Best wrinkle fillers?

To I.P.,

Hi!  I don't think you want another lecture on fillers.  So, reading your question very carefully, I conclude that your marionette lines, lip lines, and wrinkles are NOT very deep.

For more superficial lines, Restylane is the most forgiving (least likely to give you bumps), and so it is the one I use.  And it lasts 5-6 months.  Injection technique is very important.

Also bear in mind that there are other non-invasive treatments for lines and wrinkles besides fillers which might help you.  Botox is very useful, and Thermage can be, for the right anatomy.

In my experience, hyaluronic acid fillers such as Juvederm and Restylane (Perlane) have given consistent results lasting 8-12 months. Radiesse, which is calcium-based, also gives long-lasting results in deeper lines.  All of these are fairly thick fillers. 

I am starting to use more of the lasting collagen Evolence on thinner more superficial lines, as well as along the lip border because I feel I can be a little more precise in these areas.

I liked the results I was getting from Artefill, a permanent dermal filler but presently it is not available in the US.  Hopefully, the will be available again.

Sculptra is the recommended choice for filling in large volume on the cheeks of HIV patients who have developed soft tissue atrophy.

Finally, fat grafts are used by many physicians although in my experience, I have not had consistent satisfactory long-term results.

I.P.

The "best filler" will depend on many factors including:

1. The length of time the filler will last.

2. The area on the face that needs to be filled.

3. Your skin type, thick or thin, if you have sun damage or acne scarring.

4. The amount of "fill" that is required (fine wrinkles, etched wrinkles, troughs and major volume - cheeks and mid-face).

Hyaluronic acid fillers have become the "gold standard"  these days.  I believe the other fillers still have niche roles and I still frequently use them. The reason that hyaluronic acid fillers have become so popular is because they are softer than the other fillers, they are more forgiving (harder to feel or see bumps) in thinner skin and soft tissue, they can last up to 12 or 18 months in some locations, they are cheaper than other longer lasting fillers and they can be reversed instantly with a solution of hyaluronidase if needed.  

The two major hyaluronic acid players are Juvederm (by Allergan) and Restylane (by Medicis).  The major hyaluronic acid fillers can differ in the "particle size" of the hyaluronic polymer, the cross-linking of the polymers and the final concentration of the hyaluronic acid in the syringe.  Juvederm has a wider range of particle sizes and Restylane has a more uniform particle size.  Both have similar concentrations and cross-linking of hyaluronic acid.  The variations of these products have greater concentration or cross-linking to achieve better and longer lasting correction at the expense of a thicker, less forgiving product in thinner skin.

The bottom line is that each of my patients is evaluated first, then I discussed the different filler options available for each area of concern and finally we select a filler to give the best correction for that area. I photograph each patient before and after the treatments to follow the patient's progress and document the length of time each correction lasts. I insist that patients return two weeks after a treatment so we can reevaluate the treatment area and determine if any additional corrections are necessary.

There are many fillers on the market today.  Many of them work fine. 

I prefer to use Juvederm for most of my patients. I will use Radiesse as well, but not in the lips. Juvederm is a hyaluronic acid sugar and can be used in many places.  It is soft and forgiving.

Additionally, it will last 6-8 months in many areas, perhaps less in the lips. The nice thing about this is that it will not persist for years as the rest of the face ages, and if someone does not like having a filler, it will go away in time.

There are many factors which account for the best facial filler for you including your skin thickness, area intended to be injected, etc. Each filler has its risks and benefits. Generally speaking the safest fillers on the market are the hyaluronic acid derivatives and radiesse. They have an extensive history of use and when used properly by an experienced injector have little to no problems. Be cautious with the latest and greatest filler until its safety profile has been examined. A common saying is a permanent filler is a permanent problem.