What's the difference between popular wrinkle fillers?

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.

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.

There are so many on the market right now. Where do you want to start?

Picking the right one is a matter of personal preference of the physician and what that physician feels is right for you. This is often a long discussion during the consultation.

There are so many dermal fillers available worldwide, it would be almost impossible to make a comprehensive comparison. However, in the United States, there are a few fillers that probably comprise the majority of the fillers that are used. Here is a quick cheat sheet that has the most common specs and uses. I use all of these with very good results in properly selected patients.

Radiesse
1.3 cc syringe, active ingredient is 30% "powdered synthetic bone"
Very good for nasolabial folds, cheekbones, jaw lines. Not good for lips. Lasts about 3-6 months after the 1st treatment, about 12-18 months after the second treatment. Considered "semi permanent" because the collagen that it stimulates will last for years after the product has dissolved. Cannot be dissolved with any chemicals such as Hyaluronidase. Can also be used on the backs of the hands.

Restylane
1.0 cc syringe, made out of cross linked Hyaluronic acid
Lasts about 6 months. Tends to absorb a little water, which causes some temporary swelling. Good for nasolabial folds, lips, mild to moderate wrinkles. It can be dissolved with Hyaluronidase. Lasts from 3-12 months; 6 months is about average.

Perlane
1.0 cc syringe, similar to Restylane
The "particle size" in the Perlane is larger, which makes the Perlane thicker. It tends to be used for deeper wrinkles and contouring. It is very good for deep nasolabial folds, straightening the jaw line. It can be dissolved with Hyaluronidase. Lasts 3-12 months; 6-9 months is about average.

Juvederm Ultra (aka Juvederm 24 HV in other countries)
0.8 cc syringe, similar to Restylane
Injects very smoothly and tends to flow nicely under the skin. Very good for lip enhancement. Absorbs a little less water than Restylane so there is a little less swelling, which may be important in the lips. Even though the syringe is smaller, there is a higher concentration of Hyaluronic acid in the material which gives it about the same amount of Hyaluronic Acid as Restylane. It can be dissolved with Hyaluronidase. Lasts 3-12 months; average is about 9 months, less in the lips.

Juvederm Ultra Plus (aka Juvederm 30 HV in other countries)
0.8 cc syringe, similar to Juvederm Ultra, but 20% thicker
Very good for deep nasolabial folds. Softer than Radiesse, less likely to leave a palpable lump in the skin.

Sculptra
Comes as a powder, must be mixed with water and local anesthetic at least 2 hours prior to use, preferably mixed 24 hours prior to use. One vial can produce 6-10 cc of material. The initial effect only lasts for a few days. The fluid is absorbed, but the powder is left behind. The powder causes the skin to get thicker. 3-6 treatments, space 1-2 months apart, are needed. Vigorous massaging is needed 5 times per day for a few weeks after the material is injected (this is done by the patient at home). Very good for replacing lost volume in the cheeks.

The single most important factor in choosing the right filler is the injector's preference. Each injector will develop expertise with various products for various corrections. Your best bet is to ask the injector what they like to use and why. Good injectors will be able to give you a good result by choosing what works well for them.

All of the contributors focused only on the use of fillers to address wrinkles which is always a good place to start. The idea is to shape the face rather than just chasing wrinkles or filling lines. However, let's not also forget that oftentimes a combination of modalities will prove extremely beneficial in helping one to meet their goals. In our practice, we take into consideration the use of non-ablative (no downtime) lasers, laser resurfacing (ablative), Botox, and fillers. The final outcomes are excellent and may be tailored to meet each patient's budget, goals, and lifestyle.

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.

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.

Dr. Jennifer Walden shares her expertise with FOX News and compares popular wrinkle treatments:

• Radiesse
• Juvederm
• Botox
• Restylane
• Facelift

Dr. Samuel Lam explains the difference between some popular dermal fillers: Juvederm and Restylane, Radiesse, and Silicone.

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 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 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.

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.

• Compared with Restylane, Perlane or Juvederm, Radiesse is a more long lived filler. This can be either good or bad, depending on your satisfaction with the product and how it looks.
• Radiesse is an opaque product whereas Juvederm and Restylane are clear so it is possible to get white bumps with Radiesse.
• If you get bumps from Juvederm or Restylane or Perlane they will be clear.
• In addition, since Juvederm and Restylane and Perlane are all hyaluronic acids (Radiesse is made from calcium hydroxylapatite- a bioceramic material), they may be digested and dissolved by injecting something called hyaluronidase.
• The important part is that they are all safe and effective but Restylane, Perlane and Juvederm are clear and reversible.

Radiesse

Radiesse lasts longer than other fillers (e.g. Restylane) and has a thicker consistency.  It may be palpable for a longer period, and it works particularly well to fill deeper creases.

Injections that reduce the appearance of facial wrinkles and folds are increasingly popular for consumers interested in minimally invasive anti-aging treatments. But how should you choose amongst the wide variety of wrinkle fillers and relaxers?

It's important for you to be aware that each wrinkle product gets injected in a specific manner. This has significance to the type of skin care result you seek.

For instance, Sculptra is injected deep into your skin -- into the subcutaneous tissue. This allows your plastic surgeon to cover a large area such as the cheek and to build up the entire area. Deep facial folds or sunken cheeks respond to Sculptra, whereas Botox would not provide this desired effect.

Juvaderm, a new comer to the facial aesthetics market gets injected into the dermis in order to fill facial wrinkles; Restylane which is similar in composition to Juvederm is also injected in this manner.

Botox isn't technically injected into the skin. It's injected into the muscle of expression and blocks the nerve impluses to that muscle. These nerve impulses are the cause of frowns between your eyebrows and in your forehead.

More recently, bovine collagen was the gold standard of safe fillers. A small percentage of individuals are allergic to bovine collagen so a test dose was needed before treatment. Collagen was safe and pretty effective but only lasted a very short time and therefore was expensive and impractical for all but those with the deepest pockets.

• Collagen was improved with the introduction of Cosmoplast and Cosmoderm, which were made from human collagens (much lower likelihood of allergy). These offered no additional benefit in terms of longevity so when Restylane hit the market, it was essentially over for these Collagen products.
• Restylane and the recently released Perlane are hyaluronic acid based fillers. This is a sugar gel that occurs naturally in the body. Restylane and Perlane are made by Medicis. Juvederm, a competing hyaluronic acid filler, is marketed by Allergan.
  • These products last approximately 9 to 14 months in the body (somewhat less in the lips) and in sufficient volume are capable of results that cannot be achieved with surgery.
  • While treatment is expensive, these services can be comfortably performed during an office visit with almost no down time.
  • The hyaluronic fillers are so effective and versatile that it is almost not worth discussing the other FDA approved fillers. These hyaluronic fillers are so good that not only will they dominate the filler market but they will take the place of surgery in many cases.