Fillers are substances that are injected under the skin or deeper to make lines and depressions in the face less visible or to augment facial volume.
The most common areas treated by fillers include:
- Lines from the corner of the nose to the outer lip (Nasolabial folds)
- Lines from the mouth to the chin (Marionette lines)
- Lines above the upper lip (smokers lines)
- Frown lines with or without Botox
- In the lips for volume and shape
- Restore volume to cheeks or chin
- Hollows under the eyes (the tear trough)
- Hands to make veins less noticeable
Fillers, a brief history:
There are and have been many fillers on the market in recent years. In fact there are so many it can be confusing for patients and even doctors. Collagen was the first filler, and while it is still sometimes used it has limited staying power and is an animal product (cow)which can lead to allergic reactions in some people.
The most Popular fillers now are the Hyaluronic acid fillers. Hyaluronic acid is a gelatinous substance that is normally found in our bodies. It can be synthetically made so no human or cow tissue is involved. Manufactures can alter its chemistry to make it thicker or thinner and shorter or longer lasting. Most of the hyaluronic acid fillers today come with local anesthesia mixed in to make injection more comfortable.
Fillers are tailored to the location they will be placed. Thicker and longer lasting fillers may be better suited to deeper areas like the cheeks. Thinner softer fillers are used in more superficial areas such as under the eyes.
What we commonly use:
In my practice we have used all of the fillers but the most commonly used ones are:
Juviderm – Hyaluronic filler lasts 9-12 months
Juviderm Ultra – Thicker then Juviderm adds more volume and lasts longer.
Voluma – Very thick and long lasting as much as 18 months good for cheeks and cheekbones
Belotero – Thinner Ha filler good for around the eyes. Lasts 3-4 months
We find that the above group of fillers is easily tailored to the needs of our patients. In general I recommend new patients start with smaller amounts of shorter acting fillers. We can always add more but it is difficult to take back. Once patients are comfortable with their treatment and results they can gravitate to longer lasting fillers.
Note: Juviderm and Voluma are made by Allergan and are part of their Brilliant distinctions program. Because of this they are requested more by our patients.
Other fillers we sometimes use as well:
Restylane – first popular HA filler to market.
Perlane – Thicker HA filler by the makers of Restylane.
Radiesse – Has calcium like particles. may last longer, but more feel-able and less used in lips or superficial areas.
Sculptra – Adds volume to large areas, But requires multiple injections staged about 6 weeks apart. Log lasting, but uncomfortable and prolonged. Creates an inflammatory tissue response.
Fillers we don’t use any longer:
Artefil – Bovine collagen and a synthetic plastic both can lead to reactions.
Prevelle silk – a thin filler with a short duration. I wont list them here, but some fillers used to be made of pig or human dermis. Because sterile synthetic sources with no risk of disease transmission are now available these fillers are no longer used.
Alternative to Fillers:
Fat grafting to the face is becoming increasingly popular. The benefit is that the injected fat is your own tissue, and if the grafted fat takes it will remain permanently.
The down side is that not all the fat will take and grafting may require multiple treatments.
Fat grafting involves a surgical procedure to harvest and prepare the fat so the process is more involved than pre-prepared synthetic fillers.