Fillers

Fillers have been used for decades to fill in wrinkles, scars, and general defects in the skin. Collagen and silicone based fillers were initially the most frequently used fillers. In general, fillers of the past were used specifically to fill indentations. Over the past few years they have been used for the general volumization of tissue as well. This is now possible with the variety of fillers that are available. There is no best filler and the older fillers are still used today. The fillers vary in regards to main ingredient, their origin, length of effect, and viscosity, which ultimately affects the layer of tissue that it is most appropriate for.

Hyaluronic Acid - Based on a sugar/polysaccharide component of the skin; Juvedérm™ Ultra and Restylane® are the most commonly used in this class of fillers. Their mode of formulation is different but the clinical effect and longevity is approximately the same. They both have thicker versions for volume enhancement- such as Juvéderm™ Ultra Plus and Perlane®. Other hyaluronic acid fillers exist such as Prevelle® Silk, but they are generally viewed as second tier in this class. All of these products are commonly mixed with Lidocaine anesthesia which does not affect their longevity.

Collagen Based- Original collagen based fillers came from a Bovine (cow) source. Variations from Human and Porcine (pig) sources were available as well such as Evolence®. Given the need for allergy tests, expense and availability of better fillers, these fillers are not often used anymore.

Calcium Hydroxyapetite- Radiesse® is the standard filler in this class.  The substance is a natural soft component of bone and connective tissue. This filler works best for deep lines and volume enhancement. It is cost effective, safe and its results are immediate; It is often used in conjunction with Hyaluronic Acid fillers.

Polylactic Acid- Sculptra® is the standard filler in this class; A foreign substance that is used in suture material, Sculptra® is generally used for volume enhancement and is FDA approved for HIV associated Lipodystrophy. This is the potentially longest lasting temporary filler but it does take several expensive treatments to reach an end point. In addition, it may have a higher rate of complications and variability between patient results.

Silicone- Silikon® 1000 is an FDA approved medical grade silicone product that is approved for use in the eye for retinal detachment. It is used off label in the skin for cosmetic purposes. It is permanent and generally used in what is coined the micro-droplet injection technique where small amounts are placed in the skin over monthly treatments until the end result is met.

There are several other fillers that are available throughout the world. The ones listed above are the fillers that are FDA approved for some purpose in the US and are regularly used.

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