Dermal Filler

Even at a relatively young age the first signs of wrinkles can be noticed and it can be worrying when these first signs of ageing are felt.

Many patients have expressed a desire to remove these first lines, but do not want to undergo a more complex face-lift procedure.

In many cases, wrinkles are removed just around the mouth and eyes and do not requiring a full face lift.

Such lines may well be reduced, improved or even eliminated by treatment with dermal fillers  just around the mouth and eyes, but we can also treat any concerns you may have with lines on the forehead, cheeks, or deep nasolabial folds (commonly known as "smile lines" or "laugh lines").

In this method, the collagen or hyaluronic fillers (Dermal Filler) are injected into the fold and create a "padding". Both of these substances are natural components created from skin and connective tissue. While collagen only lasts a few months and must be tested before first application to ascertain the patients tolerance, hyaluronic acid can be injected without pre-testing and usually lasts 6 to 12 months.

Only after this period can the patients choose to refresh with hyaluronic acid. For best results, it is recommended in many cases to use in combination with a botulinum toxin treatment.

Treatment with these fillers is usually done under local anaesthesia with a pain-relieving ointment, or after an injection of pain medication directly into the treated facial area. In general, the results are almost immediate.

Treatment with collagen or hyaluronic acid helps your skin to look fresher, smoother and therefore presenting a younger appearance.

After multiple treatments, patients often desire a longer lasting result. In this case, the autologous fat can be injected into the areas of the face to be treated. It is extracted under local anaesthesia, using your own fat from the abdomen or the legs then injecting under the wrinkles or the lips.

The patient should be aware that this intervention may be associated with significant swelling at first but this will diminish naturally.

What is hyaluronic acid?

Hyaluronic acid is a natural part of the body. It binds water and gives skin volume, lubricates joints and shapes the eyes. With increasing age, the natural hyaluronic acid content of skin loses the capacity to store water. The skin loses moisture and volume, it becomes drier and thinner, and regenerates less efficiently. The loss of volume results in sagging skin. Hyaluronic acid is a form of crystal clear gel, which is injected to restore lost volume back to your face, smoothing lines and wrinkles, modelling your profile or give your lips a fuller form. No risk of transmission of diseases or allergic reactions even if you have allergies to certain food such as beef, poultry or eggs.

The hyaluronic acid gel comes in different viscosity and particle size, so that with the most appropriate treatment for specific wrinkles can be utilised. Hyaluronic acid gives volume to your skin, your facial expression without altering your natural appearence.

Hyaluronic acid is injected in very small volumes with a very fine needle under the skin. The gel adds volume into the skin below wrinkles, plumping and smoothing. Depending on your sensitivity to pain and the planned site of injection, your doctor may provide you pain ointment or local anaesthetic in the form of a small syringe, similar to one the dentist would administer, allowing you to be as comfortable as possible for the treatment. The treatment in plastic surgery by Dr. Dirk Kremer usually takes 30 minutes, possibly a little longer, depending on the degree of correction you want. When receiving a pain-relieving ointment expect to add about 20-30 minutes for the full effect of the ointment to wear off.

Which parts of the face can I get treatment?

The scope of hyaluronic acid gel is large: It can smooth out wrinkles, enlarge lips and even model facial contours. Most often, glabellar lines, in combination with a treatment with botulinum toxin, nasolabial and marionette lines, and small wrinkles around the mouth and lips are often treated. Very superficial or very deep wrinkles lines are difficult to treat. In these cases, you may be advised by your doctor that hyaluronic acid gel for your case is most suitable.

How long does the effect of treatment with hyaluronic acid last?

This is different from patient to patient and depends on many factors, such as your lifestyle, your skin type, your age and the injection technique of the treating physician.

Strong expression lines are more evidently visible than lighter facial expressions. In general, my patients come for the treatment of wrinkles within one year for a refresher. After a lip augmentation you should wait up to 6 months before you are generally able to extend the treatment.

What happens to my skin if I choose to not be retreated?

Your skin will again take on the appearance as it was before the first treatment with hyaluronic acid

What are the side effects of the treatment?

Side effects are relatively rare. In general, this treatment could lead to injection-related effects such as swelling, redness, pain, itching, discolouration and tenderness at the injection site. These reactions only last a few days. After an injection into the lips, this takes up to one week. For more details, ask your doctor.

What to do after treatment with Dermal Filler?

Avoid massaging or rubbing treated areas during the first 48 hours after your treatment. During the first 8 hours after treatment, you should not touch the treated areas of the face unnecessarily. Later, you can wash your face with soap and apply light make-up. Until the initial redness and swelling of the skin has diminished, avoid contact with extreme heat (eg solarium and sunbathing) or extreme cold. Cold sores (herpes, for example), can thrive again after a treatment.

Blood thinning drugs taken such as aspirin, may cause the injection site to bleed longer and/or form small bruises.

Is it possible to remove the hyaluronic acid after treatment?

No. If you are unsure of the expected outcome, you can gradually carry out treatments until the desired result is achieved.

Can the treatment of hyaluronic acid replace surgical procedures such as facelifts?

No. However, the treatment with hyaluronic acid in cases such as the small wrinkles around the mouth, is available where a surgical procedure does not help. Large and deep wrinkles on the face should be removed by long-term surgical face lift.

Different filler treatments

Tear Trough - Under the eyes:

Tear trough filler is for patients with lower eyelid dark hollows or circles (also referred to as ‘tear troughs’ or ‘tear trough defects’).

In the lower eyelid a weakening of the orbital septum, and in the cheek area a loss of soft tissue volume, tend to accentuate the appearance of the lower bony orbital margin which leads to the appearance of lower eyelid fat pockets (‘eye bags’), and this can lead to a dark shadow or hollow look beneath the eyes, thus causing a tired appearance.

How long do the results last?

The effects of the injections last approximately 12 months before repeat injections are required. For many patients the effects can last longer.

Some patients benefit from a combination of blepharoplasty- (TBT eyelift) and Tear Trough injections for even further beautiful results.


Jawline fillers

Dermal filler to the jawline can help redefine and contour a sagging or lax jawline by restoring volume. In men, dermal filler can also be used to create a more masculine jawline.

Dermal filler can help to enhance, contour and define a weak or receding jawline. It can also be used to help correct any asymmetry in the jawline you may have. This can be due to genetic factors or can be due to the ageing process as structural support in the jawline is lost.

Do I get instant results?

Rejuvenation results from filler to the jawline are achieved instantly. There will be a slightly "fuller" appearance immediately after injection of the filler due to natural swelling, which resolves after a few days. There is a chance you may get a small amount of bleeding/bruising, which usually resolves after a few days.

Lip Enhancement

Lip fillers are the perfect way to add extra volume and plumpness to lips which may be lacking in shape or elasticity, or the volume lost when we age. Lip fillers deliver almost immediate results (within 48 hours) by enhancing the lips’ natural shape and plumpness.

Dr Kremer uses fillers which contain Hyaluronic Acid; a naturally occurring substance that retains moisture and so helps the skin look plumper. It also has a fluid consistency that ensures your lips stay soft and natural looking.

Nose Reshaping

Non-surgical rhinoplasty is manipulation of the soft tissue of the nose using dermal filler injections. The dermal filler used for this procedure is FDA approved and very safe.
Re- shaping of the nose is an extremely effective procedure for improving minor defects, and it can also give volume to ethnic nose types.
This technique is an ideal substitute to the traditional surgical nose job and it offers faster yet very impressive results for the improvement in overall appearance with little or almost no downtime.

How can Dermal Filler improve my nose?

  •      Refining the nose shape or size after surgical Rhinoplasty.
  •      Improving the nose folds.
  •      Improve overall nose definition.
  •      Correcting a bump or ‘hook’ on the nasal bridge.
  •      It can correct an off-centre or crooked nose.
  •      Provide balance in the size of the nose so that it looks more proportionate with other facial features.
  •      It can re-balance asymmetry in the nose.
Is there any downtime?

As Dr Kremer uses hyaluronic acid, the same filler used in lips, cheeks and for other facial contouring, the downtime is minimal. Slight bruising and swelling may occur, but this will go down after a day or so.


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