What are the Choices with Injectable Fillers?

At present, there are five main choices when you’re talking about fillers:

1)   Hyaluronic acid gels (Restylane, Perlane, Juvederm Ultra, Juvederm Ultra Plus

2)   Radiesse

3)   Fat (your own!)

4)   Sculptra

5)   Silicone

Before we go through each of these, let’s talk about what fillers are used for.

As you age, several things happen to your face (actually, they happen to the whole body, but we’re going to concentrate on the face for now).  First, there is a loss of volume.  The youthful face typically is comparatively round and full, particularly on the cheeks.  With time, increasing amounts of that volume is lost, causing hollowing.  The second phenomenon is sagging, or loss of elasticity.  This, too, occurs on many parts of the body but, with respect to the face, it results in increased jowling and sagging of the lower face and neck, and contributes to the hollowed appearance of the cheeks.

Often, the first place this appears are the smile lines, which are also called the nasolabial lines (the deep lines that go from the sides of your nose to the corners of your mouth), which become more pronounced when you smile.  The next most common area is just below that; lines that go from the corners of the mouth down to the chin and are called puppet or marionette lines.  The last of the more common areas is referred to as the pre-jowl sulcus; it’s the hollow that forms on each side of the face between the chin and that early jowl described above.  (If there’s a lot of jowling and/or significant excess skin of the lower face or neck then you’ll need some kind of a facelift to get a real improvement.  Fillers can do a lot, but they can’t do everything).

Once you’ve decided that you’re going to have a filler, there are many choices.  One issue is how long the filler will last.  You might think that a permanent filler is the best choice, but there are many potential problems with this.  First, since your face changes as you age, what looks best right now might not in a few years.  The amount – and location – of whatever fillers you get is something that you may want to be able to adjust as you age.  Secondly, some of the permanent fillers can be associated with some – permanent – problems, or complications, particularly if your body has a reaction to them.

The most commonly used fillers right now are the hyaluronic acid products, which include Restylane, Perlane, and Juvederm (of which there are two forms, Juvederm Ultra and Juvederm Ultra Plus).  Basically, Restylane and Juvederm Ultra are the shortest-lasting fillers, lasting about 4-8 months (depending on the amount you have injected).  Perlane and Juvederm Ultra Plus last longer (about 6-12 months).  I prefer to use them for first-time filler patients until we see what each person likes, and many people stay with these indefinitely.  They are proven, safe, and effective.  And those are good things.

The first two on the list – Hyaluronic acid and Radiesse – come in prepackaged syringes and can simply be used as needed.  No preparation is required, minimal anesthesia, no downtime.  You call up, come in, and have the injections.

In addition, in the event that too much is injected into one spot they can be reversed (there are a few, very rare complications that can not be reversed) by injecting a chemical that essentially dissolves the filler.  It’s called hyaluronidase and if you’re having this procedure done, it is reasonable to ask you doctor if hyaluronidase is available just in case there’s a problem.

Each is available in individually packaged syringes that contain about 1 cc.  Most people are treated with 1-2 syringes for maximum benefit.  Some people have two syringes injected at once; others have one syringe injected at the first visit, and then come back about a month later to have more done, depending on where it is needed most.

The other prepackaged filler is Radiesse, which is a little different.  Radiesse consists of calcium hydroxylapataite (CaHA) particles which are suspended in a hyaluronic acid gel.  Those particles stimulate the growth of collagen, which is one of the building blocks of your own tissues.  As a result, Radiesse lasts longer than the straight hyaluronic acid gels. Depending on how much is injected, the correction can last up to 18 months and, in some cases, even longer.  Radiesse is available in two sizes:  0.8 cc (just a little less than the hyaluronic acid gels) and 1.5 cc syringes.  Maximum correction, as with the hyaluronic acid gels, often requires more than one syringe.

The good thing about Radiesse is that it lasts longer.  But one issue to consider is that, unlike the hyaluronic acid gels, you cannot completely reverse the effects if there’s any sort of a problem with them.  Hyaluronidase may work on the gel portion of Radiesse but it will not do so on the CaHA.  Problems are rare but, if they do occur, there is a certain peace of mind knowing that hyaluronidase is an option.

After these two fillers, the issue becomes a little more involved and, as a result, I’ll save discussions of Sculptra, Injectable Fat, and Silicone for another post.   There will also be another post that addresses the risks of fillers.

In summary, fillers are used to replace volume that has been lost as you age.  They are excellent, temporary “fixes” that contribute to an enhanced look.  To look your absolute best, you’ll probably need a little of everything:  fillers to replace lost volume, Botox or Dysport to soften frown lines between and on the sides of your eyes and on your forehead, good sunscreens and skin care all over and, for the most dramatic and longest-lasting results – surgery.

Interested?  Please call us at 212-308-7000, and come in for a consultation.