There is no one filler best for every patient, every need. Each has a strength that makes it better for certain situation.
There is still a place for the collagen family of products: Zyderm, Zyplast, Cosmoderm, Cosmoplast. These hurt the least and bruise less frequently, so are great for a quick fix. Problem is, the duration is less that 4 months in most. But for fine peri-oral lines Cosmoderm can't be beat.
The hyaluronic acid (HA) family: Restylane, Hylaform, Captique, Juvederm, Perlane, are by far the most popular, especially Restylane and Juvederm. HA fillers are versatile and reversible, and very safe. Versatile because they can go in fine lines, deep folds, do volume correction, lips, yet can be totally removed if there is a problem (using hyaluronidase). (No one is really using Hylaform or Captique anymore-too short duration)
- Restylane and Perlane are stiffer, particle gels, making them good for defining,
- Juvederm is a homogenous gel that is the best for soft lush lips. There is data supporting Juvederm Ultra Plus lasting 12 months.
Radiesse, Calcium hydroxyl apatite, is a thicker filler that lasts about one year, and stimulates collagen production for longer results. It definitely hurts the most, swells the most, and bruises the most, so anesthesia is a must and plan for a least one day down time for swelling (some don't get it). It is my product of choice for the "marionette lines" because of the structural support it gives.
Sculptra is not really a true filler. It is an injectable device that firms, brightens and tightens the skin. it is best for correction of fat loss due to age or disease. It is particularly good for anorexic patients and those with low body fat and a gaunt, tired look. It is back-end loaded. That means that the results take 2-3 treatments and 3-6 months to be appreciated, but then those results last many years. Many of my patients have seen results last 3 years and counting.
The last new one is Artefill. More like silicone in that it is permanent. Used just in nasolabial folds. Best for those older patients with thick folds, needing too much of the other products.
