Miss Sherina Balaratnam goes back to basics with dermal fillers to investigate how dermal fillers can significantly delay the need for surgery.  Most people who have cosmetic surgery are seeking a more youthful appearance, but still want to look like themselves. A possible solution to achieving this is to undergo temporary procedures that wear off, before committing to something permanent

Our understanding of how the face ages and how to best mitigate these changes, is in a perpetual state of evolution and refinement. As a surgeon and medical director of a busy clinic, one of the key signs of ageing that I see in my patients is loss of volume and the restoration of volume in a sympathetic and strategic manner is key to a successful treatment.

Facial ageing

Through anatomical and imaging studies, the discovery that facial fat exists as many dynamic compartments rather than a single confluent entity represents a major breakthrough in our understanding of facial ageing. These compartments can be assessed and augmented in a strategic fashion to produce aesthetically pleasing results.

The 3 dimensional way in which we age includes changes to the skin, soft tissue, fat, muscle, ligamentous attachments and bony support, which all have to be taken into consideration when assessing patients requesting facial rejuvenating procedures. It is essential to identify these changes, and the individualization of the treatment plan can help achieve the desired outcome of subtle and natural looking results without looking overdone.

Furthermore, levels of a sugar molecule called Hyaluronic Acid (HA), found alongside collagen and elastin in the dermis of the skin, also start to decrease, leaving skin less supported and less hydrated. Fine lines and wrinkles develop, skin starts to sag and our overall facial structure changes and we start to look older.dermal-filler-casestudy totally aesthetic magazine issue 2

While facial ageing and descent occurs as a normal ageing process, smoking, sun exposure and stress can accelerate the pace at which this happens. Patients often mention sagging as their initial concern, but also key emotions such as feeling that they look tired, or sad all the time, despite feeling their usual self.

Using this knowledge on a ‘case-by-case’ basis so as to individualise treatments remains the mainstay of facial rejuvenation to offer the sort of subtle and natural-looking results desired by my patients. My patients don’t come to me wanting ‘to be filled’. They desire to look a slightly younger and more attractive version of their tired or aged self. They don’t wish to look like a different person, they still want to look like themselves.

This is where facial fillers can help. Facial fillers – substances injected under the surface of the skin – can be used to correct and restore areas of volume loss in the face and restore a youthful and fresher appearance. Permanent fillers are available in the UK, however I tend to prefer temporary products that naturally break down with time to work in synergy with the ageing pattern in my patient’s faces.

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History of facial augmentation and facial fillers

Historically, transplanted fat to correct facial volume remained the cornerstone of facial augmentation. However with surgeons seeking the ideal filler material to restore facial fat, injectable fillers were born. In the 1980’s the first-generation modern day fillers consisting of bovine collagen produced aesthetically pleasing results and paved the way for the research and development for further facial fillers to come. Injectable collagen followed until the mid 1990’s and in 2003 the FDA approval of the first Hyaluronic Acid (HA) dermal filler became the major breakthrough in non-surgical treatments.

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Hyaluronic Acid Facial Fillers

In my practice I use facial fillers based on Hyaluronic Acid. But what exactly is hyaluronic acid? Often shortened to HA, this is a naturally occurring sugar molecule with unique water-loving properties. 50% of all the body’s HA is found in the dermal layers of the skin providing moisture and hydration, thanks to its unique ability to bind up to 1,000 times its own weight in water. The rest is found in our cartilage, joints and the fluid in our eyes.

1/3rd of our total HA is made and broken down daily, and as we age our bodies’ natural ability to regenerate HA slowly decreases. This natural regeneration process can also be affected by lifestyle factors such as sun damage (otherwise known as photoageing), smoking and stress. Whilst some topical HA products will help the top layer of skin to restore hydration and plumpness, injectable HA delivered to deep facial layers draws moisture deep within giving the overlying skin a longstanding dewy, luminous and hydrated appearance.

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One of the key aspects of using temporary facial filler is its reversibility. Our bodies contain an enzyme called hyaluronidase, which naturally breaks down our own HA daily. The HA you find in facial fillers, such as the Juvéderm range, has been formulated in such a way that it won’t be instantly broken down by this enzyme, but slowly and naturally dissipate with time.  And within the Juvéderm portfolio of facial fillers there is a filler type to suit a specific need and facial area such as for the lips, cheeks and even the décolletage (E) and back of the hands.

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Hyaluronic Acid Facial Fillers and you

Addressing facial volume loss in a full facial approach rather than the old fashion way of ‘chasing lines’ provides a refreshed and natural look. Having a full assessment and understanding “what’s been lost where” on a case-by-case basis allows me to individualize the treatment plan to offer the sort of subtle and natural-looking results desired by many patients (“I don’t want to look done, I just don’t want to look tired”)

Treating the face from “the inside out”, to preserve and maintain facial structures using the breadth of today’s product options and the latest injectable techniques makes this an exciting and realistic possibility.


BACK TO BASICS WITH FACIAL FILLERSMiss Balaratnam is a surgeon and cosmetic doctor based at the S-Thetics medical aesthetic clinic in Beaconsfield, Buckinghamshire, and a new partner clinic at S-Thetics at Bristol Plastic Surgery.

She holds the prestigious title of “Local Country Ambassador” (LCA) for Allergan, the manufacturers of BOTOX® and the Juvederm® Ultra and the latest Juvederm® Vycross range of fillers. As one of only a handful of expert UK practitioners selected as an LCA, she believes in the importance of a patient taking the time to select the right practitioner for them and an advocate of natural looking results.