A large number of injectable fillers are now available for the treatment of facial wrinkles and contour irregularities. These fillers are especially helpful for treating thin lips, nasolabial folds and marionette lines. The best injectable filler is the subject of intense debate amongst plastic surgeons. Although most surgeons have preferences regarding their filler of choice, all agree that the choice of filler needs to be individualized based on the patients’ needs.When picking a filler material several variables should be considered.These include how long the fillers will last, the amount of fillers needed, the location of the injection, and the skin type to be injected. Based on these considerations, results can be optimized for the majority of patients by choosing the right filler material.Several filler options are available for patients with facial wrinkles. These include autogenous fat injections, synthetic materials and hyaluronic acid fillers such as Juvederm, Restylane and Perlane.In most situations, hylauronic acid fillers are the treatment of choice for facial wrinkles. These fillers are highly effective and very safe. They can also be reversed with hyaluronidase if patients aren’t satisfied with their result. In most cases they last for 6 to 9 months and may last up to a year following injection. They are currently the gold standard for injectable fillers.Synthetic fillers such as radiesse and artecol tend to last for longer periods of time, but are associated with significant complications. These agents may cause infection, granuloma formation and scarring. For these reasons synthetic injectable fillers have limited application in the treatment of facial wrinkles.Another alternative is the use of autologous fat. In many ways fat is the best alternative for facial wrinkles, but is problematic because of the complexity of harvesting fat. For this reason, fat injections aren’t routinely used for facial wrinkles.For all these reasons, hyaluronic acid fillers are the work horse for wrinkle injections. If you’re considering the treatment of facial wrinkles, it’s important to consult a surgeon with experience in this area.It’s important to realize that injectable fillers can address wrinkles, but when skin sag is present more aggressive procedures may be indicated.