The technology of injectable facial fillers has revolutionized the face of cosmetic surgery practices and the faces of cosmetic surgery patients. In recent years, not only has the number of procedures increased dramatically, but the choice of fillers available to patients has also increased significantly.
According to dermatologists, facial wrinkles result from the loss of three essential skin components: collagen, elastin, and hyaluronic acid. Injectable skin fillers address this problem by replacing one or more of these substances in areas where loss has occurred. In the past few years a whole new generation of fillers has been developed for skin rejuvenation and facial enhancement, and several of these substances have been approved by the FDA. Treatments with these fillers offer immediate, lasting improvement with no down time (the proverbial “lunchtime lift”).
Since the introduction of injectable bovine (cow) collagen in 1976, skin fillers have been used for cosmetic applications such as filling in wrinkles and enlarging lips. While it has been extremely popular, bovine collagen poses some problems and risks. Because it is an animal-derived product, collagen can cause allergic reactions in some patients and also could potentially carry animal-borne diseases. (All patients must undergo an allergy test before having their first collagen injection.) A major drawback of bovine collagen injections is that the results are short-lived (generally three to six months at most).
Injectable Filler Uses
Injectable fillers are used primarily for wrinkle correction. Some wrinkles are the result of habitual muscle contraction, and these wrinkles are generally correct either with a brow lift, similar surgery, or with the use of BOTOX® injections. Other wrinkles are the result of loss of skin tone and the loss or displacement of subcutaneous fat in the face. These wrinkles can be corrected either with facelifts or with injectable fillers.
Injectable fillers can also be used for facial augmentation instead of facial implants. They are commonly used in lip augmentation, and less commonly used for chin and cheek augmentation.
The first cosmetic filler used on a large scale was collagen. Collagen injections were used to correct age-related wrinkles and folds and plump lips, but it has a relatively short lifespan. In 2002 the FDA approved the use of human bioengineered collagen (collagen derived from human cells) for treating facial wrinkles and acne scarring, and for reshaping lips. Human-derived collagen offers an improvement over bovine collagen because it doesn’t pose allergy risks, but the results are equally as temporary. At best, patients could hope to get four months of good results out of collagen injections.
The combination of collagen’s great promise and its significant shortcomings led many companies to attempt to develop new injections that overcame the shortcomings to give patients safe, consistent, and long-lasting results. These days there are many new, technologically-advanced alternatives have been developed. Now the only problem is how to choose among the options. By understanding the advantages and disadvantages of each filler, you can make the right decision for your needs.
Related article: Collagen Fillers
Hyaluronic Acid-Based Fillers
Hyaluronic acid is a natural compound produced by the body. It is found in the eye and the spinal fluid in addition to the skin. Early versions of hyaluronic acid-based fillers were derived from rooster combs and cow eyes, but modern versions are what is known as non-animal-based hyaluronic acid (NAHA). NAHA is actually derived from the protein capsules that streptococcus bacteria build around themselves. Restylane and Juvéderm are the most popular forms of NAHA fillers. Though they function in basically the same fashion, important distinctions between them and their related compounds (Perlane and Juvéderm ultra, for example) can make a big difference in how they are used and how effective they are.
The main difference between Restylane and Juvéderm is that Juvéderm is manufactured as a smooth gel, whereas Restylane has a granular texture. Juvéderm’s smoother texture causes less irritation at the injection site and can produce better cosmetic results in some applications, such as lip augmentation. Although sometimes Restylane causes swelling at the injection site for two or three days, swelling following a Juvéderm injection is generally less than 24 hours, and some people see no swelling whatsoever.
Restylane, however, is intentionally manufactured with a granular texture for a reason (and its relative Perlane have an even more granular texture).The texture of Restylane and Perlane makes them more resistant to decomposition, leading to a greater likelihood of longer results, especially in very dynamic areas, such as the nasolabial folds. In addition, the granular texture gives the fillers greater lifting power, and Perlane’s larger texture makes it suitable for injection into some of the deeper fat pockets where age-specific fat losses often occur.
Composite fillers are composed of two parts: a carrier gel and microspheres. The carrier gel is primarily a delivery system, and though it can provide some immediate wrinkle correct, it is quickly digested by the body. The microspheres, however, are made of a more resistant material. Calcium hydroxyl apatite (CHA) in Radiesse and polymethylmethacrylate (PMMA) in Artefill.
The sphere material in Radiesse, CHA has long been used as a bone filler, so it is highly compatible with the body. Because it is resistant to absorption, it provides long-lasting results as the body fills in around the microspheres with its own collagen. The improvement over NAHA fillers is significant. Juvéderm results can last for three to nine months while Restylane/Perlane results last for six months to a year, but clinical studies have shown that over 80 % of Radiesse patients receive more than one year of full wrinkle correction.
ArteFill seeks to take the concept behind Radiesse another step further. Since the PMMA is a biocompatible but completely artificial material, it is never absorbed by the body. The theory is that this should lead to permanent wrinkle correction. ArteFill has been approved by the FDA for use in the US for only a few years, and therefore large-scale data on the length of correction a person can expect. But individual patients have seen wrinkle correction that lasts for seven years or more.
Patients considering treatment with any skin filler should ask the following questions:
- How long are the results expected to last?
- What are the potential risks and side effects?
- Has the FDA approved this filler for this type of use? If so, for how long has it been used?
- How much experience does this doctor have with using this filler?
If you are interested in having non-surgical wrinkle correction, contact one of the doctors listed in this directory.