Dermal Fillers (Soft-Tissue Fillers)

As our face ages, it undergoes 4 main insults: (The 4 D’s of the Aging Face)
1. Deflation – loss of volume from our fat compartments, e.g. appearance of lines below the eye, the cheek loses volume etc. There is a loss of volume from the fat compartments as well as shifting of these compartments.
2. Tissue deterioration – the skin undergoes a battering because of environmental insults such as smoke, pollution, dust and our own habits leading to loss of elasticity and appearance of fine lines and dehydrated skin.
3. Descent – As mentioned above the shifting of fat compartments and loss of elasticity leads to a “sagging face” and appearance of jowls and down-turning of the mouth corners amongst other things.
4. Disproportion – The aforementioned changes lead to a disproportionate face and loss of balance and harmony of the face.

What are Dermal Fillers?
Dermal fillers, in fact, is a misnomer, they are actually soft tissue fillers or what is better known as fillers for soft tissue augmentation. Fillers are essentially made of Hyaluronic acid (aka HAF’s – Hyaluronic Acid Fillers) which is an essential and natural component of our skin and when this hyaluronic acid is synthetically processed and undergoes certain technological changes (converted to a gel form) its life in the skin increases as does its ability to gauge water. Post administration the HAF’s help gain support, re-inflate the deflated facial fat compartments, correct tissue hydration by gauging water leading to a supple skin and lift the face thereby addressing the descent and disproportion.
There are various types/ranges of soft tissue fillers which are chosen after a thorough facial analysis, counselling, and understanding of patient’s goals and motivations. e.g. A heavy or more robust filler maybe used for a lift to the midface or for contouring the jawline and a lighter filler maybe used for addressing lines under the eye and hydrating the facial skin to give a radiant and supple look.

Why Dermal Fillers?
The hyaluronic acid fillers are the most commonly used soft tissue fillers, as they are considered the safest, are non-permanent and are dissolvable. HAF’s are globally one of the most widely done aesthetic treatments as per the American Society of plastic surgery (ASPS) data of 2015. The reason for the popularity of fillers is due to the following reasons:
1. Non-Surgical and NO downtime – Dermal fillers treatment is a non-surgical treatment with minimal downtime. Patients can resume their work right after the procedure, which typically takes not more than 30 min.
2. Painless – Soft tissue fillers are available in pre-filled syringes and are reconstituted with the local anesthetic so as to provide minimal discomfort to the patient.
3. Longevity – The effect typically lasts anywhere between 9-18 months depending upon the product chosen for treatment.
4. Safety – At Veya Aesthetics we only use products which have undergone stringent clinical trials and have safety data supporting them. There is no compromise on the quality. HAF’s have vast safety data supporting their use worldwide.
5. Dissolvable – If a patient is dissatisfied with the results and want to reverse the effects, it is possible. This is one of the main reasons behind the increasing popularity and demand of this procedure.

Areas to be Treated
Hyaluronic Acid Fillers (HAF’s) can be used for males and females, cosmetic and therapeutic reasons and maybe administered to most age groups. There is no particular minimal or maximal age for the procedure. The person undergoing treatment should ideally be above 18 years so as to provide his/her informed consent or if less than 18 should be accompanied by a parent in order to consider the treatment for more therapeutic reasons.

Popular Cosmetic treatments for Women
– Periorbital area – The area around the eye region is the earliest to age and the one with the thinnest skin. The aging around the eye occurs due to weakening of certain ligaments and shifting of fat pads leading to sunken eyes, dark circles, fine lines and the tear trough or line extending from the inner side of the eye (close to the nose) to the mid cheek and at times all through to the other side of the eye. These changes may be accompanied by puffiness around the eyes as well. HAF’s can help to correct many of the above-mentioned issues and can result in a more pleasing appearance to the area around the eye.
Dr. Rajat believes that “treatment of the under-eye region requires to be treated by a certified professional as this area has important structures and a thorough knowledge of the facial anatomy is crucial for the injector.” Having said that a well-done job is highly satisfactory for the patient and the injector.
– Mid Face and cheek contouring – A high cheek bone and a fuller cheek are desirable in a female face. Restoration of the Ogee Curve (This is architectural shape consisting of a concave arc flowing into a convex arc, creating an S-shaped curve) with fillers is a popular treatment and is commonly asked for by patients.
– Lip plumping, definition and enhancement – “Enhancement of the lip, requires critical attention to detail as this is the only part of the face where even a minor asymmetry may seem dramatic”, says Dr. Rajat Kandhari. This is a treatment more commonly asked for by younger individuals. Dr. Rajat has his protocol of providing essential definition and some volume in order to maintain the balance to the rest of the face. Provision of hydration to the lips can also be done for people with excessively dry lips.

Other treatments for women
– Nasolabial folds / Smile lines – The nasolabial folds were at one point of time a very commonly treated indication but ever since the focus has shifted to the three-dimensional beautification of the face and restoring contours of the face, the cheek is treated first followed by the nasolabial folds or smile lines. The idea is not to over treat the nasolabial folds and give an unnatural appearance to the face.
– Marionette lines – These are lines which appear at the corner of the mouth and give the appearance of a downturned mouth or impart a sad look to the face. These lines are challenging to efface in severe cases, and other treatments such as neurotoxin for the lower face is combined to impart the best results.
– Chin reshaping – Indians ethnically have slightly recessed chins, and addressing this aspect of the face provides balance to their already beautiful faces. Dr. Rajat adapts the 6-point chin reshape, a technique innovated by Dr. De Maio.
– Jaw contouring – A chiseled jawline is desirable for not only females but even males. Dr. Rajat combines the chin reshape with jawline contouring and neurotoxin for the neck and lower face to give a “Liquid Neck Lift” to the face. This is a technique patients love and procedure requires minimal downtime that is increasing its popularity.
– Others such as temporal volume restoration, brow lifting, fines lines around the mouth are treatments which maybe asked for by women in particular.

Popular Cosmetic treatments for men
A common query of most men coming in for aesthetic procedures is that they don’t want to look “made up”, “artificial” or “feminine” – Dr. Rajat makes sure a conservative approach is followed for male patients after understanding their motives and goals for treatment. The idea is to retain the masculinity of the face and yet enhance the features for a fresher and younger look to the face.
– Mid face – the male face has more anterior projection and an angulation to the lower face. This is typically done to restore lost volume to the mid face and getting rid of the static lines in the mid face, such as those below the eyes and the nasolabial folds which impart an aged look to the face. As mentioned above, Dr. Rajat believes in softening the lines and not erasing them, as some lines enhance the look of a handsome male face and impart wisdom.
– Chin and jawline contouring – A male jawline is chiseled with a slightly wider angle to the jaw and a broader chin giving an authoritative look to the face. This is typically achieved with the help of fillers in combination with neurotoxin.
– Frown lines – Typically addressed with fillers and neurotoxin treatment for long lasting and best results.
– Other treatments are forehead reshaping and area around the eyes which are addressed for the male face.

Other areas targeted with HAF’s
Hands – the rejuvenation of the hands is sometimes asked for by patients – this is usually asked for by people who have dry skin and old looking hands.
Neck and decolletage – these are other areas which may appear rejuvenated with fillers, especially when combined with neurotoxin treatment or threads.

Do’s and Dont’s

  • Avoid green tea or green tea supplements prior to and post-procedure.
  • Avoid blood thinners pre and post procedure (you may discuss this with your doctor) so as to decrease chances of bruising e.g. aspirin, warfarin etc.
  • No deep massages/ facials post procedure for 48 hours.
  • Avoid heavy exercise on the day of procedure (post procedure).

Hyaluronic acid fillers are typically combined with other treatments for best outcomes, moreover, they form an integral part of Dr. Rajat’s FACEcraft program as well. At Dr. Kandhari’s skin clinic, it’s always our endeavor and practice to not compromise on the quality of products used for these procedures and only use products supported by solid clinical and experimental evidence.