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 pot7ential 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 patients
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. JuvaDerm and Perlane
are touted as lasting the longest currently and my
observations is that it appears to be true. 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 and 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. It would not be uncommon for me
to use, for example Radiesse in the nasolabial folds and
Juvaderm in the lips, in the same patient. Knowing the
properties of each type of injectable filler allows them to
be used to their best advantage.
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Dr Barry Eppley runs a private plastic surgery practice
through his hospital-based medspa locations at Clarian
Health in Indianapolis. To learn more about the latest
trends in plastic surgery, spa therapies, or skin care, go
to his daily blog, http://www.exploreplasticsurgery.com .
