Several decades ago, patients who were hoping to reverse the signs of aging had few options aside from a surgical facelift. Today, patients who are hoping for drastic reductions in facial fine lines, wrinkles, or other signs of aging aren't always the best candidates for plastic surgery. Dramatic improvements in dermal fillers have made these non-surgical treatments a viable option for all types of patients. However, the quickly-growing popularity of injectable fillers has also led to a wide variety of FDA-approved options.
Fillers aren't the right option for everyone. While currently available options can "replace elasticity and plump up sagging skin," they cannot typically achieve the same dramatic "lift and tighten" effect of a surgical face lift. There are a variety of FDA-approved filler products that can be used to achieve patient goals. Each filler is uniquely formulated to have a certain texture, density, and injection depth, which means that certain fillers work better for specific areas of concern. In general, fillers are categorized by the substance they are made from.
Types of Injectable Fillers
While the injectable filler options available to prospective patients may seem daunting, the wide variety of options is ultimately great news for patients hoping to achieve a more youthful appearance. The variances in dermal filler textures, density, and intended depths allow skilled plastic surgeons to create far more subtle and natural-looking effects on patients, as opposed to the unnatural looking, overly-plumped look that every patient hopes to avoid. Join us as we review the most common types of dermal filler substances, associated fillers, and describe which option could be right for you.
Hyaluronic acid (HA) fillers are the most popular type of filler used today. The American Society of Plastic Surgeon (ASPS) writes that it's often a "good choice" because it's so naturally compatible with the human body. HA is a naturally-occuring substance in cells, which transfers "essential nutrients" from the blood stream to the skin. The result of natural and injectable HA is plump, hydrated skin, with the appearance of restored volume and elasticity.
Typically, hyaluronic acid fillers are soft and gel-like in texture. Results are temporary due to the biocompatibility of this substance. Most patients will experience noticeable results for 6-12 months before the body absorbs the filler naturally. Some HA fillers include the numbing agent lidocaine, to minimize the minor discomfort patients experience during and after treatment.
HA fillers are extremely versatile and can be used throughout the face.
FDA-Approved HA Fillers Include:
- Restylane Silk
Calcium hydroxylapatite (CaHa) is the heaviest of dermal filler options per ASPS. Much like hyaluronic acid, CaHa is a naturally occurring substance. This "mineral-like" compound is found primarily in human bones. CaHa is characterized by small particles that are suspended in a smooth, gel substance. The texture is significantly thicker than hyaluronic acid, which means the results are longer-lasting.
The majority of patients who use CaHa injectable fillers will experience significant improvements in fine lines and wrinkles for 12-18 months before the substance is naturally absorbed by the human body. Due to the heavier texture of this filler, it is often recommended by plastic surgeons as a means of targeting deeper folds and wrinkles. It may be applied to frown lines, nasolabial folds, or to significantly contour the cheeks, jawline, chin, or nose.
FDA approved CaHA Fillers Include:
Poly-L-Lactic Acid (PLLA)
Poly-L-Lactic acid, also known as Polylactic acid or PLLA, is a synthetic dermal filler. While this substance does not naturally occur in the human body, it has a high degree of biocompatibility. It has been approved for use in medicine for over forty years in various forms, such as sutures or dissolvable stitches. PLLA works by stimulating collagen production, which causes your body to create natural-looking improvements in the appearance of the face.
Poly-L-Lactic acid is a thick filler material and is typically used to target deep facial wrinkles. Results typically last at least 2 years. ASPS writes that PLLA results are often not immediate, due to its function of stimulating natural collagen production. Patients who undergo PLLA injectable filler treatments will experience gradual improvements for several months after their final treatment. The only FDA-approved PLLA filler, Sculptra Aesthetic, requires 3 to 6 treatments.
FDA-Approved PLLA Fillers Include:
- Sculptra Aesthetic
Much like PLLA, polymethylmethacryate (PMMA) is a synthetic, biocompatible substance. Injectable PMMA filler contains 20% PMMA microspheres and 80% collagen gel. Several months after injection, the collagen gel used in the injection will "break down," stimulating the human body to create it's own collagen to maintain the appearance of the face after treatment.
PMMA is considered a long lasting filler and the length of results can range between 2-5 years, depending on the patient. Much like PLLA fillers, the final results of PMMA treatment are not fully visible immediately, and may not be visible for several months. Depending on a patient's unique goals and treatment plan, several courses of PMMA filler treatments may be necessary. ASPS writes that PMMA treatments are often used to treat moderate-to-deep wrinkles and and "fill out" the appearance of scars.
FDA-Approved PMMA Fillers Include:
Which Type of Injectable Dermal Filler Treatment is Best?
The right type of injectable dermal filler treatment to achieve a patient's goals for improvements in the appearance of the face can be determined by the following factors:
- Area of the Face Targeted: Some fillers are better suited than others for certain areas of the face due to properties of the filler and the area to be treated.
- Depth of Facial Wrinkles of Creases: Typically, thicker fillers are the most effective way to combat deep folds and wrinkles, while more superficial wrinkles can be corrected with lighter-textured fillers.
- Filler Longevity and Reversibility: Some fillers last longer than others, depending on the type of filler, the area treated, and the individual patient's metabolism. Additionally, some fillers can be dissolved if needed, while others cannot. These factors can have an impact on filler choice.
- Filler Cost: Some fillers are more costly than others, and this can have an impact on filler choice.
- Skin Elasticity and Tone: Patients with severely sagging skin or depleted facial fat deposits may not be able to achieve the results they desire without surgery.
- Natural Facial Contours: The natural contours of a patient's face and skin health can shape a surgeon's plan for injection depth and volume, which will affect the type of filler chosen.
Ultimately, it's critical for prospective dermal filler patients to avoid seeking filler treatment at "medical spas" and other non-licensed surgical facilities. While injectable fillers are a non-invasive way to reverse the aging process, the results of poorly-applied dermal fillers can have drastic, long-lasting effects. An experienced plastic surgeon can expertly recommend the right surgical or non-surgical treatments for your unique anatomy and goals and utilize their years of experience and training to ensure the best patient outcomes.
For more information on the injectable dermal fillers offered at the San Francisco office of plastic surgeon Dr. Larry Fan, please click here.