INJECTABLE FILLERS – Many Types, Different Uses
Up until 2002, only one type of facial line and wrinkle filler was available – injectable collagen derived from cow proteins. While it lasted only a few months, due to its animal origins, it was the only treatment option available. Since 2002, six (6) new injectable fillers have been approved for use in the United States, all of which are made up of different (and better by the way) materials which last longer with fewer skin problems. This has resulted in a great amount of confusion and misinformation for patients. (and some doctors as well) With the certainty that more new injectable fillers are on the way in the next few years, it is important for even the patient to have some basic understanding of the similarities and differences between the choices that they have.
Today’s injectable fillers can be classified into two basic types: hyaluronic acid (HA or hyaluron) and particulated (particle-containing) compositions. While both come out of a needle, they are quite different. HAs are now the gold standard of fillers since they arrived in 2002 and have relegated old-style collagen to an almost historic footnote. Since they are synthetic ‘knock-offs’ of natural human hyaluronic acid, the patient does not need a skin test prior to injection and they last at least twice as long as collagen. The alleged differences between the four commercially-available HA injectates (Restylane, Hylaform, Captique, and JuvaDerm) is largely marketing-driven and no clinical studies has ever compared how long all of them last compared to each other. Because they are like injecting a ‘soft form of Jello’, they can be used anywhere on the face including the lips (even though the FDA has never approved any injectable filler for use in the lips) without fear of excessive lumpiness. I prefer JuvaDerm at present due to his observations that it appears to last the longest. (6 – 8 months) The next few years will bring other more concentrated HA injectable fillers to the scene that undoubtably will last even longer. The particulated fillers contain synthetic beads or particles (plastic or ceramic) in different liquid carriers. (Radiesse, ArteFill) Due to the non-resorption of the beads (which usually make up less than 25% of the solution), longer-lasting effects are seen than with the HAs. Equally important, because the beads do not resorb, some ‘permanency’ of volume can be achieved over time with repeated injections. However, because of the particles and the potential risk of lumpiness, these particulated fillers should not be injected into the lips. They are best used for deeper lines and folds such as that of the cheek-lip fold which is a common cosmetic concern for aging patients.
Since no injectable filler is ideal for every patient or type of facial line or wrinkle, the best plastic surgeons usually work with two or three different ones to custom treat each facial problem.
Dr Barry Eppley
Indianapolis, Indiana