Thank you for your question. You are asking if there will be longer lasting dermal fillers in the future. You do indicate safety and reversibility, so you are aware of the limits of the limits of filler treatment.I can guide you on this question, as a facial cosmetic surgeon practicing in Manhattan and Long Island for over 20 years. I use cosmetic fillers extensively in my practice, and I'm also often called upon to dissolve fillers applied by other medical practices. As facial cosmetic surgeon who performs all types of facelifts, my knowledge and experience with facial anatomy enables me to place filler at the bone level, much deeper than most cosmetic filler practitioners that I call Structural Volumizing, which is also called the Y Lift.Longer lasting hyaluronic acid fillers have entered the market, but longevity of filler directly correlates with their viscosity or thickness, which limit the areas they can be placed. Juvederm Voluma is the longest hyaluronic acid filler in the market that can last about two years, but due to its thickness, it can only be applied to facial areas with little to no movement from facial expressions, like the cheeks, jawline, and chin. A filler as thick as Voluma would not be appropriate for the under eye area as it moves a lot with facial expression, so a less viscous filler is needed in this area like Restylane-L or Juvederm XC, which are softer and can move with facial expressions, but also don't last as long. Hyaluronic acid fillers are generally considered the safest of cosmetic fillers as hyaluronic acid naturally occurs in the body, so they are easily accepted by the body, considered hypoallergenic, and are safely metabolized with time; and also because they are reversible, and can be dissolved with the enzyme hyaluronidase.There are permanent and semi-permanent fillers available, but I do not recommend them due to safety concerns. Permanent and semi-permanent fillers are generally made to resist the metabolic processes of the body, so there is a high likelihood they are recognized by the body as a foreign substance, especially if they are left in the body too long. Permanent and semi-permanent fillers can migrate and dissipate, causing lumps, swelling, foreign body reactions, and infection. The only way to remove these fillers is through surgery, and surgery most often does not remove all the material. The take home message here is a longer lasting filler resists metabolic processes, which makes them more prone to foreign body reactions, infection, and they can't be reversed or dissolved.I think that hyaluronic acid fillers are the safest for patients, but they do need maintenance. I have found that longevity and benefit can be extended with other materials like platelet-rich plasma (PRP), and they do have a synergistic effect with skin quality improvement alongside volume enhancement. Anything beyond that where the extended life of a cosmetic filler resists metabolic breakdown of the material is a safety issue for my patients, so I wouldn't risk their health and results for something that lasts longer. I hope you found this information helpful. Thank you for your question.
