There are so may "wrinkle fillers" like Restylane, Juvaderm, etc. How can I pick the right one?
Best Cosmetic Wrinkle Filler?
Doctor Answers 16
My practice uses 7 different facial fillers on a regular...
My practice uses 7 different facial fillers on a regular basis. The main “workhorse” of facial fillers are hyaluronic acid (hi-ya-lu-ronic) fillers, such as Restylane, Perlane, and Juvederm. This group of fillers are a smooth transparent gel, can be used essentially anywhere on the face, require no allergy testing, and typically last around 6-8 months. The duration is less when used in lips.
The next filler is Radiesse, a calcium-based filler with a milky white color and a thicker consistency than the hyaluronic acid fillers. Radiesse also requires no allergy testing and can be used in most locations on the face except for lips. Radiesse is the ideal filler for the cheek and midface areas, the nose, as well as the chin and the jaw-line. The firmer consistency of Radiesse makes it typically unsuitable for lip augmentation. The typical duration of Radiesse is 8-12 months.
The most natural of all facial fillers is fat which is removed from the person’s own body using a very gentle liposuction technique. Fat can be injected into all facial locations and has the advantage of longevity since the fat can stay alive in the new location. Fat injections are ideal for individuals with a thin face who need a substantial amount of volume augmentation.
Another category of facial fillers is Sculptra that is poly-lactic acid, a semi-natural substance that is easily broken down by the body to natural by and sake byproducts. The unique characteristic of Sculptra is that it has the ability to stimulate collagen production by the body. Sculptra treatments are typically performed in a series of 4 or 5 monthly injections into the regions that are in need of volume augmentation. Results appear gradually, typically within a few months form the start of the treatment and can last over 2 years. Sculptra is ideally used in the cheeks, jaw-line, and temples and does not require allergy testing.
The other filler that I use is ArteFill, permanent filler that was recently approved by the FDA. What makes ArteFill permanent are millions of tiny beads of acrylic that are not absorbable and cause the body to build a shell of collagen around then. ArteFill is only recommended for the nasolabial folds (creases to the side of the nose and mouth). ArteFill does require allergy testing, although allergies are extremely rare. Results for ArteFill appear gradually over 2-3 months as the product stimulates collagen production.
Juvederm, Radiesse, and ArteFill are all true fillers....
Juvederm, Radiesse, and ArteFill are all true fillers. That is, the patient looks better the day of the injection. Sculptra is a volume agent that gives volume to the skin but only several months after injection.
Juvederm is a sugar-like substance that can last up to one year from injection. Radiesse is a calcium gel that can last one to two years. ArteFill contains collagen and synthetic beads. It can last five or more years but requires a skin test to make sure the patient is not allergic to the collagen.
Juvederm, Radiesse, and ArteFill can be used for smile lines and a variety of other wrinkles. Sculptra is a synthetic sugar-like substance that over a series of injections done months apart works best at helping sunken cheeks and hollow sunken lower eyes.
Wrinkle Fillers Juvederm, Restylane, Prevelle or Fat Transfer
Over the last several years, a number of new soft-tissue fillers including Restylane, Perlane and Juvederm have been introduced to the U.S. For physicians, deciding what to inject is an extremely important decision, as some fillers are safe for essentially all patients, while others can have troubling and even disfiguring side effects. The first filler that gained widespread acceptance is bovine collagen. However, that product tended not to last very long and also required a skin test prior to treatment. Human-sourced collagen products were then developed, but they had the stigma of being derived from the tissue of human cadavers. Also, the results did not last much longer than those from bovine collagen.
Injectable hyaluronic acid (Restylane, Perlane, Juvederm) is produced in culture instead of being taken from an animal or human source, which eliminates many of the concerns associated with injectable collagen products. Hyaluronic acid has many of the qualities of the ideal filler: it is safe and affordable, it produces natural-looking results, and it is extremely effective for most patients. In our plastic surgery practice and medical spa, we have seen a much higher rate of patient satisfaction when using hyaluronic acid products than with collagen products.
The enhancements produced by hyaluronic acid products tend to last six months on average, but in some patients, results can be seen for as long as 10 to 12 months. Hyaluronic acid injectables have advantages above and beyond the long duration of results seen in most patients. In three years of experience using this material, we have never encountered an adverse reaction, such as infection, inflammation, migration, allergy, or scarring.
There are many injectables currently available that carry a significant risk of one or more of the above complications, which points out the importance of choosing an injectable agent that is not only effective but also safe.
Evolence is a new Dermal Filler derived from Porcine (Pig) Collagen. There have been reports of nodule formation following lip injection.
For permanent wrinkle elimination, I perform facial fat grafting. Fat grafting can also be used to enhance the lips, cheeks, chin, under eye hollows and hollow aging brows.
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degree of volume loss and location
Because there are so many "wrinkle fillers", as you state, it is important to have a thorough assessment and consultation with your provider.
Let me also answer your question by stating that fillers should be viewed as "volume restorers" as much as "wrinkle fillers." When used with this in mind, patient satisfaction may even be higher.
The choice of which filler to use will depend on the degree of volume loss and location. There are a few fillers which are better suited for superficial placement in order to "fill wrinkles" and other fillers that should be placed deeper to restore the lack of volume in that area. The choice of fillers should be made with those factors in mind.
For example, Radiesse is a very good volume restorer and is injected deeper into the dermis and even below the skin, such as when augmenting the cheekbone area. However we would not use Radiesse in the lips. Juvederm is a good choice for the lips because it injects smoothly and has a softer feeling. Juvederm is also a good choice to use for the lines and sunken area between the nose and the mouth corners and below the mouth corners. Those areas are referred to as nasolabial and marionette lines.
Both Radiesse and Juvederm are considered temporary fillers and have been shown to stimulate natural collagen formation. They do not require any allergy pre-testing. For these reasons they are good choices for first time users.
There are other fillers available for much longer-lasting results and are more often used for patients who have already used the more temporary fillers. Fillers such as ArteFill require a skin test at least 4 weeks prior to treatment, but it may be even more permanent than some of the other fillers. Sculptra, FDA-approved for treating the facial fat loss or lipoatrophy from HIV, is another long lasting filler that is good for deeper soft tissue filling.
The choice of filler is extremely important, but as important is your choice of provider. Check with the American Society for Aesthetic Plastic Surgery for a member provider near you, as a preponderance of what they do is aesthetic surgery.
A thorough and individualized consultation should provide you with all of the information that you need in order to make a well informed choice of filler best for you.
Picking the right filler!
There are a number of wrinkle filler products available with different characteristics. I will mention them in order of longevity.
The first group are the Hyaluronic Acid products. There are a number of products containing this material. These include:
Rastylane, Perlane, Elevess, Prevelle, Hylaform, Juvederm, and Captique
The differences in the products are subtle despite claims made by the manufacturers. The newest products are Elevess and Prevelle. These 2 contain a numbing medicine that decrease the discomfort associated with the procedure.
All the products mentioned above last about 6 months despite claims to the contrary by the manufacturers. And they are avaiable off the shelf with no preparation.
Other types of fillers include Radiesse and Sculptra. These are also available off the shelf with no preparation.
Radiesse is a hydroxyapatite product (similar to the material found in bone) and lasts about 8-9 months.
Sculptra is a poly-L-lactic acid product (similar to suture material used in surgery) and lasts about 2 years. This is more of a volume filler than a wrinkle filler.
All of these products can be used to effectively in the face. However, as mentioned, all of the products listed above are temporary fillers.
The only FDA approved permanent filler that is available off the shelf is Artefill. This product can improve wrinkles permanently with excellent results.
Last but not least is fat injections. Fat injections can also permanently add volume to the face. Although this is a surgical procedure, with proper technique excellent results can be achieved.
Let your doctor be your guide
Your doctor will suggest what is best for your condition. The depth and width of the lines determines whether a thicker or finer filler would be used. Restylane and Juvederm are virtually equivalent; some doctors prefer one over the other.
A person's face changes over time; therefore, any...
A person’s face changes over time; therefore, any dermal filler should allow the face to change harmoniously. The disadvantage of synthetic fillers is that they may look unnatural as your face ages. Ideally you should use natural substances such as hyaluronic acid, which does not cause allergic reactions.
Collagen injections erase lines and wrinkles and will...
Collagen injections erase lines and wrinkles and will last up to six months. Sculptra adds fullness and volume to lift sinking areas of the face. The added benefits of Sculptra are that it stimulates collagen production in the body and can last up to two years.
Radiesse is less gel-like than other fillers used for...
Radiesse is less gel-like than other fillers used for wrinkle treatment. It’s thicker and great to use for smile lines and chin and cheek augmentation. You can place this product near the bone. It can last up to a year or two.
It’s made out of calcium hydroxyapetite, which is much different than a hyaluronic acid (Perlane, Restylane, Juvederm). Radiesse can produce nodules more easily and is not used for lips.
There is no one filler best for every patient, every...
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.