What are dermal fillers and how do they work?

The world of facial injectable treatments can be overwhelming with all the options seen in print and TV ads. The biggest breakdown in classes of injections are between Botox and it’s counterparts, Dysport and Xeomin, (hereby referred to as “neuromodulators” because they affect muscle nerve endings) and injectable fillers such as Juvederm, Restylane and Radiesse, etc. While neuromodulators are best used to affect lines caused by repetitive muscle motion, facial fillers are best used to enhance areas of low volume or deeper folds that are present at rest. For a straightforward example, frown lines between the eyebrows, crows’ feet outside the eyelids and lines on the forehead are ideal for neuromodulator injection because these are due to motion. Decreased volume in the lips, smile lines around the mouth or decreased volume in the cheeks is best treated with fillers to improve volume and support soft tissue.

There are many different types of fillers available on the US market today. Some are permanent, such as Artefill, but most are resorbed into your body over time. The vast majority of commonly used resorbing fillers are composed of a material called hyaluronic acid, which is part of the normal makeup of our skin. Because of this, it is easily tolerated by the body and rarely has the adverse side effects that are associated with previously-used collagen fillers. The hyaluronic acid fillers that are most used include: Restylane, Juvederm (including Ultra and Ultra Plus), Voluma, Prevelle Silk, Belotero and Perlane to name a few. Some of these are available premixed with lidocaine, a local anesthetic, to minimize discomfort associated with injection. 

Radiesse, also a commonly-used filler, is made of a material called calcium hydroxyapatite. It is also dissolving but tends to be thicker in composition and is only injected deeper to avoid risks of visibility or lumpiness.  

Sculptra, also categorized as a filler, is best thought of as a collagen-stimulator. This is intended for patients who need larger areas of gradually-increasing, more subtle volume. Because of the composition of Sculptra, it is hydrated with water for 48 hours before injecting and then injected in small doses throughout the tissues under the skin. The process of volumizing takes up to six weeks for each vial injected, with the recommendation being at least 3 vials to get to full correction per area treated. 

So how do you determine the ideal filler for the area you are interested in treating? The best answer is to consider carefully what areas are most bothersome to you and make an appointment for consultation with a board-certified Facial Plastic or Plastic Surgeon with experience treating the face. Depending on the area of concern, the depth of the issue and the thickness of the material, your surgeon will determine the best product for injection. Each of us has cultivated years of experience with many of the fillers available on the market and has individual preferences based on those experiences. Feel free to ask questions, return for a second discussion or look at photos if you deem it helpful. Ultimately, what all of us want is a happy patient, so make sure your desires are communicated effectively to ensure your best result!!