Do Fillers Make Wrinkles Worse? An Expert's Perspective

Miriam Hanson explains how dermal fillers work & what risks they carry when used for cosmetic purposes.

Do Fillers Make Wrinkles Worse? An Expert's Perspective

Miriam Hanson, Certified Dermatologist and Cosmetic Expert in Austin, Texas, is well-versed in the use of dermal fillers. Dermal fillers are a family of injectable medications that restore volume to areas of the skin where it has been lost. People seek treatments to soften smile lines and crow's feet and fill lips, cheeks and hands. Injecting dermal fillers into the face and hands can improve the appearance of facial lines and volume loss caused by age or certain medical conditions.

In studies of dermal fillers approved by the U. S. Food and Drug Administration (FDA), people generally report that they are satisfied with the results of their treatment. However, dermal fillers aren't for everyone.

Dermal fillers may not be suitable for people with certain conditions, such as bleeding disorders or some allergies. If your healthcare provider confirms that dermal fillers are an option for you, know that all medical products have benefits and risks. Dermal fillers are gel-like substances that are injected under the skin. They are designed to create a softer or fuller appearance, or both.

The FDA regulates dermal fillers as medical devices. As reported in clinical trials, the effects of most FDA-approved dermal fillers are temporary because they are made of materials that the body eventually breaks down and absorbs. The injection procedure may have to be repeated to maintain the desired effect. There is only one FDA-approved dermal filler that is not absorbed by the body; it is made with polymethylmethacrylate (PMMA) beads suspended in a solution containing bovine (cow) collagen.

As with any medical procedure, there are risks associated with the use of dermal fillers. Most side effects reported in clinical trials and post-marketing surveillance occur soon after injection and disappear within a few weeks. In some cases, side effects may appear weeks, months, or years later. People should be tested for allergies before receiving dermal fillers made with certain materials, especially animal-derived materials, such as collagen.

The most serious risk associated with dermal fillers is accidental injection into a blood vessel. Filling that enters a blood vessel can cause skin necrosis (tissue death), stroke, or blindness. While the chances of this happening are low, if it occurs, the resulting complications can be serious and can be permanent. If you want to have your fillers removed or reduced because of side effects, you may need additional procedures to reduce the filler or surgery to remove it.

These procedures carry their own risks; keep in mind that it may be difficult or impossible to remove some fillers. The FDA has also approved botulinum toxin products such as Botox, Dysport, Xeomin and Jeuveau to treat facial wrinkles. These products are not dermal fillers; they are injectable medications that work by preventing muscles from contracting, so wrinkles are not seen as much. The safe use of dermal fillers in combination with Botox and other treatments has not been evaluated in clinical studies.

Although botulinum toxin products are derived from the same bacteria that cause botulism, the amounts used for cosmetic purposes are purified and are many orders of magnitude smaller. The FDA has approved these injectable drugs for temporary improvement in the appearance of one or perhaps several types of facial lines, including frown lines, forehead lines, and crow's feet. Side effects reported in clinical trials include facial weakness, drooping of the eyelids and drooping of the eyebrows. Other adverse events included localized pain, swelling, redness and bruising at the injection site.

In rare cases, injections have caused double vision, dry eyes, or difficulty swallowing or breathing. Injection of botulinum toxin products for cosmetic purposes is not recommended for use during pregnancy or breastfeeding. If you have had a problem with a dermal filler or other FDA-regulated product, you can voluntarily report it to MedWatch, the FDA's safety information and adverse event reporting program. Sign up to receive email notifications for updates.

The use of fillers has gone astray and has gone to an extreme; its use to give the face unnatural proportions, fill in wrinkles and lines and lift the face has the opposite effect of making the face look older and age faster. Although this is rare, the filler can be accidentally injected into a blood vessel and cause blurred vision or permanent blindness; you should call your doctor or emergency room if your skin turns blue and you feel a lot of pain: these are two possible signs that there is filling in the bloodstream. Again, this is why you want to see an experienced doctor who is trained to perform the procedure; when you put more filling than your body can hold in one place, the filling has to go somewhere and it goes south, causing sagging. His artistry and skill allow him to discern the precise amount of dermal filler needed to give you the results you're looking for without seeming artificial or exaggerated.

Dermal fillers are composed of hyaluronic acid, a natural molecule found in the skin that gives it the ability to attract and retain moisture; when dermal fillers are injected into areas of the face they fill the skin and restore lost volume but it takes months or years for them to break down naturally.