Do dermal fillers for acne scars need repeating forever?
Less often than is generally supposed. It is often claimed that hyaluronic acid filler lasts twelve to eighteen months, however in reality filler persists considerably longer than was once assumed and has been demonstrated on MRI scanning years after treatment.
The visible correction can reduce over time as the filler is broken down or migrates elsewhere in the face. However the filler material itself may still be present long after the visible effect has gone. This matters in two respects. Repeat treatment is frequently topping up a partial correction rather than replacing something that has disappeared, so smaller volumes are usually required than at the first treatment. It is also an argument for treating conservatively, since filler placed over successive years accumulates.
For acne scars I use filler primarily to correct the loss of volume beneath the surface, which is what produces a genuine lift. I do not generally place filler into the surface of the skin itself. Superficial filler tends to migrate to the edge of the scar rather than remaining where it was placed, and the material can become visible in certain lighting, which converts a shadowed depression into a different and equally noticeable problem.
I use only hyaluronic acid fillers, because when a complication occurs with hyaluronic acid it can be dissolved with an injection of hyaluronidase, and overcorrection, migration and nodules can potentially be treated. With permanent and semi-permanent materials none of this is available and the remaining options are surgical.
Filler is best used for the volume loss that remains once the structure of the scars has been addressed. It can be placed in the same session as subcision for tethered scars. Other options are TCA CROSS or punch excision.
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