Dermal fillers, do just what their name suggests: they fill in the area under the skin. Injectable fillers are injected into the skin at different depths to help fill in facial wrinkles, provide facial volume, and augment facial features: restoring a smoother plumper, more lifted appearance. Most of these wrinkle fillers are temporary because they are eventually absorbed by the body.
Fillers are made of sugar molecules or composed of hyaluronic acids, collagens (which may come from pigs, cows, cadavers, or may be generated in a laboratory), autologous fat injections and biosynthetic polymers. Examples of the latter include calcium hydroxylapatite (CaHA), polycaprolactone, polymethylmethacrylate (PMMA), and poly-L-lactic acid. Most dermal fillers today consist of hyaluronic acid, a naturally occurring polysaccharide that is present in skin and cartilage.
Approved Uses of Dermal Fillers
The FDA has approved dermal fillers for use in adults 22 years of age or older (over the age of 21) for specific uses:
Absorbable (temporary) fillers are approved for moderate to severe facial wrinkles and skin folds, such as nasolabial folds (lines extending from the sides of the nose to the edges of the mouth) and perioral lines (small wrinkles in the skin around the mouth and lips), augmentation (increased volume) of lips, cheeks, chin, and back of the hand.
Non-absorbable (permanent) fillers are approved for only nasolabial folds and cheek acne scars. The restoration and correction of signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus (HIV), correction of contour deficiencies, such as wrinkles and acne scars.
Types of Dermal Fillers
There are several different types of dermal fillers: The common ones in the US are:
Hyaluronic acid Fillers (HA)
Hyaluronic acid is a natural substance found in your body, usually in high concentrations in soft connective tissues in and around the yes, cartilage, joint fluids and in skin tissue.
Juvéderm products: JUVÉDERM® Vollure®, Ultra Plus XC, Ultra XC, Voluma® XC, Volbella® XC , Volux™ XC
Restylane products: Restylane, Restylane Silk, Restylane Lyft, Restylane Refyne, Restylane Defyne, Restylane Kysse, Restylane Contour
Belotero Balance
Revanesse® Lips Revanesse® Versa™
The RHA collection: RHA Redensity, RHA 2, RHA 3, and RHA 4
HA fillers are used cosmetically to improve some common areas such as:
Acne scars
Cheek volumization and contouring
Crow's feet at the corner of your eyes
Deep smile lines that run from the side of the nose to corners of the mouth (also known as nasolabial furrows)
Frown lines between the eyebrows
Marionette lines at the corners of the mouth
Redefining lip border
Volumizing and reshaping lips
Jawline definition
Scars including burns, acne and those caused by wounds
Smoker's lines; vertical lines on the mouth
Some facial scars
Worry lines that run across your forehead
Forehead reshaping
Temple rejuvenation
Chin augmentation
Necklace lines
Décolletage rejuvenation
Polylactic acid (PLLA)
Brand Names: Sculptra® Aesthetic
This is a synthetic dermal filler that is injected in your body to help in production of collagen. It is commonly known as a stimulator. This product does not produce immediate result, but instead stimulates your body to produce collagen. Injections are repeated about every 6 weeks until you have complete response. Results can persist up to two years in most patients. Sculptra is known to work particularly well in the lower half of your face, and is used to:
Fill the lines caused by laughing
Plump thin lips
Treat deep nasolabial folds
Other treatable areas that are not FDA approved include temples, preauricular areas, décolletage, neck lines, buttock and hip dips enhancement. The average patient will probably need three treatments to achieve desired results. With each treatment, there is re-stimulation of one's own collagen. Then it can take four to six weeks to see the full effect. While this type of dermal filler is considered semi-permanent, you may still need occasional touch-ups.
Calcium hydroxylapatite (CaHA)
Brand names: RADIESSE® and RADIESSE® (+)
Radiesse is a biosynthetically produced filler, meaning no animal or animal products are used. This lowers the risk of an allergic reaction. Calcium hydroxylapatite is found naturally in human bones and is a mineral-like compound. Radiesse is also used for its biostimulatory purposes, meaning that it helps build on your own collage, to improve tone and texture, creating more tighter skin.
It's often used for:
Moderate-to-severe creases such as nasolabial folds, marionette lines and frown lines
Enhance fullness of the cheeks and other facial contours
Correcting volume loss in the back of the hands.
Improve volume in areas of facial wasting such as can occur in HIV-positive people taking certain medications.
Other non-FDA approved areas include preauricular area, jawline contouring, buttocks and hip dips enhancement, Neck lines, décolletage, cellulite softening, above knee and upper arm skin rejuvenation. Radiesse can be used as an adjunct with other modalities for volume augmentation. It is also used with skin tightening procedures like radiofrequency and fractionated resurfacing for optimal results.
Polymethylmethacrylate (PMMA)
Brand Names: Bellafill®
Polymethylmethacrylate (PMMA) is a synthetic, biocompatible substance that has been used in medicine for much of the last century. As a dermal filler, PMMA takes the form of tiny ball, that remains beneath the skin indefinitely to provide continued support. PMMA also contains collagen, creating structure and firmness. It usually requires several treatment for full effects. PMMA is considered a semi-permanent filler and is most often used to treat:
Medium-to-deep wrinkles, folds and furrows, particularly nasolabial folds.
Pitted scars
Lip augmentation
Filler results can lasts anywhere from six months to 5 years, depending on the type of filler. Successful results depend on health of the skin, skill of the health care provider, and type of filler used. Filler duration is highly dependent on amount of activity in the region where it is injected. Exercise and high intensity activities can stimulate blood flow and shorten the lifespan of fillers.
Risks:
Common, expected filler related symptoms include bruising, minor pain, and some swelling. Less commonly, there may be infections or allergic reactions, which may cause scarring and lumps that may require surgical correction. More rare serious adverse effects such as vascular occlusions leading to skin necrosis could occur. Blindness while very rare, could occur due to retrograde embolization into the ophthalmic and retinal arteries. Blindness is usually permanent.
Fillers can be a simple office based procedure with usually predictable desirable results, with minimal risks and side effects. Make sure that you chose your injector wisely.
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