Injectable fillers
Injectable fillers may be used to correct a variety of cosmetic concerns, such as wrinkles, thin lips, acne scars, and dark or puffy under-eyes.
Cosmetic injectables, wrinkle fillers or dermal fillers are generally classified in two main categories:
- Temporary injectable fillers
- Semi-permanent or permanent injectable fillers
While these injections are often used as wrinkle fillers, they act differently than Botox or Dysport, a Botox competitor. Botox freezes the muscles that form wrinkles. Hence, you will rarely see a doctor suggest Botox for filling, such as lip injections.
Temporary injectables and dermal fillers
Temporary injectable fillers include two categories: collagen and hyaluronic acid fillers. Collagen is a naturally occurring connective tissue. Both collagen and hyaluronic acid injectable dermal fillers are created in a lab to mimic these natural substances.
Hyaluronic acid fillers (HA fillers)
Hyaluronic acid is a naturally occurring substance between the skin cells that binds moisture and provides fullness. Unlike collagen fillers, hyaluronic acid fillers do not require an allergy test before they are injected and rarely cause an allergic reaction. These fillers are used to plump lips, fill facial lines, nasolabial fold, and other signs of aging.
Image: Juvederm Before and After by Orange County Dermatologist Nissan Pilest, MD
HA fillers results can be reversed using hyaluronidase injections in the event results are undesirable. The 3 most popular hyaluronic acid fillers are:
Other HA fillers offered by doctors may include Prevelle, Teosyal and Macrolane.
Injecting or transfering your own fat
Fat injections involve performing a fat transfer to move fatty tissue from one body area to another. Fat may be removed from any body area with enough tissue to spare, and it is important to note that you can only use your own fat for fat injections.
Image: Fat transfer may be used in hand rejuvenation. Photo by Dallas-based Sam Lam, MD
Many doctors recommend fat injections over other injectable fillers because they carry a low risk of side effects and can offer permanent results. However, the body may reabsorb some or all of the injected fat, so results cannot be predicted and may not last. Read real patient stories about their fat injections and fat transfers.
Semi-permanent and permanent injectables
Semi-permanent and permanent injectable fillers are used to correct deeper facial creases and restore volume in large areas. They injected deep within the soft tissue for more long-lasting and large volume correction.
There is great debate in the medical community regarding the use of semi-permanent and permanent fillers. Many doctors discourage using semi-permanent and permanent fillers in the lips and occasionally, the under-eye area. However, some doctors discourage the use of all foreign substance permanent fillers altogether.
Semi-permanent fillers
Radiesse is a white, paste-like suspension of calcium hydroxylapetite FDA approved to treat nasolabial folds. Radiesse is also frequently used off label to add volume to the cheeks. Results from Radiesse injections typically last about 1-2 years,
Sculptra is FDA approved for aesthetic use on facial wrinkles, although it was originally created to treat lipoatrophy in HIV patients. Sculptra is a suspension of microspheres composed of poly-L-lactic acid (PLLA), the same substance as some absorbable sutures, suspended in methylcellulose.
The PLLA microparticles injected during Sculptra treatment may last upto 2 years, but Sculptra may have a more permanent result, as it can promote new collagen production even after it has been absorbed by the body.
Permanent fillers
- Artefill (Artecoll)
- Silicone injections
- Aquamid
Artefill is a gel filler consisting of millions of synthetic microspheres (polymethylmethacrylate or PMMA) suspended in purified bovine (cow) collagen. The company that produced Artefill filed bankruptcy in 2008.
Silikon 1000 and other types of silicone injections are not FDA approved for aesthetic use and may cause contour irregularity, dimpling, infection, migration, nodules, granulomas, inflammatory reaction, and deformity.
Aquamid is another permanent filler not FDA approved for use in the U.S. Aquamid is a hydrogel consisting of water and cross-linked polyacrylamide gel (PAG). Aquamid injections may carry high risk of infection.
Injectable filler side effects
Common injectable filler side effects may include:
- Bruising
- Swelling
- Hematoma
- An unsatisfactory outcome
Infection and necrosis are also potential side effects, although less common. Fillers may also migrate, or move to areas where their effects are not desired. Improper injection technique may cause temporary injectable fillers to be visible, palpable, and in some cases, to form small lumps that will dissipate with time.
Semi-permanent and permanent fillers may also carry a risk of inflammatory reaction, which causes the formation of granulomas, or lumps, that can be felt or seen beneath the skin. Injection of an anti-inflammatory may help to improve minor lumps or swelling, however surgery is often needed to fully resolve permanent filler side effects.
The greatest risk occurs when injectable fillers are injected by a practitioner who is not properly qualified to perform cosmetic injections.
What about getting Collagen fillers?
Along with the rise in demand for hyaluronic acid fillers has come a decline in collagen injections. Since collagen injections are typically made of collagen derived from cows (bovine) or pigs (porcine), an allergy test is required before collagen fillers may be injected. This inconvenience and relative shorter life span reduced consumer demand for collagen. Brands you may still encounter incude Evolence (now off the market), Cosmoderm, Cosmoplast, Zyderm, and Zyplast. Note that despite the name, collagen injections do not increase your rate of collagen generation.
