A Complete Guide To Dermal Fillers

According to the American Society for Aesthetic Plastic Surgery, over two million people received some kind of injectable toxin or filler in 2017 – a massive increase of over 40 percent in just five years. And while the likes of Botox, Dysport and Xeomin continue to win the popularity contest, fillers aren’t too many miles away.

But the problem with injectable fillers is there’s just SO much to take in. From collagen to hyaluronic acid and Radiesse to Restylane, where on earth does one start? Well, this is why we’re here, to make the world of dermal fillers a little easier for you. You’re welcome.

What Are Dermal Fillers?

Skin aging usually begins in your 20s when the structure of your skin starts to slowly lose essential collagen and elastin. Collagen and elastin are proteins that give your skin firmness and suppleness, so when levels start to drop, skin loses the ability to maintain elasticity and retain moisture. Dermal fillers, as their name suggests, help to replace lost proteins in the skin by filling or bulking up underlying tissues. Unlike toxins that relax muscles by blocking the nerve impulses which control movement, dermal fillers have absolutely no paralyzing effect at all. Like, nada.

Injectable fillers come in a variety of forms to replace this loss of volume. Historically, the most common filler was collagen (either natural or synthetic), but due to the high chances of allergic reactions occurring with collagen, more popular these days is hyaluronic acid. Hyaluronic acid (HA) is a naturally-occurring substance that helps hydrate your skin and replenish lost volume, which is why HA fillers are a very effective option in modern aesethetics.

What Are Fillers Best For?

While injectable toxins are great for expression lines like crow’s feet, frown lines and bands around the neck, fillers are much better for deeper wrinkles that have been hanging around a little longer. They can also add improve recessed scar appearance and add volume to anything from sagging hands and sunken cheeks, to thin lips and painful balls of the feet (a procedure well-known in the fashion world as a ‘loub job‘).

What Should You Expect?

Depending on the size of your treatment area (or areas) and the type of filler you choose, your procedure can be completed in anything from 15 minutes to an hour.

Treatment usually involves injecting a tiny needle into the target area – a quick and relatively painless procedure, but certainly not pain-free. We’re talking needles in the skin, people: you do the math;) Topical numbing creams and/or ice packs are often administered during the procedure and some fillers contain their very own local anesthetic, lidocaine, which will obviously help lessen the sting.

Once you’re done, you’ll be able to leave the office and go back to your normal activities straight away. Downtime? What downtime? OK, so you may experience a little tenderness and swelling, but this can be reduced with gentle ice packs, and any discomfort should be gone in a couple of days. Try to avoid too much facial muscle flexing or sudden movements for a few days as this can disturb the filler, and avoid extreme temperatures for one week after your treatment – no sunbathing in the Caribbean or skiing in the Rockies, sorry. As with most injectables, results are immediately gratifying, but because of the swelling it’ll take a couple of days for your skin to properly stabilize and for you to fully see the difference.

In terms of your results, most HA fillers offer visible effects for anything from four to 12 months, but again this depends on the type of filler you choose.

So, What Are Some Of The Options?

Bellafill

Previously called Artefill, Bellafill was approved by the FDA in 2015 for the treatment of smile lines and acne scars  and it was the first injectable filler to offer results lasting for up to five years (one year for acne scars).

While most fillers offer immediate results, Bellafill acts more like a stimulating agent. Formulated with bovine collagen, polymethylmethacrylate (PMMA) microspheres and that all-important pain reducer lidocaine, the procedure does offer some limited instant results, but the real effects take time. Once injected, the collagen gel immediately fills and plumps the skin, while the microspheres act as a bio-stimulant for your body, creating a ‘scaffold’ effect for natural collagen regeneration over the coming months. The results are natural-looking, smooth skin that keeps getting better and stronger for many years to come.

Belotero Balance

Belotero is an HA-based filler and one of the lightest dermal fillers available. Often called the ‘starter filler,’ it offers natural-looking, immediate results and has been approved to temporarily smooth out and fill in moderate to severe nasolabial folds for up to six months.

So, how does Belotero differ to other HA fillers?

“Many fillers have a sort of blue hue to them, which can cause something called the Tyndall effect. The Tyndall effect occurs when fillers are injected too close to the skin’s surface, and it leaves behind a kind of blue-ish gray tint under the injection site. Due to the thinness of Belotero, however, I’ve found I can inject superficially without this unwanted effect, meaning I can target troublesome fine lines with greater ease,” explains top Bay Area plastic surgeon, Dr. Shahin Fazilat, M.D, FACS.

Juvéderm

Allergan’s Juvéderm is the world’s number-one selling collection of dermal fillers and includes many different HA fillers to suit your every aging concern.

Juvéderm XC – First approved by the FDA back in 2006, Juvéderm XC smooths facial folds and lines around the nose and mouth for up to a year. The XC in the name refers to the inclusion of lidocaine which help prevent (or at least distract from) any pain involved.

Juvéderm Ultra XC – Ultra XC is an injectable gel for temporarily adding fullness to the lips for up to a year. It is also approved for smoothing and correcting moderate to severe parenthesis lines such as smile lines around the nose and mouth.

Juvéderm Volbella XC – Volbella was one of the most recent fillers to be approved by the FDA and is indicated for both lip augmentation and the correction of perioral rhytids (fine lines around the mouth) in adults over the age of 21. Volbella contains a proprietary cross-linking technology called Vycross, which stabilizes the filler molecules and gives it a certain thickness to prevent the body from breaking it down too quickly. This means it’s able to provide more lift… and for longer. It also has a lower HA concentration, which results in less immediate swelling. Bonus.

Juvéderm Vollure XC – Formulated to tackle moderate to severe lines around the nose and mouth for up to 18 months, Vollure is all about dealing with laughter lines in a super-effective but totally natural-looking fashion. Like Volbella, it also contains Vycross technology to help create a more malleable, gel-like substance that can be molded to lift sunken skin and fill in fine lines, while maintaining enough movement to work with your facial expressions.

Juvéderm Voluma XC – Also known as the ‘liquid facelift,’ Voluma was the first non-surgical, hyaluronic acid filler to be FDA-approved for filling and plumping hollowed cheeks for adults over the age of 21. Voluma also contains Vycross technology and can last for up to 18-24 months.

Radiesse

Often thought of as the ‘foundation filler,’ Radiesse celebrated its 10th birthday in 2017 and is FDA-approved for adding volume to both the face and the hands.

“Radiesse is a wonderful, natural way to anti-age the hands as it significantly reduces the appearance of lines and veins,” explains HintMD partner and board-certified cosmetic and plastic surgeon Dr. Barbara Persons, MD FACS, owner of Persons Plastic Surgery in Lafayette, CA.

“We use it a lot for hand rejuvenation as it delivers hyaluronic acid and a natural calcium derivative underneath the superficial fascia of the hand, turning old skin into youthful-looking skin with a simple, two-minute injection and a short massage.”

Made primarily from synthetic calcium hydroxylapatite (CaHa) – similar to the calcium found in your teeth and bones – Radiesse offers immediate volumization as well as long-term benefits for up to 18 months. How so? CaHa acts like a scaffold to support the skin’s structure and also stimulates collagen production over time. Double. Bonus.

Restylane

Like Juvéderm, Restylane is one of the big guns in the world of HA fillers. Produced by pharmaceutical giants Galderma, the collection includes five fillers, each offering natural-looking results.

Restylane – The original Restylane is an HA filler primarily used to smooth away moderate to severe wrinkles and folds. It can also be used to add volume and definition to thinning lips. With a full treatment (usually two sessions), results can often last as long as 18 months.

Restylane Refyne and Defyne – Coined as the ‘next-generation, flexible hyaluronic acid fillers,’ Refyne and Defyne both incorporate a brand new technology called XpresHAn which allows the HA gel to move with your facial expressions, specifically when used to treat nasolabial folds. This gives Refyne and Defyne an unheard of amount of flexibility, making them perfect for use on areas where there’s a lot of movement and expression such as around the nose and mouth. Refyne is softer, making it the perfect choice for moderate fine lines and wrinkles, whereas Defyne is slightly less flexible and offers more suppor, so is more effective for deeper wrinkles. Both offer results lasting from eight to 12 months.

Restylane Lyft  – Formerly known as Perlane-L, Restylane Lyft is a thicker HA filler that’s used for correcting severe wrinkles and volume loss in the hands and cheeks. It uses larger particles and higher concentrations of hyaluronic acid than the original Restylane, and administers deeper injections, which is why it’s best for treating pronounced lines and wrinkles. Lyft is not suitable for lip augmentation.

Restylane Silk – Designed specifically for enhancing the lips, Restylane Silk is another relatively soft HA filler that uses small, smooth particles to precisely contour and shape a perfect pout. Due to the high level of muscle and skin activity around the mouth, expect results to last around six months.

Revanesse Versa

Launched in January 2018, Revanesse Versa is one of the newest kids on the block and has been approved by the FDA for the cosmetic treatment of facial wrinkles and creases. It uses a wet milling technology to create spherical and uniform particles which, according to the brand’s website, ‘provide the perfect balance between smoothness and volume.’ Versa’s biggest draw is that it results in less bruising and swelling than other HA fillers – it’s also less expensive, btw.

Sculptra Aesthetic

Dubbed ‘the filler that can do it all’ by the team at Plastic Surgery Specialists (PSS) in Marin County, California, Sculptra is a unique, FDA-approved injectable that, unlike HA fillers, has the ability to stimulate collagen growth, rather than simply ‘filling’ or increasing volume. It’s made from poly-L-lactic acid which acts as a collagen stimulator to restore the skin’s inner structure and plumpness and is indicated for mid-cheek, nasolabial folds and much much more (including cellulite, would you believe?).

“It works slower and is a different treatment to regular HA fillers,” explains top plastic surgeon and PSS partner, Dr. Stanley Poulos.

“Usually a patient starts with one or two vials (depending on the amount of correction needed), then returns for another treatment after one month and a final treatment the following month. Results appear gradually appear throughout this time and will continue to improve for up to two years, sometimes even more.”

Things To Consider

1. As with all cosmetic procedures, the greatest risk with fillers, is having your filler botched up by an under-qualified physician, so only ever have yours administered by a board-certified, experienced injector. Need help with that? You got it.

2. It’s always a good idea to have a pre-treatment consultation just to check your eligibility and talk through the results you’re looking for. Don’t be afraid to ask a ton of questions and make sure you’re fully aware of the hows, wheres and whys of your treatment including risks, symptoms and things you can do to enhance your results at home.

3. Avoid taking blood-thinning meds like aspirin, vitamin E supplements, St. John’s wort, ginseng and ginkgo biloba for at least a week before your treatment.

4. Fillers are not for you if you are pregnant, breastfeeding or have bleeding disorders, diabetes, lupus, oral infections or suffer with blood-clotting problems.