Dermal Fillers At A Glance
- Best Results1-3 sessions
- Treatment RecoveryNil
- Procedure Time5 to 30 min
- Skin SpecialistDavin Lim, Dermatologist
- Duration of ResultsYears
- AnaestheticNumbing & blocks
- Back to WorkImmediately
- Cost$-$$$
Dermal Filler Acne Scars
Acne scars can be treated with subcision & dermal fillers. This provides instant acne scar reduction with no downtime. Fillers are best used when your immune system can not regenerate enough collagen or fat to replace volume changes associated with acne scars. I use many types of fillers including hyaluronic acid & collagen stimulating fillers, taking into account age of patient, types of scars as well as the location of scarring.
FactsFacts on Dermal Filler Acne Scars
- Fillers are used to correct volume deficits due to scarring
- FIllers are indicated when your immune system can not generate enough collagen
- HA fillers last 18+ months
- Collagen stimulating fillers last up to 5 yrs
- Correcting age related volume loss is equally as important as addressing acne scars
- Fillers give support to skin, thereby indirectly improving acne scars
- Unlike lasers, soft tissue fillers have no recovery time
When are dermal fillers used to treat acne scars?
Dermal Filler Acne Scars
Dermal fillers are used in two situations. Firstly, if you are in a hurry to get immediate results with no downtime. Secondly, if your immune system can not generate enough collagen & or fat to correct depressions.
Most patients will have a mixture of acne scars. These include rolling, mixed, atrophic, tethered, & depressed scars. These scar types can respond to dermal fillers.
How to dermal fillers work?
Dermal fillers correct volume deficits due to loss of collagen & fat. Fillers are indicated in patients whose immune response can not stimulate enough tissue.
Lasers & radiofrequency can stimulate collagen-producing cells to start laying more collagen. The disadvantage of this process is that it takes time and several treatments for the best results. Downtime, meaning skin recovery can take between 2-10 days. Results from energy based devices like lasers & micro needling RF rely on your own immune system to stimulate collagen production – this means results are only seen after 6-8 weeks, and maximal at 3-4 months after the procedure.
In some patients, the immune system can not replace the volume loss due to both age & acne. Fillers are used to correct volume changes.
Are fillers permanent?
No, however they typically last 1.5 to 5 years in the context of acne scars. Like everyone else I want a permanent solution for acne scars. The fact remains that if your body’s immune system can not correct volume changes you are left with only 2 choices- namely dermal fillers or fat transfer.
Pros of fillers– 1 to 1 correct, meaning if I place one ml of volume, there will be at least one ml of correction. HA fillers are reversible should there be any over correction or injection into a blood vessel.
Cons of fillers– In some cases volume deficits can be large (upwards of 8 mls). In this situation fat may be a more cost effective solution. Fillers last 18 months to 3 years for hyaluronic acid brands, whilst some collagen stimulating fillers last up to 5 years
What is the newest bio-stimulatory injectable for acne scars?
In late 2022, Australia has a new product know as a bio-stimulatory injectable. It is made out of high & low molecular weight Hyaluronic Acid.
Unlike traditional HA dermal fillers, this one stimulates your own collagen & fat cells. This product can treat atrophic scars. 2-4 sessions are required for optimal outcomes.
What can I expect form biostimulator Hyaluronic Acid injections?
You can expect 10-50% improvement in acne scars after each treatment. Sessions are spaced 4-6 weeks apart. Optimal results are seen 8-16 weeks after the last treatment.
This injectable is a cost effective way to treat acne scars. Each session cost $850 (2 ml of product, treatment by our specialist nurses).
Do I mix different types of fillers for acne scars?
Yes. I use thick fillers for support, & thin fillers for filling fine areas such as the temples & tiny open pores. For most of my patients I use what I call a ‘layered technique’- support for deep scars, & finesses for fine scars. Hence I combine two types of cross-linked HA fillers.
I also combine collagen stimulating fillers with HA fillers. Additionally I also combine fat transfer, ASC (Adipose Stem Cells), with fillers.
View our Treatment Gallery
When do I use fat transfer & stem cells over dermal fillers?
Unlike dermal fillers, fat transfer is less predictable. I employ fat & stems in the following situations-
- When there is a large volume deficit (more than 10 mls).
- In older patients where fat loss is more apparent
- In young patients whose facial structure is thin
- In patients who have stable weight
- In situations where patients can understand that fat transfer is less predictable than dermal fillers.
Fillers provide the most predicable outcome.
Do I use permanent fillers?
No. I do not use silicone, nor do I use Bellafill (semi-permanent or 5 year filler).
I never use permanent fillers due to the increased rate of serious side effects associated with these fillers. Bellafill is a PMMA filler approved in the US & was available in Australia over 10 years ago. Because Bellafill is not an HA based filler, there is no ‘antidote’ or reversal agent. If PMMA finds its way into an artery, it may cause skin death in the area. If HA fillers such as Juvederm enter an artery, early reversal is possible with good outcomes.
If you are keen for a more permanent solution, consider the latest injectable. This new group of molecules stimulates your own immune system to produce dermal collagen.
Basic acne scar revision concepts
.
👉Real life: Is not that simple. Scar signatures vary considerably even within patients.
Scar morphology changes with procedures. Classification however is a great starting point
.
🛬Many doors to the same destination: In most cases the rules are not set in stone, & there are various methods to treat each scar type. Add to this the differences in devices & skill sets of operators. If all things are equal, there is a marked variation between each patient’s regenerative & remodeling potential. Furthermore age related atrophy plays an important role in acne scar revision
.
👍🏻It’s much more complex than matching scars to procedures, but it is a step in the right direction💯
.
😎Dr Davin Lim
Dermatologist
Brisbane 🇦🇺
.
#acnescar #scarrevision #acnescartreatment #acnescarcure #icepickscars #drdavinlim #brisbanedermatologist
Long story short, 2 issues here- highly atrophic acne scars plus textural changes secondary to a deep phenol croton oil performed many years ago by another physician
.
👍🏻Scars treated with subcision. Given the amount of scarring & atrophy, I expected a large amount of dermal filler was required, ended up using only 4 ml, considering age related atrophy also in play (patient nearly mid 30s)
.
👉🔫Textural changes improved immensely with VBeam vascular laser alternating with Picoway laser. Looking back, I do think the textural issues were harder to treat than the scaring, but she’s got normal skin now…probably better than the average Aussie in the 4th decade of life👌🏻
.
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
#laserdermatology #acnescar #scars #subcision #acnescarrevision #acnescartreatment #picoway #picotoning #vbeam #drdavinlim #dermatoloigstbrisbane #skinscience #pico
Fillers are invaluable in the management of atrophic acne scars. If there is too much collagen & or fat loss due to inflammation, some patients require a helping hand to correct volumetric deficits. In many cases soft tissue fillers accelerate the revision process. Filling in this patient was done over two sessions
.
🔬Scar types: Atrophic rolling scars are amenable to fillers, especially if there is significant volume loss. In older patients fillers provide structural support to the overlying scars in addition to traction & countertraction in specified vectors
.
⚖️Filler vs Fat: in the context of acne scars, I prefer to correct volume loss with fillers. Smaller volume defects with hyaluronic acid fillers, larger defects with hyper diluted calcium hydroxyapatite & larger defects with poly L lactic acid. I also employ autologous fat if volume loss exceeds 15 to 20 ml. The predictability of fat is the unpredictable nature of adipose resorption
.
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
#drdavinlim #davinlim #PLLAfiller #acnescarcure #skinclinic #scareraser can’t fill #dermatologist #brisbanedermatology #hyaluronicacid #HAfillers #injectors #acnescars #scarrevision #dermalfiller #hyaluronicacidfiller #dermatologistbrisbane #facialanatomy
When will I see the results from dermal fillers?
Immediately after the procedure. Unlike lasers & energy devices that require time for results, dermal fillers give an immediate correction of volume. In situations where I employ collagen stimulating fillers, results will continue to improve over time. It is important NOT to overcorrect acne scarring.
How many sessions will I require?
1-3, depending on the volume deficit. The bigger the volume loss, the greater the number of sessions. This is because I employ fillers at different levels.
What has age got to do with dermal fillers for acne scars?
Lots. This is vitally important to understand. In older patients, replacement of age related volume loss can support the scars. Over time, everyone loses collagen, bone & fat. This natural age related volume loss also has an impact on acne scars. By supporting deeper structures, acne scars can indirectly improve.
What procedures do I combine with dermal filling?
In most cases, I combine surgical subcision at the same time. This is important to release the underlying scar tissue before filling. This is because fillers follow the physics of flow dynamics, namely they trek to an area of least resistance.
In some cases I use lasers, TCA, Phenol peels & microneedling in the same session. It really depends on your scar pattern.
Are treatments painful?
No. I use fillers with numbing agents. This ensures that acne scar treatments are comfortable. If you require more extensive work, I use anaesthetic gas & nerve blocks.
What is the recovery time following dermal fillers?
Immediate. Unlike lasers, peels & microneedling, dermal fillers are delivered under your skin, not from the top. Make up can be worn 3-4 hours after the procedure.
The caveat is that if I conduct extensive subcision prior to filler placement, bruising can last up to a week. I will give you an accurate estimation of recovery time pertaining to your scar pattern.
What is dermal grafting?
Dermal grafts are tiny pieces of tissue taken from behind the ear. These are ‘chopped up’ into tiny fragments which are then placed underneath atrophic scars.
I used to perform dermal grafting for acne scars over a decade ago, however with the event of new dermal fillers (& fat grafting), I hardly perform this procedure. The disadvantages of grafting include – limitations of the types of scars that can be treated, limits on the number of sites, limitations on the donor site (area & tissue), as well as side effects such as inclusion cysts.
Does skin colour matter?
Dermal fillers are compatible with all skin colours. Unlike laser treatments, fillers are not associated with skin colour changes because no heat is produced. As dermal fillers target the loss of collagen deep in the skin, it spares any superficial damage and eliminates the chances of skin colour changes.
What is Profhilo & how good is it for acne scarring?
Profhilo is a hyaluronic acid injectable. It is different from HA dermal fillers which primarily give volume.
There are two good studies to show that Profhilo is better than Juvederm products (HA filler). This treatment can be use in the following manner.
- Post laser resurfacing to help with more collagen stimulation.
- As a stand alone for shallow boxcar acne scars or low volume atrophy.
- With cannula subcision & concomitant injection (over & under method).
The advantage of Profhilo is that downtime is limited to only a few hours as it integrates well into tissue.
2-4 sessions are required, spaced 4 to 10 weeks apart. In summary, I really like this injectable for acne scarring, especially for rolling atrophic acne scarring.
What about older collagen stimulating injectables like Sculptra & Radiesse?
Sculptra is useful for large volume defects, namely rolling scars in more mature patients. This injectable requires 2-5 sessions over 3-8 months. It works by stimulation of collagen.
Radiesse is made from calcium hydroxyapatite. It is an excellent dermal filler if I need to project & to correct. It can also be used to treat medium volume defects, especially rolling acne scars. It requires 2-3 sessions for optimal outcomes.
What is Rejuran S for acne scars?
Rejuran S is known as a polynucleotide, derived from DNA products. Unlike Profhilo, it is not classed as a hyaluronic acid injectable.
There are 2 major studies on polynucleotides for acne scarring. Rejuran S has a higher viscosity compared to Rejuran & comes in a one ml. syringe.
2-4 sessions are required for optimal outcomes. This injectable is best for low volume shallow atrophic acne scars, namely boxcar scars, shallow saucer scars & low volume atrophic scarring. Rejuran can be combined with other scar directed treatments including lasers, RF micro needling & subcision.
What is the cost of dermal fillers?
Costs vary according to volume replacement & the type of filler. In some cases fat transfer maye a better option, especially if large volume corrections are required.
Where can I get treated in Sydney?
Our Sydney clinic can provide select treatments for acne scarring, including –
- Dermal fillers
- Biostimulatory injectables
- RF Microneedling (Secret RF)
- Vascular lasers
- Cannula subcision
- TCA Paint
To obtain a booking, contact us. This clinic is not set up for surgical cases or ablative/CO2 laser resurfacing. This will be offered in 2024 via a day hospital in the Eastern Suburbs of Sydney.
Davin’s Viewpoint On Dermal Fillers
I too want a permanent solution for patients. In the next 2 years there will be newer fillers entering the market offering longer duration, however as it stands they max out around 5 years.
In the early years, acne scar revision started off with full dermabrasion, followed by fully ablative lasers such as CO2 and Erbium. I started skin needling or skin rolling early in my career & introduced fractional laser resurfacing to my practice in 2006.
A decade later, the addition of new cross linked HA injectables has given acne scar patients another modality to improve their scars. Acne scar revision is always based on 3 factors- acne scar type, skin type and downtime of the patient. Fillers are primarily used for atrophic, rolling, & tethered acne scars, and can be used in all skin types. This means skin colour does not play a rate limiting role for filler treatment.
Fillers have a clear and distinct advantage over lasers in that they provide ‘instant’ collagen & scar correction with no downtime. The procedure takes only a few minutes to perform, and patients can resume exercise the next day. The procedure is well tolerated as I combine a local anaesthetic together with the filler.
With increasing research and development we will be seeing a newer generation of HA fillers in 2022 that will last beyond months to years. In the context of scar revision, fillers remain at the forefront of the procedures I conduct on a daily basis.
The newest product introduced in 2022 is a unique heat treated, low & high molecular weight Hyaluronic Acid molecule with unique properties. This product tightens skin, induces your own immune system to generate collagen, fat & connective tissue. It has unique tissue integration with virtually no downtime. Best of all, it is cost effective. Treatment starts at only $850 per session (performed by my head nurses). Most patients will require between 2-4 sessions. Is it as good as multi-layer subcision & correction there after with dermal fillers? No, but is it one tenth the price of surgical intervention. More on Profhilo.
In 2023-2024 we have newer injectables that have been TGA approved, this includes PDLLA fillers & polynucleotide DNA derived products, namely Rejuran S. The latter is a highly effective treatment for shallow acne scars. 2-4 sessions are required. I often combine this post laser as part of a recovery package for skin, however it can also be used as a stand alone treatment.
Fillers are not a substitute for my other procedures such as laser ablation, fractional lasers, subcision, surgery & TCA CROSS, however this technique adds another avenue for scar revision for suitable candidates. Fillers provide instant results with no downtime.
