and is used to fill out folds and wrinkles.
Restylane is a stable, bio-degradable, non-animal hyaluronic acid. It is produced under carefully controlled conditions in Sweden. It is a clear viscous gel. Tolerance to the gel is excellent, and is gradually absorbed. The material is slowly metabolised and excreted by the same pathways as natural hyaluronic acid.
Can fillers help me?
If you have lines, wrinkles or deep fold around your mouth and nose that you feel are ageing your appearance or giving your mouth a down-turned look, then dermal fillers may be a suitable treatment option to help restore lost volume to your face and jaw line.
Why come to the Private Skin Laser Clinic for fillers?
The Private Skin Laser Clinic has been providing professional consultant dermatologist appointments and treatments at the Royal Free Hospital in London since 1995. During this time, our team have collectively treated tens of thousands of patients and this wealth of experience will help us give you the best possible outcome.
What will happen during my treatment?
You will have time to discuss the procedure with a Consultant Dermatologist and then go away and consider it before booking a treatment. We inject the gel into your skin in tiny amounts with a very thin needle. The injected gel gives natural volume under the wrinkle, which is lifted up and smoothed out.
A treatment takes about 30 minutes and the results can be seen immediately. Restylane is not of animal or human origin, so a skin test is not needed. Depending on the effects desired, an initial treatment is usually maintained with occasional follow-up treatments. Most patients choose to have a follow-up treatment six to twelve months after an initial treatment of wrinkles. Clinical trials show that Restylane is effective for up to one year.
What can be treated?
Restylane is used for smoothing out folds and wrinkles, for lip enhancements and shaping of facial contours. Typical sites are deep creases between the eyebrows, and the folds running between nose and mouth.
What will I look like after the treatment?
Immediately after the treatment you can expect slight redness and swelling. This is a normal result of the injection. The inconvenience is temporary and generally disappears in a day or two. If the inconvenience continues or if other reactions occur, please contact the clinic. The initial swelling after lip treatment lasts longer, and can be dramatic. Some patients experience swelling for about a week and the lips can look somewhat uneven during this time. This means that the result directly after the treatment should not be looked upon as the final result.
Does it hurt?
For wrinkle treatments, no pain relief is generally necessary, although some patients like to apply an anaesthetic cream an hour or so before the treatment. When enhancing the lips, pain relief in the form of a local anaesthetic injection is often used.
Is it safe?
No procedure is ever completely safe. Common injection-related reactions can be expected. Other types of reactions are very rare, but about one in every 7,000 treated patients have experienced localized reactions of a hypersensitivity nature. These have usually consisted of swelling at the injection site, sometimes affecting the surrounding tissues. Redness, tenderness and rarely acne-like formations have also been reported. These reactions have either started a few days after injection or after a delay of two to four weeks and have generally been described as mild to moderate and self-limiting, with an average duration of two weeks. There has been one report of small ulcers forming over the injection site, which healed to leave pitted scars. In addition, rare cases (less than 1 in 15,000 treatments) of granuloma formation, superficial necrosis and urticaria have been reported.
The results of several studies and experience from over 700,000 treatments indicates that a skin test is not necessary. Restylane has undergone extensive histological and clinical studies and there is an impressive and increasing body of evidence regarding its ease of use, tolerability and effectiveness. Restylane is not licensed for use during pregnancy or whilst breastfeeding.
What are the anticipated side effects?
After the injection, some common injection-related reactions will occur. These include redness, swelling, pain, itching, discoloration or tenderness at the injection site. These improve by themselves, within a few days after injection into the skin, and within a week after injection into the lips. Temporary lumpiness has been felt in some patients. There may be a few days of discomfort before optimal results are achieved.
Can Restylane be used after laser treatment or a peel?
Yes, but it is recommended that you wait until the treated area is totally healed and the skin has settled completely; four to six weeks would be reasonable.
How long does the effect of the treatment last?
If you have a treatment for lines, wrinkles and folds, you would typically need a follow-up treatment after six to twelve months.
For lip treatments, in general follow-up treatment is needed after about six months, but it depends on many factors, such as the structure of the skin, lifestyle, age, the degree of perfection demanded by the patient and the injection technique of the practitioner. Clinical experience indicates that touch-up and follow-up treatments will add to the duration. Lips often swell a great deal but this is typically gone within a week.
Does Restylane stiffen in cold weather? What happens in the sun?
You should not expose the treated area to intense heat (e.g. solarium and sunbathing) or extreme cold for the first few days after the treatment. This is to avoid risk of inflammation since the area has been disturbed. However, once the Restylane is integrated into the body, it will adjust to a normal body temperature.
What does the treatment cost?
Please refer to Fees for current pricing.
The history and chemistry of hyaluronic acid
In 1934, Karl Meyer and his colleague John Palmer isolated a previously unknown chemical substance from the vitreous body of cows’ eyes. They found that the substance contained two sugar molecules, one of which was uronic acid. As a result, they proposed for convenience, the name hyaluronic acid, from hyaloid (vitreous) + uronic acid. At the time, they did not know that the substance that they had discovered would prove to be one of the most interesting and useful natural macromolecules.
Hyaluronic acid (HA) was first used commercially in 1942 when Endre Balazs applied for a patent to use it as a substitute for egg white in bakery products. He went on to become the leading expert on HA, and made the majority of discoveries concerning HA during the next 50 years.
In the last two decades, the therapeutic and aesthetic uses of hyaluronic acid have been extended to a number of areas, including treatment of joint pain, use in fertility clinics, and tissue augmentation. In recent years, biotechnology has been used to develop hyaluronic acid derivatives with tailor-made molecular sizes; this will further increase the potential applications of this remarkable molecule.
Hyaluronic acid exists naturally in all living organisms and is a universal component of the spaces between the cells of body tissues (extracellular space). It is a polysaccharide that has an identical chemical structure whether it is found in simple bacteria or in human beings.
Hyaluronic acid plays a vital role in connective tissues such as the skin. The dermis of the skin comprises a network of collagen fibres plumped up with hyaluronic acid. The elastic properties of hyaluronic acid offer resistance to compression, so that the skin protects underlying structures against damage. At the same time, the slippery properties of hyaluronic acid allow the collagen fibres to move easily. This lubrication by hyaluronic acid allows the skin to accommodate the changes in shape and volume that occur when the underlying bones and joints move.
The hyaluronic acid gel in the skin also inhibits movement of foreign particles, such as bacteria. This makes an important contribution to the skin’s defensive function as a barrier to infection. The barrier also affects the free passage of other exogenous material, such as some drugs. This is the reason why some subcutaneous injections and drugs in creams or ointments include a small amount of the enzyme hyaluronidase. The enzyme degrades the hyaluronic acid gel around it, so that the drug is able to pass more freely through the tissues of the skin.
When we get older, the amount of HA in the skin diminishes as the skin cells lose their ability to produce hyaluronic acid. In addition, the molecular weight of the HA decreases with age, so that it does not hold water as well. This can be demonstrated by squeezing the skin between the fingers. In young people, the skin rapidly restores itself to its original volume. However, as we get older, the skin’s ability to restore itself is reduced.
Structure of hyaluronic acid
Hyaluronic acid is a glycosaminoglycan (GAG). GAGs are giant molecules (macromolecules) made up of repeating disaccharide units. The molecular length of hyaluronic acid varies between different tissues and species. It may also vary depending on the condition of the tissue. For example, the molecular size of HA in synovial fluid is often lower than normal in joint diseases. An HA molecule of 10,000 disaccharide units could extend to 10 angstroms if stretched out straight, a length approximately equal to the diameter of a human red blood cell. This may not seem very large, but in comparison with most chemical substances, it is a very large molecule indeed.
The HA molecule is hydrophilic (water loving) and attracts water molecules to it. This means that HA is readily soluble in water. In solution, the very long and thin hyaluronic acid chain molecules kink and bend and adopt a conformation of an expanded random coil. These hyaluronic acid coils are so large that, even at a low concentration of about 0.1 % (1mg/ml), the hyaluronic acid molecules fill up the whole solution. At higher concentrations the hyaluronic acid coils intertwine and entangle, forming a flexible molecular network of entangled molecules. This entangled network of hyaluronic acid molecules is able to hold large amounts of water while allowing the passage of metabolites to and from cells.