Fillers are materials that are used to replenish the collagen in the skin. They specifically are used to plump up wrinkles, decrease nasolabial folds, fill out lips, provide fullness to the brows and smooth out depressions under the eyes (tear trough). In addition, fillers may be used to sculpt the face and restore cheek bone volume. There are several different types of fillers available. Additional fillers are available in Europe and Australia/ New Zealand. Additional fillers are expected to be approved by the FDA and there are several still in development. The most commonly available fillers in the United States are Zyderm and Zyplast, Cosmoderm and Cosmoplast, Restylane, Perlane, Juvederm, Radiesse and Sculptra.
Collagen is the molecular scaffolding of the skin. As one ages, the amount of collagen decreases and that collagen remaining tends to lose its elasticity. There are many techniques available to add collagen to the skin directly. These are known as fillers. There are also techniques and compounds that are designed to stimulate collagen production.
What are Zyderm and Zyplast?
Zyderm and Zyplast are two formulations of bovine (cow) collagen in suspension with Lidocaine, a numbing medication, that are used to fill wrinkles, facial depressions and plump lips. There have been no reported cases, to date, of illness transmitted by these materials.
These injectable materials last 3-4 months. When the effect wears off the injections can be repeated. Patients must be skin tested at least one month prior to treatment as there is a 3% risk of allergic reaction.
What are Cosmoderm and Cosmoplast?
Cosmoderm and Cosmoplast are injectable fillers made from a tissue culture of human skin. There have been no reported cases, to date, of disease transmission from these fillers. Cosmoderm and Cosmoplast are also delivered in suspension with Lidocaine, a numbing medication. As this is human derived, skin testing prior to administration is not necessary. The filler effect of Cosmoderm and Cosmoplast lasts 3-4 months. Injections can be repeated when the effect diminishes.
Restylane is a filler composed of pure hyaluronic acid. This molecule is a building block of the structure of skin. This injectable material was approved for use in the United States in 2003. It has however, been used in Canada, the European Union, Australia and New Zealand for many years.
Restylane is useful for plumping lips and filling in wrinkles at rest. This material is especially useful in filling in the area around the mouth and nose (nasojugal lines) and the frown lines between the eyebrows. Restylane lasts between 4-6 months depending on the individual.
Perlane is an injectable cosmetic dermal filler used to soften wrinkles and facial folds. It is also a popular filler for lip augmentation, facial depressions, and facial scarring. Perlane is made from non-animal stabilized hyaluronic acid (NASHA) gel. Unlike Zyderm or Zyplast, Perlane contains no animal products. Since hyaluronic acid is a natural substance found in the skin and other tissue, there is no need for a skin test when using Perlane filler.
The hyaluronic acid in Perlane supplements the body's natural supply, which becomes depleted with age. Perlane is biodegradable so its effects are not permanent. The results of a Perlane filler treatment last six months to a year. Perlane can be used in conjunction with BOTOX Cosmetic. Botox relaxes the muscles that create wrinkles. Perlane simply reduces the visibility of wrinkles and folds by filling them.
The hyaluronic acid in Perlane can be used to improve the contour of facial skin and to reduce wrinkles, folds, scars, and other facial skin depressions.
Restylane is also composed of hyaluronic acid, but Perlane contains a larger concentration of hyaluronic acid. Because of this higher concentration of hyaluronic acid, Perlane is used for larger, deeper folds, while Restylane is better suited for smaller wrinkles or to maintain the results of a previous Perlane injection.
Juvederm is a filler manufactured by Allergan. This is the same company that manufactures Botox and Botox Cosmetic. This filler is composed of cross linked hyaluronic acid, a sugar manufactured by a bacterial fermentation process. Hyaluronic acid is a natural part of our skin. Juvederm lasts approximately 6 months. No skin testing is required. There are three types of Juvederm available: Juvederm, Juvederm Ultra and Juvederm Ultra Plus.
Previously known as Radiance, Radiesse is an injectable form of calcium hydroxyl apatite. This thicker injectable material stimulates collagen formation and lasts up to 2 years. It has been FDA approved for injection into the deeper nasojugal lines as well as the furrows which may form between the brows. One of the thicker injectables, Radiesse stimulates the production of collagen while adding volume and providing some lift. It is useful for the correction of moderate to severe facial wrinkles, nasolabial and marionette lines, facial fat or volume loss in areas such as the cheeks, chin and hands.
Sculptra Aesthetic is a long lasting filler composed of poly L lactic acid. Used since 2004 to plump the cheeks of HIV positive patients with facial wasting, Sculptra Aesthetic received FDA approval in 2009 to treat creases and folds around the mouth. It is best suited to fill broad areas such as the cheeks. Sculptra Aesthetic can last up to two years. It is injected over a series of several treatments. Sculptra Aesthetic is a volumizing agent that stimulates collagen growth gradually.
Sculptra Aesthetic cannot be easily removed. Side effects include tenderness and redness near the injection site. The injections may occasionally (8.6%) form palpable lumps or bumps under the skin. Massaging after injection helps to distribute the Sculptra Aesthetic and diminish the lumps.
Sculptra Aesthetic is an alternative to Radiesse and other fillers to provide a wide area of volume enhancement with long (2 years) lasting results.
Artefill is a permanent filler that consists of microspheres enrobed in bovine collagen. This material injected over a course of three sessions may last up to five years. Patients must be skin tested 4 weeks before injection to ensure there is no allergic reaction. Unlike the Hyalurons, this material can only be removed surgically. Artefill may be used to treat deep folds and wrinkles.
There are many additional fillers either in development, undergoing clinical trials in the United States or in currently in use in other nations. Macrolane, Juvederm Voluma, Vavelta and Revanesse are a few of the products currently in development or undergoing FDA evaluation. Check back with our website or contact us for details regarding these and other products developments in the future.