As we age, our faces begin to show the effects of gravity, sun exposure and years of facial muscle movement, such as smiling, frowning. The tissues that keep our skin looking youthful and plumped up begin to break down, often leaving laugh lines, smile lines, crow's feet or facial creases over the areas where this muscle movement occurs. Fillers can help fill in these lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers plump up creased and sunken areas of the face. They can also add fullness to the lips and cheeks. Injectable fillers may be used alone or in combination with other procedure, such as BOTOX, laser treatment, or a contouring procedure. These fillers are popular for several reasons: they're non invasive, they provide dramatic, natural results. But which one's right for you? There are a few questions you have to ask yourself and your doctor :
Do I want a permanent filler or something temporary?
What areas of my face do I want enhanced?
What is my budget for these procedures?
What are the risks involved?
Patients should go into any consultation with their eyes wide open. There can be side effects, like bruising and swelling, so you definitely don't want to get work done the day of a big event. Rarely, there can be infection from the injection, or in the case of some permanent fillers, small bumps called granulomas (These can usually be treated by a shot of cortisone). The permanent fillers usually have a slightly lumpier feel to them, though this usually isn't visible to the naked eye, while the temporary fillers can have a varying lifespan-usually anywhere from 3 months to a year.
So what are your options? Following is a menu of the most exciting, popular and enduring fillers that are available:
Aquamid
It’s widely used in Europe, composed of water and crossed-link polyacrylamide. It’s expected to last at least 2 years. It’s good for deep lines or grooves. Also used in patients with lipoatrophy (fat loss) or patients who need large volume augmentation.
Artecoll
Comprised of Plexigas beads in collagen, Artecoll is a permanent filler that is expected to last at least 5 years or more. Some say that it’s not good for lips but excellent for the nasolabial folds. It's also great for acne scars. An allergy test is required before treatment.
Autologen
A long-lasting filler that is made from skin and collagen harvested from your own body. Usually requires 2 to 3 treatments, but is not permanent.
CosmoDerm/CosmoPlast
A collagen-based filler from human skin grown in a laboratory-no allergy test required. CosmoPlast is excellent for lips, while CosmoDerm works on fine lines. These fillers are great if you don't want a lot of swelling. They also have lidocaine in them, so patients like them because they are less painful than other fillers. CosmoPlast is also being used in combination with other fillers to create a more luscious-looking lips.
DermaLive/DermaDeep
DermaLive and DermaDeep are a combination of hyaluronic acid and acrylic hydrogel, which are minute particles; collagen builds around the particles, giving the fillers their volume. DermaLive is used for augmenting lips and smoothing out deep wrinkles. DermaDeep is very effective on nasolabial folds and for chin and cheek augmentation.
Dermalogen
For nasolabial folds, frown lines (glabellar folds) and other problems areas like acne scars, this filler is made from a human tissue matrix modified in a lab. Usually lasts from three to seven months.
Fat Injections
It is soft and can add lots of volume. It’s normally used in the cheek area, the chin and under the eye. It doesn't work as well in the lips as it moves around too much. In this procedure, intact fat cells with connective tissue are removed from one part of the body and injected in the areas needed. Not all the fat usually takes, however, and sometimes most of it is reabsorbed by the body.
Hylaform
This is an animal-based hyaluronic acid that is used to fill out wrinkles, fine lines, acne scars and enhance lips. Its effects usually last 3 to 6 months.
Juvederm
Juvederm is non allergenic hyaluronic acid derived from a non-animal source. It comes in three versions: Juvederm 18 for fine lines and crow's feet, Juvederm 24 for forehead and cheek wrinkles, and Juvederm 30 to fill lips, sculpture cheeks and fill deep nasolabial folds. Results can last 9 months to 1 year.
Perlane
It is an excellent product for treating the deeper nasolabial folds. Perlane is a non-animal based hyaluronic acid that is part of the Restylane family. It is used for plumping up wrinkles, frown lines and marionette lines. Results usually last a year or more.
Radiesse/Radiance
This new filler is calcium hydroxylapatite microspheres, which are suspended in a water-based gel carrier. Over time, as the patients own soft tissue replaces the gel carrier, the newly formed collagen matrix provides the long-term effect which is expected to last at least 18 months.
Restylane/Restylane Touch
A popular lip enhancement filler, it’s good for lines, wrinkles and creases. Restylane is a finer hyaluronic filler than Perlane and usually lasts 6 months to a year. Restylane Touch is often used with Restylane to fill out tiny creases around the lips or undereye area.
Reviderm
This filler consists of biodegradable micron-sized beads in a hyaluronic base. Usually two injections are required, the second one coming six weeks after the first, giving time for tissue to form around the beads. Results usually last 6 to 9 months.
Sculptra
Another newly introduced filler made of poly-L-lactic acid. The results are not immediate, it provides a gradual and significant increase in skin thickness, improving the appearance of folds and sunken areas. Touch up treatments may be required up to six times every six weeks to achieve an optimal result. Results can last for up to 2 years.
ZyDerm/ZyPlast
Once the most popular filler of them all, this collagen filler is fading from prominence. Not only do you require an allergy test because it is an animal-based product, results usually don't last much longer than 3 or 4 months. ZyDerm is great for fine lines, while ZyPlast works especially well on the lips.
What's New
Everytime it seems like the last possibility in cosmetic treatments has been reached, something new comes along. Restylane will be introducing a new filler called Restylane Sub-Q. This product is designed specifically for contouring and shaping the cheeks and chin, not for use on lips and wrinkles-and will be an alternative to fat grafting.
What lies in the future? Many doctors feel that patients are asking more for permanent fillers. It's very expensive to keep coming back for fillers. The ideal would be a product that stimulates collagen and that is permanent. But I just can't see that happening.