I have marionette lines, lip lines, and wrinkles all at once! What's the best wrinkle fillers to get rid of these lines!?
Best Wrinkle Filler
Doctor Answers 28
Correcting marionette lines and plumping lips with dermal fillers
I am a board-certified plastic surgeon practicing in the Los Angeles area for 20 years. I have a vast experience with dermal fillers.
For "marionette lines" (medically-termed labio-mental rhytides), I prefer Juvederm Ultra Plus or Perlane. These fillers give substantial and lasting support to the heavier tissues in the marionette area. The skin here is thicker and the muscle activity is quite powerful, so a more supportive filler is required.
Also, many of the marionette lines, feather out to the inner cheek area and upward toward the corners of the mouth, so a natural result can be created by blending the filler throughout these areas, rather than just simply "filling" crevices.
It is a very artistic and 3-dimensional process in my hands and it is amazing how it can immedicatly take years of of your face! It is very satisfying for me to do this, especially since I can relate to the needs of my patients and I am a consumer of the same procedures that my patients desire.
The fine "lip lines" can be filled with a finer, thinner filler, which can vary according to the skin thickness of the lip, the extent or depth of the lip wrinkles. I like Juvederm Ultra for thicker skin and Evolence for thinner skin.
More importantly, I love to not just "fill lines" but to shape the lips with a natural contour (not duck lips), including the bows of the lip, the philtral columns and the philtrum-the beautiful part of the upper lip around the cupid's bow region.
The lower lip also can benefit from some filler in the center to provide fulless and volume. The filler is used almost like a "makeup" and "highlighter" on the lips or a gloss on the lips, making them full and blended to a natural contour. We have all seen the overdone, hideous lips of patients that were just pumped up and not treated as works of art.
Truthfully some patients are very afraid of having the body of the lip filled with dermal fillers, because they specifically fear looking like a freak, or having an "obvious" lip filling result. If I truly feel from my aesthetic assessment that the patient will benefit overall from having the body of the lip filled to naturally recontour the entire area around the mouth and lips - then I explain why to them, and give them a mirror to show them what I plan and tell them I can stop at any time.
During the treatment, I tell them that they will have an opportunity to look at what I have done, and we go slow and steady so that they feel they are in control and they affirm they like the result. This has worked well for me and for my registered nurses who are also professionally trained by me to do dermal fillers under my supervision.
My nurses have been trained by me and worked with me in the operating room, where I make many changes in an attempt to restore a patient to a youthful, but more importantly, a natural and pleasing result.
Additionally, we take our time and try to make this sensitive area as painless as possible and we have formulated customized and reliable techniques to make this event as gentle and supportive as possible.
Juvederm is my favorite wrinkle filler
When we graduated medical school, our professors told us "primum non nocere", first don't harm people. I interpret this as meaning that the treatments we give our patients should be safe.
I am proud now that the reports of granulomas with Artecoll and Radiance are surfacing that not one single patient of ours has ever been injected with that substance. Now that silicone horror stories are well-known, not one patient has ever been injected with silicone in our office.
While many patients will continue to be injected by the newest fillers with non-natural components such as methyl methacrylate beads, plastic spheres, liquid silicone, silicone gels, we will not inject them in our practice, because it simply does not make sense to put a permanent or semipermanent non-biologic material into the face in my opinion.
I am impressed with the safety and effectiveness of hyaluronic acid fillers. Prevelle is a lighter hyaluronic acid with a little lidocaine in it for sensitive patients or patients with little or no recovery time.
You can see by the posts that occasionally the heavier hyaluronic acids such as the Juvederm series and Restylane or Perlane, wonderful fillers which we use daily, can cause swelling for several days, so this should be factored for patients who are on camera (i.e. newscasters) or have important social obligations immediately following their injections.
So while you can argue which is the best filler, please avoid the bad ones.
A variety of wrinkle fillers work for different facial wrinkles
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.
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Best Wrinkle Filler
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.
Smiling is the best wrinkle filler
Smiling is the best non-invasive wrinkle filler.
Of the temporary fillers mentioned by others (Restylane, Juvederm, and Radiesse, etc.), I believe that a patient's own fat is the best "wrinkle filler."
Fat transfer returns volume to the face, and has the advantage of being a permanent filler. The stem cells in the fat also work over time to improve the tone and texture of the overlying skin.
Prior to 2008, I did not use Sculptra in my practice because of some extremely mutilating granuloma reactions and nodules that I had seen experienced by patients of other physicians. From it's original use in 2000 to 2008, experienced Sculptra injectors found that the granuloma reactions and nodules were related to how and where the product was injected, and how Sculptra was prepared. After a year of due diligence and studying under expert Sculptra injectors, I was convinced of the safety and efficacy of Sculptra. I have used Sculptra in my patients since early 2009 with excellent results and no adverse events.
For those of us needing a quick fix, certainly Restylane, Juvederm, and Radiesse are all great wrinkle fillers.
Overall, the most versatile, long lasting, and effective...
Overall, the most versatile, long lasting, and effective filler currently is Juvederm. I like it because it comes in two concentrations, Ultra and Ultra Plus, that can be used for finer or deeper lines. After injection, this product has excellent longevity (upwards of 6 months), is soft and supple, and causes minimal skin reaction. It can be used anywhere, including the lips, and, worst case scenario, it can be dissolved with hyaluronidase.
Radiesse is an excellent choice for deep nasolabial folds, for 'non-surgical' rhinoplasty, and for deep injection augmentation of the cheeks and chin. It is unpredictable in the infraorbital region and definitely should not be injected in the lips.
Restylane is equally as versatile as Juvederm, with great short-term results, but perhaps only 10% of my patients still have results after 4 - 6 months. It generally lasts only 1 - 2 months in the lips.
For permanent results, Artefill is the one and only choice. Presently, I am using it only in the nasolabial folds and marionette lines, but with excellent results.
Sculptra stimulates collagen production, resulting in filling and overall volume restoration / augmentation over time (and requiring 3 - 5 injection sessions spaced 4 - 6 weeks apart). It is not a traditional, 'what you inject is what you get', filler. It works best for patients with criss-cross crepey wrinkles and diffuse lower face hollowing.
Juvederm or Restylane in combination with a very low dose of Botox works well for fine vertical lines extending from the lips, although CO2 laser resurfacing really works best.
Restylane is the best wrinkle filler for fine lines
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.
Juvederm wrinkle filler can achieve beautiful results
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.
The Best Wrinkle Filler
A "liquid facelift" is a procedure that is performed using temporary dermal fillers like Juvederm Restylane or Perlane. There is little to no downtime with a liquid facelift. This might be an ideal treatment for some, but the results are temporary and it does not address excess skin
Some synthetic materials are available which can be used in an attempt to produce a permanent soft tissue augmentation. Unfortunately, the body treats such materials as foreign objects, and as a result the placement of synthetic materials may lead to inflammation, infection, migration and granuloma formation. In general, synthetic materials are less likely to produce a result that looks and feels natural.
For patients seeking permanent enhancement of soft tissue volume, the ideal material to use would obviously be something that is naturally-occurring and not rejected by the body or treated by the immune system as a foreign material. Whether the goal is to restore volume to an area such as the lips or the cheeks, or to fill in a crease or depression such as the nasolabial folds or marionette lines, the ideal material is quite clearly the material that one wishes was there in greater abundance in the first place: YOUR OWN FAT.
A relatively new technique has been developed called structural fat grafting, in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.
This is a procedure that requires specialized training and specialized surgical instruments, as well as patience and attention to detail on the part of the surgeon. When performed properly, permanent improvements in facial plastic surgery are possible. If enough fat resorption occurs following a fat grafting procedure such that the desired result is not achieved, a second 'touch-up' procedure can easily be performed to augment the result obtained from the first injection.
Facial fillers vs Botox cosmetic
Often times, patients question which ancillary procedure is best for improving facial wrinkles/lines. The answer depends on the nature of the facial wrinkle that is in question.
Broadly speaking, facial lines either are static or dynamic. Static lines would include those that are present in complete rest, i.e. - without any animation. Examples of these would include, nasolabial folds, marionette lines, prior acne scars, as well as some deep frown furrows, forehead wrinkles, and crows feet lines that are present at rest (the last three can be exacerbated by animation, though).
Dynamic lines are those produced during facial animation - as true of crows feet, forehead lines, and glabellar (frown) lines. Dynamic lines are largely produced by the contraction of the underlying muscles, which in turn, "wrinkles" the overlying skin.
As discussed elsewhere, Botox cosmetic is an excellent option for dynamic lines, as it addresses the etiology - i.e. the underlying muscle. By paralyzing the muscle, one is not able to contract it, thereby overlying skin is spared of associated wrinkling.
Facial fillers, whether they be Juvederm, Restylane, Catique, Hylaform, Collagen, etc, etc, etc... - as there are literally countless many more - are used for, as the category indicates, "filling" in facial lines/wrinkles/folds. But realize that if the line is caused by the underlying muscle, then simply "filling" in the line is inadequate, as it is not addressing the etiology.
Also, it should be evident that the reason why there exists countless number of facial fillers is because no one filler is clearly the "best" for all situations. After all, if one was the "best" - why would there be a need for so many others? In general, most facial fillers are all temporary, and bring about an improvement in deeper lines, folds, or wrinkles. Most facial fillers come prefilled in a 1cc syringe, and depending on the line treated and degree of correction desired, may require more than one syringe.
Several other uses of facial fillers include:
- Lip augmentation - All of us have our own bias in regards to our "favorite" filler for this purpose. I personally like to use a different filler depending on the desired outcome - are we striving to DEFINE THE LIP OR TO VOLUMIZE THE LIP? For lip definition, I personally still like to use collagen, as I feel it is more precise in its delivery, but for lip volume, I utilize one of the hylauronic acids (Juvederm, Restylane, etc).
- Facial fillers can also be used to fill in the "lower eye bags" as well. For this area, I prefer the softer hylauronic acid gel fillers - they may last less, but for this area with thin skin, it looks and feels better. Once again, this is just my own preference, and not point of right or wrong.
The field of facial fillers are constantly coming up with new products, so ask your local health professional about it. Ideally, the day when one filler is more durable (i.e. more permanent), soft, and cost efficient will be the day when further fillers will not fill the 5 o'clock news as the "latest" and the "best."
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.