Over time, the skin loses the substances that give it its firmness, elasticity, and vibrancy. Aging skin has less collagen, hyaluronic acid, elastin, and subcutaneous fat than younger skin does. As a result, the skin wrinkles, sags, and droops. One obvious way to reverse this skin aging process is to replenish those substances. Indeed, injectable fillers are substances injected the skin to restore the skin’s youthful vibrancy.
Injectable fillers are used for a variety of cosmetic applications. They been used most successfully in facial cosmetic procedures, but they may be useful for neck, chest, and hand rejuvenation. Injectable fillers may be used to treat vertical (glabellar) or horizontal lines on the forehead. Injectable fillers may be used as a nonsurgical approach to eyebrow lifts. Some injectable fillers are particularly good at filling in concavities of the face, such as the troughs that form between the eyes and a nose, the nose and the corner of the mouth, and creases below the mouth. Indeed, any moderate to deep skin fold that is not aesthetically pleasing can be filled in with injectable fillers.
Injectable fillers may be temporary (biodegradable) or permanent (not biodegradable). Biodegradable injectable fillers are substances that the body can break down into smaller pieces. That means the effects of temporary injectable fillers may only last between 6 and 24 months. Non-biodegradable fillers, on the other hand, remain in the skin for much longer periods. While non-biodegradable fillers are called permanent fillers, additional “touch-ups” may be required.
Temporary injectable fillers include hyaluronic acid, collagen, poly-L-lactic acid, and calcium hydroxylapatite. Hyaluronic acid is sold under many brand names including Restylane, Perlane, Juvéderm, Elevess, Prevelle, Teosyal, and Revanesse. Calcium hydroxylapatite is sold under the brand name, Radiesse, and poly-L-lactic acid is sold under the brand name, Sculptra. Collagen is an older type of filler. Collagen is not used as often as newer injectable fillers because its effect is shorter than other temporary fillers and patients usually must undergo allergy testing prior to use.
Permanent injectable fillers include polymethylmethacrylate microspheres, hydrogel polymers, and liquid injectable silicone. The main FDA-approved from of polymethylmethacrylate microspheres is sold under the name, Bellafill. It is used to treat nasolabial folds (the deep folds that form between the nose and the corner of the mouth). Hydrogel polymers (Aquamid and Aquamid Reconstruction) are less commonly used in the United States, but available in some other countries. The use of liquid injectable silicone for cosmetic purposes is even less common in the US, but may be used by properly trained physicians in select patients.
Fillers are not interchangeable. There is an art and a science to choosing the right injectable filler. Patients who are interested in injectable fillers should speak with a facial plastic surgeon who understands the subtle differences between fillers. This provider should be willing to discuss the patient’s goals and tolerance for risk. For example, permanent injectable fillers last longer, which is an advantage if someone wants lasting effects. On the other hand, If patients don’t like the results of a temporary filler, the effects will go away in a few months. Allergic reactions to permanent fillers can be more serious than reactions to temporary fillers, which is an important consideration.