Injectable Fillers

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Introduction To Soft Tissue Fillers

Soft tissue fillers are substances that are injected or implanted under the skin to plump up a hollow contour, soften wrinkles, and fill in furrows and some depressed scars on the face. Filling substances may include bovine collagen, hyaluronic acid gel, liquid silicone, fat removed from another part of your body, and many other variations, as well as polymer implants. Generally, thicker substances are best for deeper creases, and recontouring areas like cheek hollows and lips. Thinner substances work better for fine lines and superficial wrinkles or thin-skinned areas around the eyelids and the lip lines.

Restylane® and Radiesse are some of the products available for filling creases and wrinkles not associated with facial animation. The products are injected after topical or regional anesthetic and gradually resorb over the course of four to six months and may last up to nine months. Compared to the collagen products of the past, the currently used dermal fillers do not require pretesting. Radiesse lasts for approximately 12 to 18 months and Sculptra may last 2½ years, but it is only FDA approved in the U.S. for treatment of facial fat atrophy in HIV positive patients. It can be used “off label” in other areas and has great promise for achieving a “lifting” effect in mild cases of skin laxity. New dermal fillers continue to be under clinical investigation all the time. The duration of dermal fillers is very variable and depends on the formulation of the material, how deeply it is injected, and how much is used. Most dermal fillers are only temporarily effective so that repeat treatments will be needed every three to six months on average but may last up to nine months.

Read the product literature in advance or check out the company’s website for details about any filler you are considering. It is also a good idea to keep your own records of what type of treatment you had, when you had it, and how much was used. Most doctors routinely record this information in your medical chart. When you return for a touch up, the doctor can better judge how long the material lasted and can make an informed decision as to whether more filler is needed to maximize the correction. Many doctors request that you return to the office in two to three weeks after a treatment, whether or not a touch-up is required, in order to document the success of the procedure.

In some cases, laser skin resurfacing, microdermabrasion, or chemical peels which help to soften wrinkles by removing and smoothing the outer layers of the skin, may be more effective than adding volume to the face with dermal fillers. Each patient needs to be evaluated individually, and the appropriate treatment is based on assessment of the skin tone, the location, depth and extent of the creases, and the degree of skin laxity.

“There is no filler substance that is right for every face, and most doctors like to use a wide variety that are suitable for different purposes.”

Types Of Dermal Fillers

Resorbable Fillers – Resorbable fillers are made from natural or synthetic materials that are broken down and resorbed by the body over time. They are temporary and will need to be repeated, typically in three to nine months. The good news is that if you are not happy with the results, the material will eventually disappear. Of these, hyaluronic acid based fillers are the safest and most predictable, and the one that we use most often in our practice. Other commonly used resorbable fillers include human and bovine or cow collagen.

Nonresorbable Fillers – The nonresorbable class of fillers has synthetic components that do not get broken down by the body. They are considered permanent because the particles cannot be removed, or semi permanent’™ because the particles are suspended in a substance that gets absorbed in three to six months. They are considered permanent because some of the material cannot be removed after it has been injected. Examples of nonresorbable fillers include silicone and polyacrylamide gels.

There are over 70 commercially available fillers reportedly on the market around the world, most of which will never enter into widespread use and will not enter the FDA approval process for various reasons including safety record and lack of funding.

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