Dermal fillers are substances that injected beneath the skin to replace soft tissue volume loss, smoothen wrinkles and soften the crease. Dermal fillers are always known as ‘wrinkle filler’ and primarily used to treat static wrinkles. Static wrinkles are those facial lines and folds that present when our face is at rest, thus constantly visible such as forehead lines, frown lines, laugh lines, marionette lines (lines at the corner of the mouth) and lip lines.
Dermal fillers can be classified into different category based on their biodegradability or longevity. The longevity of dermal fillers varies and a is generally based on their materials. There are few types of legally available dermal fillers using different materials as discussed below.
Brand names include: Juvederm, Restylane, Belotero.
Hyaluronic acid-based filler is one of the most popular dermal fillers as it has less side effects and readily reversible. Hyaluronic acid (HA) is a natural substance that produced by the body and almost 50% of body HA found in the skin tissue, cartilage, joints and inside eyeball.
HA secures moisture, provide elasticity and flexibility. As you age, the ability of the skin to produce HA decrease significantly, making the skin lose its elasticity and the visible signs of aging become more apparent. HA injection is not only replacing the volume loss, reduce wrinkles immediately but also help to replenish your levels of hyaluronic acid to keep skin supple.
HA dermal filler will last for 6-18 months. Hyaluronic acid filler can be removed easily with hyaluronidase (enzyme used to dissolve hyaluronic acid) if you don’t like the results.
Brand name: Radiesse
Radiesse is used to correct moderate to severe facial wrinkles and folds. It contains calcium hydroxylapatite, a natural and soft component of bone, which is suspended in a water-based gel. It is designed to restore volume in deeper tissue areas and bone such as temple, cheek, nose chin and jawline because the gel is thicker.
Radiesse provides immediate correction and volume replacement but it also continues to work by stimulating your body’s own natural collagen over time which results in soft and natural look. Individual results are dependent on age, skin types, lifestyle and metabolism. Results of Radiesse lasts longer compared to other fillers as it stimulate your skin to produce new collagen. Radiesse cannot be reversed.
If you unhappy with the result, time is solution. Unlike hyaluronic-acid based fillers like Juvederm, Restylane and Belotero, it is not possible to dissolve Radiesse.
Poly-L-lactic acid (PLLA)
Brand name: Sculptra
Sculptra helps gradually replace lost collagen on deeper soft tissues area. It works similar to Radiesse as both of them are collagen stimulator. It contains biocompatible and biodegradable poly-L-lactic acid to stimulate collagen production. Sculptra is a slower acting filler and usually done in multiple sessions over a few week period, typically 3 injection sessions with an interval of 4-6 weeks between each session.
Massage at injection areas after treatment is important to make sure the products distribute evenly and to avoid bumps formation. It may takes about 3-6 months to see the results. Individual results may vary. Results can last more than 2 years. Sculptra is not reversible as well.
Hyaluronic acid in dermal fillers is synthesized in labs and also modified (cross-linked) to make it last longer in the body. Because hyaluronic acid fillers mimic those that are found in our body, it is slowly degraded once injected, leaving no traces in the body.
As it is of non-animal origin, there is very low risk of allergic reaction to hyaluronic acid fillers. The best feature of hyaluronic acid fillers lies in its reversibility. Meaning, if a client is unhappy with the placement of the filler or should any complication arise from the filler injection, an enzyme can be injected to “melt” the filler.
Hyaluronic acid fillers however do not last as long as their semi-permanent counterparts. Except for Juvederm Voluma which claims a life-span of up to 2 years, other hyaluronic acid fillers can only last from 6 -18 months depending on filler brand and type. For comparison, semi-permanent fillers may last from 3-5 years once injected.
Needless to say, nowadays, there are many brands and types of fillers to choose from. It is up to the final consultation between the physician and the client to decide on the type and longevity of the filler used based on the desired treatment outcome.
Dermal fillers are commonly confused with botulinum toxin (Bootox, Dysport). In aesthetic medicine, botulinum toxin which are proteins purified from bacteria is used to weaken muscles of facial expression to reduce wrinkles.
Dermal fillers on the other hand are injected into different layers of skin or even on the bone depending on its viscosity to effect different outcomes i.e improve hydration, even out irregularities or for volumization. In short, dermal fillers are a crucial tool for aesthetic doctors to sculpt the face.
These days, synthetic hyaluronic acid fillers command the largest share of injectable fillers in the market. This is mostly due to its easy availability and lower cost compared to semi-permanent and permanent fillers. Hyaluronic acid is a naturally-occurring substance in our body, usually found in the skin and cartilage.
With aging, the fat pads that define the outline and contour of the face is slowly lost. The fat pads become thinner. With that comes wrinkles and sagging as there are no more fat pad support for the overlying skin.
The gold standard for re-volumization will therefore be autologous (self) fat. However, the procedure involves first a minor liposuction procedure and then for the fat to be grafted back to the face.
Problems associated with fat grafting and liposuction include:
- There is surgery involved, therefore risk and cost is higher.
- Downtime e.g bruising and swelling is longer.
- Survival of grafted fat is variable. There is gradual reabsorption of fat after surgery ~30-40% or more depending on fat grafting technique. Client may need to repeat fat grafting procedure to achieve desired results.
In view of the above, dermal fillers were invented. The very first fillers were paraffin, silicone, then bovine collagen in the 80’s. Liquid paraffin and silicone presented problems like granuloma formation, migration, and embolization.
Bovine collagen became popular but requires allergy testing prior to its administration. In 2006, Restylane became the first synthetic hyaluronic acid filler to be approved by the FDA. Slowly, non-hyaluronic acid fillers are also introduced into the market e.g Radiesse (calcium hydroxylapatite) and Sculptra (poly-L-lactic acid).
Both Radiesse and Sculptra are capable of stimulating the body’s own collagen on top of the volume the filler itself provides. They also stay longer in the skin after injection as compared to hyaluronic acid fillers which is why they are also called semi-permanent fillers.