It’s sometimes hard to believe that dermal fillers have been around for more than four decades. The industry has come a long way since the days of bovine collagen in the 1970s; the introduction of hyaluronic acid fillers, nearly 20 years ago, completely transformed the marketplace. More recently, the world of fillers has become even more saturated, thanks to major advances in technology and the debut of new brands and product iterations. But as demand for fillers continues to skyrocket, the wide range of options available to patients can often feel confusing and overwhelming. With so many fillers to choose from, how do you know which one is best for you and your specific goals? Ultimately, that’s the responsibility of your injector (who should be knowledgeable about them all but may stock only certain brands), but it’s important to have a conversation with them about your desired results. Here are six talking points to touch on while considering your choices.
1. Is this your first time getting filler?
“For the first-time patient, the most important characteristic is dissolvable versus non-dissolvable,” explains Dr. David Shafer, a board-certified plastic surgeon in New York City. “Only hyaluronic acid fillers can be melted or dissolved, so when I see first-time patients, I explain that they should use one of these products as their first filler.” Using a hyaluronic acid filler, like Juvéderm, Restylane, or Belotero, will ensure you have the option to remove it (via injection of an enzyme called hyaluronidase) if, for any reason, you don’t like the result or are experiencing a complication or the placement is incorrect.
Other fillers, which cannot be dissolved with hyaluronidase, are known as biostimulatory fillers and include Radiesse, Sculptra, and Bellafill. Unlike hyaluronic acid fillers, each of these options uses ingredients that gradually spark collagen production, or cell-activating “biostimulators.” Thanks to the uptick in collagen they provide, biostimulatory fillers can last a long time but, for first-time filler patients, are generally not recommended, since their results cannot be reversed.
2. Are you vegan or looking for a “clean” option?
“All fillers are tested on animals, so getting filler may not align with vegan ethics,” says Dr. Deanne Mraz Robinson, a board-certified dermatologist in Westport, Connecticut. But with that said, there are certain fillers that are more vegan-friendly than others. “Restylane and Juvéderm are produced with non-animal-based hyaluronic acid, so they are more vegan-friendly,” the dermatologist notes. “And Sculptra does not contain any animal products or by-products, making it clean-friendly.” The new RHA Collection from Revance, which features four different hyaluronic acid fillers, is also a great choice for those seeking a clean option, because it does not include unnecessary additives or preservatives. The one product all vegans should absolutely avoid, however, is Bellafill, which uses collagen derived from bovine sources.
3. What is your budget?
Dermal fillers can be pricey, and costs can vary, based on the brand and whether your doctor charges by treatment area or number of syringes. To avoid sticker shock when you go to pay, it’s important to bring up your budget with your injector during the consultation. They can then figure out the best treatment plan for your budget, taking into account the price of maintenance visits down the line. But it’s worth noting that the cheapest option may not always end up saving you money in the long run anyway. One example: “In our practice, Juvéderm Voluma, which lasts up to two years, costs about 30% more than Juvéderm Ultra, which lasts about 8 to 12 months,” Dr. Shafer says. “So, while Voluma costs more, the long-term savings can be substantial.”
Prices will fluctuate, depending on where you live and your provider’s experience level, but there’s always a fairly fixed market price for each product, so be wary of any coupons and discounts that aren’t from the manufacturer. There’s also been a spike in knockoff and counterfeit fillers in the past few years, so lower pricing could indicate that such a product is being used, that your injector isn’t credentialed, or that the filler has been more heavily diluted. “My advice for patients is not to bargain shop,” Dr. Shafer says. “In the end, you get what you pay for—and you don’t want to mess around with your face by looking for a bargain.”
4. How long do you want your filler to last?
On average, hyaluronic acid fillers will last between six months and two years. In terms of the biostimulatory fillers, Radiesse will last 12 to 18 months, Sculptra will last up to two years, and Bellafill will last up to five years. But up to is the key phrase. Some effect may be seen for that long, but the full effect of the product could be much shorter. “One analogy I give patients is, when you fill your gas tank up and it’s on ‘full,’ as soon as you start driving, the gas starts to deplete as it’s being used by the car,” notes Dr. Shafer. “Similarly, filler starts to go away as it’s metabolized by the body over time. And just as you wouldn’t wait for your gas tank to go to ‘empty’ to refill it, you should not wait for your filler to completely go away before your next treatment.” It’s also important to consider the placement of the filler when estimating its longevity. “Filler that is placed in areas of movement, like the smile lines around the mouth, usually doesn’t last as long as filler that’s placed deeply in areas that don’t have as much movement, such as the mid-cheek,” Dr. Mraz Robinson says.
5. Are you looking for a subtle or dramatic result?
Each filler varies not only in its formulation and longevity but also in its results, so thinking about what sort of look you’re after is crucial when communicating with your injector. “‘Subtle’ and ‘natural’ are common requests from first-time patients,” Dr. Shafer explains. “And part of my job is to keep patients’ expectations realistic and not lose touch with what looks natural.” With that in mind, he suggests thinner products, like Volbella in the lips and Vollure in the cheeks, for young patients who still have a lot of natural volume or those looking for a lighter touch. “For subtle smoothing but less volumizing in the lips, Juvéderm Volbella would be a great choice, and for pillowy fullness while still appearing natural, Juvéderm Ultra is excellent,” Dr. Shafer says. “But if you want a wow factor, then you really need thicker products, such as Juvéderm Ultra or Vollure in the lips and Voluma or Radiesse in the cheeks.” These are especially good options for those looking for lift in their cheekbones, because they will stay in place rather than spread out underneath the skin. More important than the product, though, is going to a trusted and experienced injector. “You should not feel ‘sold’ or pressured into how much to do and should feel comfortable explaining your expectations,” Dr. Mraz Robinson advises.
6. Are you getting filler as an alternative to surgery?
Dermal fillers are capable of a lot, which is why many patients look to them before considering more drastic treatments, including surgery, but they have their limits. “There has to be some moderation of expectations, especially when it comes to patients who really need a facelift,” Dr. Shafer says. “I often say that if you have to push your skin back to achieve the results you want, then you are more likely a surgical candidate. However, if you can point with your finger at areas [where] you want enhancement, then filler will likely work well for you.” He also suggests thinking in terms of improving, softening, and enhancing rather than getting rid of, removing, or erasing. “If you can describe what you want in more general and less definitive terms, then you will likely be happy with your filler results.” Dr. Mraz Robinson thinks that a blend of Sculptra and hyaluronic acid filler is the most effective for those wanting more intense rejuvenation. But it’s also important to keep in mind that filler is just one component of rejuvenation, and often, the best results come from using filler in combination with Botox and laser and light therapies.
