Where are dermal fillers actually injected?

So, it’s called a dermal filler, but is that really where we put it?

The answer is…sometimes.

The majority of dermal fillers aren’t placed in the dermis. The dermis is the 2nd layer of the skin, the first being the epidermis. When we same dermal filler, it’s because the filler is designed to sit in the dermis. The reason why it isn’t often placed here, is because it’s a very small space, about 2 sheets of paper thick and very hard to inject into accurately. Often when we are injecting we inject deeper than the dermis, and we end up in the small layer of fat under the skin.

So, if we aren’t injecting in the dermis, where so we inject? The most common areas are actually the fat under the skin and the deep fat under the muscle, above the bone. When treating certain areas like the cheeks, we actually aim for the bone and use this as a guide to reach the right spot for injecting.

Layers of the face

We try and avoid placing filler in the muscle – because if filler is placed here it can migrate. This happens because the muscle moves and will push at the filler over time. Filler can sometimes be injected into the collagen of the face, but there is some evidence that this can also migrate from this position as the collagen is interconnected throughout the face.

Other places we want to avoid placing filler is of course the blood vessels. It is important to avoid the blood vessels as very small bits of filler can block these vessels causing the skin and tissue in this area to be without blood and nutrients and they will start to deteriorate and eventually die if the blockage is not removed. This is why we use ultrasound in clinic when injecting fillers. We can see blood vessels on ultrasound and can actually see filler as it is placed, ensuring we put it in the right place. We can also investigate at which level in the tissues old filler is sitting, we can also follow blood vessels and look for any blockages in the vessels just after a treatment. This can make filler treatments safer and help identify blockages quicker, limiting the damage by fixing the problem quickly.

Layers of the face

Filler as seen on ultrasound

Dermal fillers should also not be placed in the organs of the face such as the parotid. This is a salivary gland located in front of the ears. Ultrasound can help us see how much space is above the organs and muscle, so that we can inject at the right depth and avoid putting filler into the wrong places.

Once in the tissue the filler, which is made of Hyaluronic Acid, sits between the collagen, elastin and fat cells, giving them support. The more natural a filler can integrate into this area, the more natural the result. Here the choice of filler is important and some fillers integrate better than others.

Images of filler in the tissue. A) is normal tissue and B, C and D are filler in the skin. The more it looks like A, the better integrated it is. Courtesy of Tran, et al.

Dr Kim Offers Ultrasound guided fillers in Bromley and Beckenham

Interested in an ultrasound guided filler treatment? Why not book a consultation with Dr Kim Booysen. She will assess your face with ultrasound prior to injection and can follow the fillers over time. Dr Kim can be reached via email on drkimbooysen@gmail.com.

Dr Kim Booysen has clinics in Beckenham and Bromley.

References:

Peng, Jui-Hui & Peng, Peter. (2020). HA Filler Injection and Skin Quality–Literature Minireview and Injection Techniques. Indian Journal of Plastic Surgery. 53. 10.1055/s-0040-1715545.

Tran C, Carraux P, Micheels P, Kaya G, Salomon D. In vivo bio-integration of three hyaluronic acid fillers in human skin: a histological study. Dermatology. 2014;228(1):47-54. doi: 10.1159/000354384. Epub 2013 Dec 3. PMID: 24503674.

Ultrasound Images courtesy of Dr Kim Booysen