Dermal Filler Wrinkle Treatment

This is Dr. Cal Shipley with a review of the use of dermal fillers to treat facial wrinkles and lines.

Wrinkles in human skin are caused by degeneration of the supporting collagen and elastin fibers located in both the superficial and deep layers of the dermis.

Dermal Fillers

The target area for dermal filler is the deep dermis. There are multiple types of compounds and substances used as dermal fillers. A few of the more commonly used substances are Artefill, a gel suspension which contains synthetic microspheres and collagen derived from cows. Hyaluronic acid gel. Hyaluronic acid is a carbohydrate polymer which occurs naturally in the human body and serves a variety of purposes, including lubrication of muscular connective tissues and as a major structural component in joint cartilage and skin.

Last but not least, human fat is used as a dermal filler.

Dermal Filler Wrinkle Treatment Technique

Regardless of which type of dermal filler is used, the injection technique is virtually identical. For the purposes of this presentation, I’m going to use treatment of a wrinkle located on the sidewall of the nose.

While the left hand stabilizes the patient’s skin, the right hand holds a syringe containing, in this example, Artefill, and places the tip of the needle at the base of the wrinkle and parallel to it. The needle is placed at a very narrow angle relative to the facial plane. The tip of the needle is then inserted into the deep dermis. Once the tip is inserted, the needle is rotated so that it is parallel to the facial plane.  The needle is then fully inserted beneath the wrinkle.

Now let’s return to the cross-sectional view showing the wrinkle and the deep dermis, as well as the dense network of  arterioles and capillaries which form the blood supply. From this viewpoint, we can more readily view the advance of the 27 gauge needle into the deep dermis, parallel to the skin surface. The advance of the needle creates a tunnel in the deep dermis. As the needle is slowly withdrawn, gentle but steady pressure is exerted on the plunger of the syringe.

As the needle is withdrawn, the tunnel is filled with dermal filler. The pressure exerted by the filler pushes the dermis up, resolving the wrinkle.

The typical volume of filler injected per injection is very small, typically amounting to no more than 1/500th of a teaspoon.

Multiple injections may be required to resolve a particular wrinkle. Additional injections of filler may be place above previous injections, or alongside them.

Cal Shipley, M.D. copyright 2020