Everything you wanna know about filler
What are hyaluronic acid fillers?
They are sterile gels consisting of non-animal, cross-linked, hyaluronic acid (HA) and are made in a laboratory. HA is a natural sugar found in the skin. They contain no human or animal, and have the best safety profile of all the fillers currently on the market.
Fillers all have slightly different uses and properties based on their molecular weight, amount and type of cross-linking, elasticity, etc.
Here’s a brief summary of each:
Galderma owned fillers are Restylane Lyft, Restylane Defyne, Restylane Refyne, Restylane and Restylane Silk. Basically, Lyft is the “stiffest” and is used mostly for lifting. Defyne has a heavier weight but is more elastic so it supposedly conforms to facial movement better. Refyne is a lighter weight but similar to Defyne. Restylane is mid-weight and Silk is very light and was formulated mostly for lips. More may be coming soon.
Allergan owned fillers are Voluma, Vollure, Volbella (Vy-cross technology), and Juvederm Ultra Plus, and Juvederm Ultra. More may be coming.
Merz – Belotero is light and usually used for lips or fine lines.
Teoxane (Swiss company) – Teosyal HA fillers are just beginning to be used in the U.S. Very similar to many of the products named in 1 & 2.
Sculptra– poly-L-lactic acid – Think of this as a collagen builder, not a line filler. It is best for the facial hollowing, especially the temple area, and volumizing. Particularly nice for restoring facial volume for low body weight individuals. When mixed, injected, and massaged correctly, it does not form bumps.
Radiesse – calcium hydroxlapatite – Basically a constituent of bone and cartilage in a creamy, injectable form. Purports to last longer than HA but often seems not to. Like Sculptra, it generates collagen. More prone to complications and bumps then HA fillers. It cannot be adjusted if mistakes occur. There is a diluted version that may be used for body sites.
Fat – This would seem to be the ideal dermal filler since it’s your own tissue. But it can be unpredictable, sometimes lasting months and sometimes years. It can be lumpy. Be prepared for 1-3 weeks of bruising and swelling, and it’s difficult to find dermatologists or plastic surgeons who are expert at it.
Belafill, Silicone – Belafill (was Artefill) is tiny plastic beads that are not adjustable. They can look great initially but complications can occur 3 months to even 10 years later, and the complications can be permanent. These complications can be disfiguring and, in some cases, even life-ruining.
What are fillers used to treat?
lines from the nose to the mouth (nasolabial fold)
lines from the mouth to the chin (marionette lines)
lines above the upper lip
hollows in the temple area (experts only please)
in the lips for volume and definition
to restore volume to cheekbones or cheeks
in some situations, under or around the eyes (experts only please)
to fill out the backs of the hands and make veins look less prominent
other uses which can be customized
body sites – dilute Sculptra or Radiesse generally.
How long will HA and other fillers last?
Depending on the area treated, your skin, and the injection technique, these fillers will last 4 to 6 months. In some cases, the duration of the effects can be a bit shorter or longer. Juvederm Ultra Plus and Perlane are thicker and last approximately 6-9 months
How long do fillers take to work?
It’s immediate, but it can take a week to “settle into” its final shape. It often looks even better after a day or two. Many patients are surprised at how much better they look right after their treatment. Sculptra because it builds your own collagen takes 2-3 months and usually an initial series of 2-3 treatments.
How much do fillers cost?
Syringe cost varies by filler and region. This approximately $500-$1,200 per syringe.
Are they painful?
Many offices use topical anesthetic to make you comfortable during the injections. The cream is applied and sits on the skin for 30-40 minutes prior to your appointment. The cream not only makes you more comfortable, it decreases the chance of bruising (by constricting blood vessels temporarily).
Some offices offer a dental block, which is done by numbing the skin under the lip with a flavored gel and then injecting a small amount of numbing solution (xylocaine) at the gum line (just like at the dentist). You will be numb for about 1-2 hours after.
What will I look like right after treatment?
Most patients go right back to normal activities. If you’ve remembered the no aspirin, Excedrin, Advil, Ibuprofen, Aleve (think ones that start with vowels) rule, then you should have very little bruising after your treatment provided your provider is gentle. A small amount of puffiness or mild swelling for a day or two is normal. Tylenol is fine, as long as you’re not allergic.
There is a small group of patients who really (really) puff after Restylane treatments, especially in the lips. Most of these same patients do not have this response to Juvederm and do fine after changing to it.
Do I need to come for repeat or maintenance treatments?
Yes. All of these dermal fillers require maintenance 1-3 times a year depending on which filler, the area injected, and your own particular body chemistry.
Who should NOT use fillers?
Do not use if you are pregnant or breastfeeding.
To avoid swelling and bruising, you should avoid:
Aspirin, Excedrin, ibuprofen, Aleve and Advil for 1 week before and 2 days after. Tylenol is always fine.
Vitamin E (multivitamin ok) and St. John’s Wort for 2-3 days before or after.
Exercise (except for walking) for 24 hours after the procedure.
Possible side effects of fillers?
If you’ve previously had cold sores around the mouth (facial herpes simplex), the treatment might provoke an outbreak. Be sure you have a supply of the oral tablets (prescription) Valtrex, Famvir or acyclovir.
Do not use fillers if you are pregnant or nursing because these products have not been tested for safety in pregnancy or nursing.
