08 Oct Juvéderm, Belotero, Radiesse
“BOTOX goes in the mountains and fillers go in the valleys.” – Melvin Elson, MD
A dermal filler is any product or material injected into or just below the skin for soft tissue augmentation. The different products can be divided by type of material, which I will discuss below, and by duration of effect. A filler is considered to have short duration if it lasts up to 6 months; long lasting or semipermanent with effects up to 3 years; and permanent for effects more than 3 years.
Over the last 30 plus years, a number of different materials have been used. The original, commercially available fillers were naturally occurring products. These products included purified bovine (cow) and porcine (pig) collagen. While still available today, fillers from bovine or porcine collagen require skin allergy testing before use. The collagen is readily degraded by the immune system and these fillers are of short duration. Zyderm and Zyplast are two brands of bovine collagen.
One unique filler uses a mix of eighty percent collagen for immediate results combined with twenty percent polymethyl methacrylate (PMMA) microspheres for permanent results. The PMMA is permanent because it is inert in the body, meaning the molecule does not react with the immune system. Permanent results may sound great but as Dr. Elson says, “Permanent results can lead to permanent complications.” PMMA, when used in other industries, is also known by the brand names of ‘Plexiglass’ and ‘Lucite.’ Artefill is the only brand of filler with PMMA.
Another unusual filler is poly-L-lactic acid (PLA or PLLA). PLA is derived from corn starch in the United States and like PMMA has many uses outside of the body. PLA is injected three to four times over several months. After each injection the PLA is released by its aqueous matrix and stimulates the body to produce its own collagen at the injection site. The results from the new collagen production last up two years. Sculptra Aesthetic is an FDA approved, PLA filler.
Calcium hydroxylapatite (CaHA) is another long lasting filler. CaHA is a naturally occurring compound found in teeth and bones. The CaHA acts like a scaffolding around which the fibroblasts construct collagen. Over time the CaHA is metabolized leaving just the new collagen in place. Microspheres of this material can be injected into the deep dermis giving results lasting up to two years. Radiesse is the only CaHA filler available.
Two autologous products can be used as dermal fillers: fat and platelet-rich plasma (PRP). Fat cells, removed from other parts of the body, are cleansed and injected into the face where needed for additional volume. Similarly, PRP can be isolated from a blood draw and re-injected. Both procedures offer the benefit of using only ones own material and often at significantly greater volume than can be had economically with commercial fillers.
Last but not least, hyaluronic acid (HA) is the most commonly used filler. HA, a glycosaminoglycan, is found in the body normally in connective tissue (type I collagen), epithelial tissue (such as skin), and neural tissue. HA is a long string-shaped molecule which in its normal shape would be recycled in the body overnight. However, the strings can be connected or cross-linked in different ways and to different extents. The cross-linking allows the HA to resist breakdown in the body long enough to act as a scaffold for collagen formation. HAs with less cross-linking don’t last as long, 6-9 months, but can be injected more superficially for fine lines. Whereas, HAs with more cross-linking last longer, up to 2 years, but need to be injected much deeper for lift or ‘body.’ Many brands of HA fillers exist, including Juvéderm, Voluma, Restylane and Belotero.
Currently at De Luz Medical Aesthetics we carry the Belotero, Radiesse, and the Juvéderm family of fillers, including Voluma. Additionally, we offer PRP for use as a dermal filler and for topical use with microneedling.
Thank you for your time and attention,
Robert Zieber, MD
De Luz Medical Aestheics
Next: Dermal filler indications, contraindications and risks.