Injectable Aesthetic Facial Fillers - Sorting Out The Confusion

Many new injectable fillers for aestheic facial concerns have been approved for use in the United States since 2000, all of which are made up of different materials which last longer thanh traditional collagen with fewer potential skin problems. This has resulted in a great amount of confusion amongst patients...and sometimes doctors as well.

Today's injectable fillers can be classified into two basic types: hyaluronic acid (HA or hyaluron) and particulated (particle-containing) compositions. Just because they are injectable does not make the different fillers the same. Traditional collagen injectable fillers have been replaced by the longer-lasting HAs since 2002. 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. Hyaluronic acid fillers can be injected without fear of excessive lumpiness as they have the consistency of 'warm Jello'. 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. The beads that partially comprise the particulated fillers do not resorb, so theoretically over time, some permanent volume is acquired. However, because of the particles and the potential risk of lumpiness, these particulated fillers should not be injected into the lips. the common problem of deep nasolabial folds is an ideal location for the particulated injectable fillers.

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. Wihtout understanding the different properties of the various injectable fillers, they can not be used to their best advantage.