Collagen was one of the first available FDA-approved soft tissue fillers. Initially, the collagen was derived from an animal source. Later on, human-derived collagen became available on the market. The main disadvantages of collagen were its cost and relatively short duration of results. These days, collagen is seldom used, having been eclipsed by many newer products with better aesthetic properties, less expense, and longer-lasting results.
Hyaluronic Acid Based Fillers
Hyaluronic acid (HA) based fillers are the most studied and frequently used of the injectable fillers. Hyaluronic acid is a substance found naturally as a component of the skin’s connective tissue. It has the general property of attracting water molecules; therefore, it is able to plump up an area by absorbing water like a sponge. HA fillers also stimulate natural collagen production to some extent as another mechanism for increasing tissue volume. The duration of improvement after injection varies from six to twelve months, depending on the area of application and the product’s specific chemical properties. The different properties of various HA fillers are due to the differing hyaluronic acid concentrations and degrees of cross-linking. These differences make some HA products more suited for specific applications. They can be broadly characterized as hyaluronic acid fillers for volume, or hyaluronic acid fillers for
delicate areas or fine lines. Other characteristics that may distinguish hyaluronic based treatments from other fillers include:
- Reversible Property of HA Fillers: One unique aspect of hyaluronic acid fillers is that the results are “reversible.” Injecting an “antidote” into an area previously injected with a HA filler will “melt” the filler away completely, usually within 24 hours. This is the only filler type that can be quickly reversed if the result is unsatisfactory.
- Volumizing HA Fillers: Some HA fillers are well-suited to provide optimal volume enhancement. Examples include JUVÉDERM® Ultra Plus, JUVÉDERM VOLUMA™, and Perlane® Injections. Board-certified plastic surgeon Lawrence Tong, MD uses these fillers most commonly for lip augmentation, cheek augmentation, and correction of the nasolabial folds and “marionette lines.”
- HA Fillers Designed for Fine Lines or Delicate Areas: Restylane® Fine Line and JUVÉDERM VOLBELLA™ are the HA fillers preferred for camouflaging the bags under the eyes, and “smoker’s lines” (fine lines around the mouth).
JUVÉDERM® is a hyaluronic based injectable filler from Allergan. It comes in different preparations that reflect varying degrees of volume enhancement. The HA concentration and cross-linking affects its volume enhancing properties. JUVÉDERM® Ultra provides moderate volume enhancement, while JUVÉDERM® Ultra Plus provides maximum volume enhancement. It is most commonly used in the nasolabial folds, lips, “marionette lines,” and cheeks.
Developed by Allergan, JUVÉDERM VOLUMA™ is the first, and currently the only, hyaluronic acid based filler to be FDA-approved for midfacial volume enhancement in patients 21 and older. This injectable treatment is most commonly used to augment the cheeks and regions of the midface to achieve a fuller, more youthful contour. Additionally, it can also help smooth and fill out lines and wrinkles in the targeted treatment area. The volumizing effects of JUVÉDERM VOLUMA™ have been clinically-proven to last up to two years in several instances.
JUVÉDERM VOLBELLA™ is a newer generation of HA filler from Allergan. It has the unique property of looking very “smooth” and is suitable for injection very close to the skin’s surface. The result is that even very superficial fine lines can be treated with a low risk of looking bumpy or creating contour irregularities. The properties of VOLBELLA™ generally make it an excellent HA filler for natural augmentation of the lips, lip lines, and lower lid tear trough region.
JUVÉDERM VOLIFT™ is also a newer HA filler from Allergan. Similar to Volbella, it has the unique property of looking very “smooth” and is suitable for injection close to the skin’s surface. It is positioned “in between” JUVÉDERM VOLUMA™ and VOLBELLA™, and is commonly used for correction of “laugh lines” (nasolabial folds) and “marionette lines,” pre-jowl sulcus, and submalar cheek hollowing, among other areas.
Restylane® is a hyaluronic acid (HA) based injectable filler. Restylane® provides a moderate degree of volume enhancement. It is most commonly used for enhancement of the lips, nasolabial folds, and “marionette lines.” Restylane® Fine Lines is a filler that provides less volume enhancement than regular Restylane®. Its properties are more suited for delicate areas, such as camouflaging bags in the lower lids and “smoker’s lines.” For long-term enhancement in the upper or lower eyelids, Dr. Tong also offers eyelid surgery for individuals seeking more enduring results than can be provided with soft tissue fillers.
Perlane® can be thought of as the maximum volumizing version of Restylane®. Its chemical composition is formulated for improving fullness and correcting volume deficiency. It is most commonly used by Dr. Tong in the nasolabial folds, “marionette lines,” cheeks, and lips.
Calcium Hydroxylapatite Fillers
Calcium hydroxylapatite (CaHA) is a mineral substance found in teeth and bones. When used in tissue fillers, it is synthesized as smooth microspheres and is suspended in a gel carrier. As the gel dissolves, the CaHA remains and induces collagen production, which is thought to be the mechanism of its volume enhancement. The CaHA is eventually broken down by the body. It is thus a filler and stimulatory agent. RADIESSE® is the only available CaHA based filler on the market.
RADIESSE® is calcium hydroxylapatite based filler. RADIESSE® has the advertised advantage of longer-lasting results over HA based fillers. The average duration of results varies between 9-12 months. RADIESSE® is best used for increasing volume in the cheeks and filling the nasolabial folds or “marionette lines.” The filler should not be used in the lips or the lower eyelid area. RADIESSE® tends to be slightly firmer in feel during the early recovery period when compared to other fillers. Dr. Tong uses RADIESSE® primarily for cheek augmentation, nasolabial folds, “marionette lines,” and general volume enhancement.
Platelet Rich Fibrin Matrix Fillers (“Vampire” Facelift)
Platelet rich fibrin matrix fillers are soft tissue fillers that use a patient’s own blood as the principal active ingredient. Its mechanism of action is thought to be due to the release of the abundant growth factors found within platelet cells. Selphyl® is the only commercially available soft tissue filler that utilizes this technology.
Selphyl® (The “Vampire Facelift”)
Selphyl® is a product that allows a patient to use a small amount of their own blood to create a filler used for treating wrinkles and folds in the face. Thus, it has been termed the “Vampire Facelift.” Despite its name, the treatment is not a facelift procedure, but one that helps improve fine lines and skin quality. The appeal is that the filler is completely natural, using growth factors found naturally in the platelets (the clotting cells in your blood).
The procedure involves drawing blood from the patient, and preparing it immediately to form the filler for injection by Dr. Tong. These growth factors stimulate improvement in the injected areas. The enhancement tends to be more of a qualitative improvement of skin quality and fine lines, rather than strict volume enhancement.
Poly-L-Lactic acid is a material used to make dissolvable stitches. In a different form, it can be utilized as a soft tissue filler. Unlike HA and CaHa fillers, the result is not immediately apparent. The Poly-L-Lactic acid works by stimulating collagen synthesis under the skin. Over a period of weeks, the result gradually emerges, and the treatment is repeated two to three times until the desired end-result is achieved. The brand name for this filler is Sculptra®.
Sculptra® is a filler made from Poly-L-lactic acid, the material used in dissolvable stitches. Sculptra® is injected as a liquid solution underneath the skin. Results are not immediate, and generally require an average of three injection sessions over a period of months to achieve optimal correction. Following each injection, there is gradual collagen deposition that results in increased facial volume and decreased facial lines, folds, and areas of depression. Sculptra® is a very gradual treatment, but the duration of results can last up to two years.