San Diego Juvederm, Restylane, Radiesse and other Soft Tissue Fillers

Soft tissue fillers are injectable, purified substances that can accentuate the lips or improve the appearance of wrinkles and laugh lines. They can be used to fill in the volume loss of the cheeks, around the eyes, mouth, jaw-line, brow and other areas, which occurs naturally with age. Fillers also can be used to elevate depressed scars, re-shape the bridge of the nose and address irregular facial contours and facial asymmetries. Use of fillers can achieve a smoother and significantly more youthful appearance.

Patients can undergo filler procedures without significant interruption to work or daily activities, with typical recovery periods of only 3-5 days. The list of available fillers is rapidly expanding, enabling dermatologists to tailor the filler material to the individual`s needs and desires.

What fillers are currently available to the consumer?

The wide range of fillers available on the market can be placed in two broad categories: temporary and permanent.

TEMPORARY FILLERS

• Hyaluronic acid fillers (e.g. Restylane, Juvederm): hyaluronic acid is a complex sugar molecule, a naturally occurring gel-like substance in the connective of the skin. Its moldable nature and tendency to expand in the presence of water make it an excellent filling substance for the skin. They work especially well in the lips, smile and frown lines and hollows of the eyes. Hyaluronic acid fillers last 4-12 months.
• Collagen (e.g. Cosmoderm/Cosmoplast, Zyderm/Zyplast): collagen is a protein, another naturally occurring, component of the soft tissue. Some collagen products are derived from cows, while others are human-derived. This filler material is especially useful for filling fine lines around the mouth, eyes and forehead. It can be used in the lips and to contour the nose as well. Collagen fillers last 2-3 months.
• Calcium hydroxyapatite-based fillers (e.g. Radiesse): this filler material is based on an inorganic material containing calcium, similar to bone. The product is moldable and composed of microspheres suspended in a water-based gel. Radiesse is useful for the nasolabial folds, to address lipoatrophy of the cheeks and to contour the nose. Calcium hydroxyapatite fillers last 7-12 months.
• Poly-L Lactic Acid (Sculptra) is a biodegradable, biosynthetic polymer. In theory, the injected material stimulates the production of collagen. It is most commonly used to correct facial fat atrophy, especially the sunken appearance of the cheeks in HIV lipoatrophy. Results typically last 12-18 months. Typically 3 injection sessions are required to achieve the desired result.

PERMANENT FILLERS

• Autologous fat: Donor fat is harvested with a small volume liposuction procedure from the thighs, buttocks or abdomen and transferred to target facial locations including the cheeks, lips, temples and hollows of the eyes. Multiple sessions may be required to achieve the desire results. Over several months to a year, approximately 2/3 of the fat is absorbed, while 1/3 of the fat engrafts and persists.
• Artefill: A relatively new permanent filler comprised of synthetic beads called polymethylmethacrylate, purified collagen gel and lidocaine anesthetic. It is FDA-approved for use in the nasolabial (smile) lines.
• Silicone: A purified chemical called polydimethylsiloxane known as Silikon 1000 has been approved by the FDA for use by eye doctors for certain eye diseases. Though silicone-based products have been used by dermatologists as permanent fillers for facial wrinkles, fat atrophy and scars, it has not yet been FDA-approved for these purposes.

The filler industry is rapidly expanding. There is sure to be many new products on the market in the coming months.

What are the risks of filler injections?

The use of soft tissue fillers is generally considered to be safe and effective when carried out by a knowledgeable, experienced practitioner. When you are electing to undergo any procedure, including the injection of filler, you must become familiar with the associated risks. The risk profile differs somewhat, based on which filler is selected and the injection site.
Possible risks and complications include bleeding, bruising, swelling, redness, infection, allergic reactions, formation of firm areas under the skin, migration of injected material and cold sores. Inform your doctor of any history of cold sores prior to obtaining filler in the lips.

What can I expect after my filler procedure?

There may be some mild discomfort of the injected area for a day or so after filler injection. Bruising can be covered with make-up and usually resolves within 7-10 days. Swelling of the injected areas can occur for 2-4 days after injection. Swelling is more pronounced with the hyaluronic acid-based fillers, particularly in the lips.

The use of fillers for facial rejuvenation can greatly enhance an individual`s healthy and youthful appearance. Consult your dermatologist to help you determine which filler product would be most appropriate for you.