8 minute read
Treating Hip Dips Using Dermal Fillers
Dr Lucy Glancey discusses the use of PLLA dermal fillers for contouring the hips
Aesthetic practitioners have augmented the body for more than 100 years. Before the development of dermal fillers that we recognise today, surgeons used the body’s own fat (known as autologous fat) and for the first 20 years of the 20th century, foreign substances such as paraffin to enhance both the face and body.1 Hyaluronic acid (HA) was the first ingredient used contemporaneously which we still harness in our practice today.2 They were first used for breast augmentation, as well as correcting small body irregularities, particularly post-liposuction.2 In my experience, these fillers required large quantities to achieve satisfactory results and the results were often short-lived, which was costly for the patient, meaning they could become disillusioned with the outlay required. In more recent times, we have been using fillers to meet the demand for curvier figures, which I have found is often influenced by reality television stars. I find that it is younger patients driving this demand – image conscious consumers who want to improve their already slim bodies. There are studies which have established the most attractive waist to hip ratios for women. The results show patients have an overall preference for a ratio of 0:7, with researchers noting that consumers deem this ratio healthier and more youthful.3,4
The rise of buttock augmentation
The popular Brazilian Butt Lift (BBL) procedure involves the transfer of fat to help create more fullness in your backside. In the UK, we have been advised by the British Association of Aesthetic Plastic Surgeons (BAAPS) to not carry out the BBL surgery until more is known about safer techniques of fat injection into the bottom.5,6 Although recent studies have suggested that the procedure can be safe and effective when safety protocols are adhered, it is almost impossible to get an indemnity cover for carrying out the procedure in the UK.5 This has inspired aesthetic manufacturers to innovate their filler offerings to include a non-surgical alternative.
However, even if the fat transfer treatment was reinstated by BAAPS, in my view there are many prospective patients who aren’t suitable for the procedure. There is a large patient group seeking bigger hips or buttocks, but who are very slim. They simply don’t have the excess fat needed to transfer, as these areas require a substantial amount of fat to make a difference in their appearance. When you undertake a fat transfer treatment, 50% of the injected fat does not survive.5 As a result, some patients may request another treatment to reach their desired volume, and these patients are prime candidates for body fillers instead. I have also noted that there a large amount of my patients who do not wish to undergo an invasive procedure due to downtime and risk, and so body fillers provide a good alternative.
HA vs PLLA fillers
As mentioned, HA fillers have been used to treat the body for some time. HA is produced naturally by skin cells in a bid to maintain moisture levels. It is well known for its skin benefits, especially alleviating dry skin, reducing the appearance of fine lines and wrinkles and speeding up wound healing. HA filler is a biocompatible and biodegradable gel which is injected directly into the treated tissue to restore volume, shape and symmetry.7 More recently, poly-L-lactic acid (PLLA) fillers have been indicated for body treatment. Formulation of PLLA induces collagenasis and fibroblast proliferation by stimulating the body’s inflammatory
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Case study
Before After Before
After
A 50-year-old patient presented to the clinic wanting to improve the appearance of her hip dips. She had two treatment sessions spaced four weeks apart. The first session aimed to improve the shape of the area, while the second session improved the projection and shape of the area treated, using 0.5ml on each side of the body. Across the two sessions, I used 2mls in total. Ahead of treatment, the defect is outlined, and the area is divided into evenly spaced squares. Each square equals an injection point. I inject into the subcutaneous tissue, filling the area. For larger areas I use a longer needle, ensuring that my patient has fewer injection sites. The patient was delighted with her results following the treatment. The patient was advised to massage the area to distribute the filler, with no side effects experienced. Typically, the treatment is expected to last for 18-24 months, after which the patient will need to come back for a top-up.
Figure 1: 50-year-old patient before and one year after hip dip treatments using PLLA dermal filler Lanluma.
response.8 The bio-stimulation helps to restore the skin’s inner structure and shape.8 For my patients, the added firmness from the collagen production is a significant benefit. The injected filler is absorbed by the body, and then over time the new reshaped appearance emerges, which has a longevity of more than two years, far longer than conventional HA filler results which are six to 12 months.9 PLLA lasts longer than HA fillers as it has regenerative properties restoring collagen in the skin. It also has a continuous improvement effect compared with the immediate effects of HA fillers.9 Therefore, while practitioners may opt for HA fillers when looking to treat the face, neck and hands, I find that PLLA is a better option for larger surface areas of the body. Recently, I have seen an increased demand for treatment of the buttock area, especially amongst patients who do their own research. In my experience, fat transfer and traditional HA fillers can actually give a puffy appearance to these areas where the skin is thinner, and doesn’t provide the desirable skin tightening. Therefore, I find that collagen stimulating filler is better suited for these delicate areas, as well as offering greater longevity, making it more cost effective for my patients. Depending on the size of the area to be remedied, I’ve found that the best results from PLLA fillers come after two to four treatments are performed four to six weeks apart depending on the results from the previous session. PLLA fillers can give results after just one session, as the skin is volumised and rehydrated.9
Considerations
In my experience, PLLA body filler patients need to be compliant as there is a need to massage the treated area post-procedure for five weeks to bring about the best results and distribute the filler evenly in any treated area, no matter the placement on the body. As with any injected treatment, patients may experience minimal bruising and minimal acute inflammatory tissue reaction.10 There are medical contraindications; for example patients with autoimmune diseases aren’t suitable for treatment, as there is a higher chance of having an adverse reaction.11 The future of body augmentation
The latest body fillers have seen great improvements, meeting an increased demand for safe, effective buttock augmentation. Using careful application, we as practitioners can use PLLA fillers to enhance curves, add volume, or rejuvenate lax skin to encourage a firmer texture. Encouraging the body’s own collagen production gives better firmness and greater longevity than the equivalent HA fillers.7
Dr Lucy Glancey is an aesthetic practitioner with a background in cosmetic surgery, trauma and orthopaedics in the NHS. She owns the Dr Glancey clinics in London and Essex and is a member of the Royal College of Surgeons of England and the British College of Aesthetic Medicine. She is currently joint president of the British Association of Body Sculpting (BABS). Qual: MRCS, MAACS
REFERENCES
1. J Glicenstein, ‘The first “fillers”, vaseline and paraffin. From miracle to disaster’, Annales de Chirurgie
Plastique Esthétiqu, Volume 52 (2007) https://pubmed.ncbi.nlm.nih.gov/16860452/ [25.11.2021] (157-61) 2. Michael Gold, ‘Use of hyaluronic acid fillers for the treatment of the aging face’, Clinical Interventions in Aging, Volume 2007:2(3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2685277/ [03.12.2021] (369—376) 3. Adrian Furnham, Joanna Moutafi, Peter Baguma, ‘A cross-cultural study on the role of weight and waist-to-hip ratio on female attractiveness’, Personality and Individual Differences, Volume 32 (2002) https://www.sciencedirect.com/science/article/abs/pii/S0191886901000733#:~:text=A%20ratio%20 of%200.7%20can,proposed%20by%20Henss%20. [25.11.2021] (725-745) 4. Sybil A Streeter, Donald H McBurney ‘Waist-hip ratio and attractiveness: New evidence and a critique of “a critical test”’, Evolution and Human Behavior, Volume 24, Issue 2 https://www.sciencedirect.com/ science/article/abs/pii/S1090513802001216 (2003) [03.12.2021] (88-98) 5. Surgical Fat Transfer (UK: NHS.UK, 2020) <https://www.nhs.uk/conditions/cosmetic-procedures/ surgical-fat-transfer/> [25.11.2021] 6. The Bottom Line (BAAPS, 2018) https://baaps.org.uk/about/news/1630/the_bottom_line/ [05.04.2022] 7. Brandt FS, Cazzaniga A., Hyaluronic acid gel fillers in the management of facial aging, Clin Interv
Aging, 2008 8. David Goldberg, Adriana Guana, Andrea Volk, Elizabeth Daro-Kaftan, ‘Single-arm study for the characterization of human tissue response to injectable poly-L-lactic acid’, Dermatol Surg, Volume 39 (2013) https://pubmed.ncbi.nlm.nih.gov/23464798/ [08.12.2021] (915-922) 9. Rhoda S Narins et al ‘A randomized study of the efficacy and safety of injectable poly-L-lactic acid versus human-based collagen implant in the treatment of nasolabial fold wrinkles’, J Am Acad
Dermatol, Volume 62 (2010) https://pubmed.ncbi.nlm.nih.gov/20159311/ [08.12.2021] (448-62) 10. De Boulle K, Heydenrych I. Patient factors influencing dermal filler complications: prevention, assessment, and treatment. Clin Cosmet Investig Dermatol. 2015;8:205-214. Published 2015 Apr 15. doi:10.2147/CCID.S80446 11. De Boulle K, Heydenrych I, Patient factors influencing dermal filler complications: prevention, assessment, and treatment, Clin Cosmet Investig Dermatol, 2015
