Juvederm™, Restylane®, Radiesse®, Perlane®, Prevelle™
(soft tissue fillers)
In the last few years, commercially produced filler agents have become available in the United States. More will become available in the future. Fillers are designed to fill beneath wrinkles. The wrinkles are softened and made less visible. Fillers also can add volume to facial features. Lack of facial volume is a major factor in the aging face.
Hyaluronic acid fillers (HA); Restylane®, Juvederm™, and Prevelle™ are the currently available fillers in the United States. Hyaluronic acid fillers contain a molecule that is common to all humans. Therefore, allergic reaction is extremely unlikely. Hyaluronic acid’s best attribute is that it can be applied anywhere such as beneath shallow or deep wrinkles. It can be used to increase the fullness of areas of the face that characteristically “deflates” with aging such as the cheeks and brows. It can also be used to fill the hollow beneath the eyes and make the dark circles better. Many other applications exist. Hyaluronic acid’s only limitation is that in some areas it lasts only 6 to 12 months.
Semi-permanent fillers are longer acting. They may last one to two years. Radiesse®, an example of semi-permanent filler, is not well suited to placement beneath shallow wrinkles but is effective to add volume to cheeks and to diminish the appearance of nasolabial folds (the crease that goes from the side of the nose to the side of the lips). Sculptra is a filler agent derived from compounds generally used for surgical suture material. This is well-accepted filler which is best used for adding volume to areas such as the cheeks. It is well tolerated and results can be expected to last up to one year.
Collagen is still available. It was the first filler used and has been available for many years. There is currently a product (cosmoderm) which is derived from human collagen instead of bovine collagen, so it is less likely to cause allergic reactions. Its limitation is that it is short acting but fine wrinkles are appropriately treated with collagen.
Some patient’s facial features would benefit from filling with a relatively large volume of the filler material. This would become prohibitively expensive for some patients utilizing commercial filler products discussed in the above text. Utilization of one’s own fat may be more appropriate. The fat can be harvested with liposuction techniques from other parts of the body. The amount of fat available for transfer is usually abundant. Once processed, it can be reinjected into the body with expectations that some of the fat transferred will persist on a long-term basis.
This is a review of the large volume of information that is currently available. More information is becoming available as more filler products become available in our country. Our experience continues to evolve.
