What are Dermal Fillers?
As we age, the production of two proteins called collagen and elastin in the skin decreases. These proteins are what create fullness in the skin. Sun exposure, diet, and smoking also speed up the aging process, making the wrinkles even more prominent. Dermal fillers are a type of injectable that diminishes facial lines and restores volume to the face. These injectable soft tissue fillers are one of the most common non-surgical cosmetic procedures for adding volume to the skin.
Dermal Filler Treatment Areas
Soft tissue fillers cannot correct facial lines with the long-lasting effects of surgery, but in many cases, they provide an excellent non-surgical option to improve the appearance of wrinkles. The most commonly treated wrinkles are those around the nose and mouth, known as the nasolabial lines and marionette lines. Soft tissue fillers are also an excellent option for patients wishing to have more full and youthful appearing lips. The results of injections and the length of time results will last vary by each individual and by the treatment.
Types of Dermal Fillers
At Austin Cosmetic Surgery we offer the following fillers:
- Juvéderm Ultra XC
- Juvéderm Ultra Plus
- Juvéderm Volbella XC
- Juvéderm Vollure XC
- Juvéderm Voluma XC
- Restylane Defyne
- Restylane Refyne
- Restylane Lyft
- Belotero Balance
The Juvéderm Collection of Fillers
- Juvéderm Ultra XC: Adds volume to thinning lips and can provide results for up to 12 months
- Juvéderm Ultra Plus: Smooths, plumps, and volumizes using a thicker formula than other Juvéderm products that contains lidocaine
- Juvéderm Volbella XC: Treats vertical lines and adds volume to the lips with 18-month results
- Juvéderm Vollure XC: Softens frown lines and wrinkles for up to 18 months
- Juvéderm Voluma XC: Volumizes the cheek and jowl area and provides results for up to 2 years
Radiesse is an FDA-approved filler that plumps the skin and reduces moderate to severe wrinkles, folds, and creases. Specifically, Radiesse is used around the nose and mouth and stimulates the skin’s natural collagen supply. Radiesse is a water-based gel that provides immediate results that can last up to a year after injection.
The Restylane Collection of Fillers
- Restylane: Treats lines and wrinkles that run from under your nose to the chin
- Restylane Defyne: Diminishes deep and prominent nasolabial folds and marionette lines
- Restylane Refyne: Targets dynamic wrinkles as well as nasolabial folds and marionette lines
- Restylane Lyft: Contours cheeks and the chin, enhances lips, and treats facial lines
Belotero Balance is a hyaluronic acid filler that integrates into the skin tissue. Unlike normal fillers that rebuild facial volume and structure, Belotero targets etched in lines and wrinkles. This commonly includes lines around the lips.
Sculptra is a biodegradable synthetic filler used to replace lost facial fat, giving the face a more youthful appearance. It is made of poly-L-lactic acid and is currently the only FDA approved injection that can treat facial fat loss in patients with HIV. Presently, Sculptra use on healthy individuals is considered off-label.
Injections at Austin Cosmetic Surgery
It is our role as practitioners to understand the way fillers behave when injected into a particular area or layer of the skin and to choose the most appropriate dermal filler to achieve the desired aesthetic result. For instance, when treating deep subdermal and supraperiosteal layers of the cheeks, it is important to choose a filler that gives good volume and projection that can withstand deformation and flattening. Conversely, when injecting into superficial dermal layers, it is important that fillers can easily spread through the tight connective tissue in order to sit smoothly in the upper layers of the skin.
The majority of dermal fillers are made of hyaluronic acid. Hyaluronic acid, HA, is a natural component of the extracellular matrix and is the framework in which skin cells live. In scientific terms, it is a glycosaminoglycan polymer consisting of repeat disaccharide units of glucuronic acid and N-acetylglucosamine; basically a fancy sugar molecule. Approximately 50% of the body’s total HA is in the skin. It is the scaffolding supporting your collagen and elastin fibers that also provides rigidity, hydration, turgor, and allows cellular movement and regeneration. Fillers that contain HA can fill hollow areas of the face, including the cheeks and lips.
Hyaluronic acid is rapidly metabolized in the tissues, with one-third of total body HA being turned over daily. As we age our body produces less HA and the support of our collagen and elastin fibers starts to collapse. Using hyaluronic acid based fillers you can literally “rehydrate” tissue from the inside by its ability to attract water. Commercially available HA products are based on non-animal stabilized hyaluronic acid (NASHA); they are synthesized by bacterial fermentation of Streptococcus equi. Hyaluronic acid gel does not pose an allergy risk for patients and there is no risk of transmitting animal diseases by injection. The science of cross-linking these chains of HA together is what forms the fillers we use today of various consistencies.
To make hyaluronic acid usable in cosmetics almost all HA fillers are cross-linked with a chemical called butanediol diglycidyl ether, BDDE. This chemical ties up the polysaccharide chains and creates a macromolecule, basically a gel consistency. The amount of cross-linking impacts how hard and resistant the filler will be to degradation by the body’s own hyaluronidase enzyme. How different fillers are produced and the science behind there cross-linking technology is the key difference between the brands. Juvederm by Allergan, Restylane by Galderma, and Belotero by Merz are the prominent brands approved in the United States by the FDA at this time.
Monophasic monodensified gels are a single “phase” HA technology that consist of a mixture of high and low molecular weight HA particles and no free HA. These include Hylacross, Juvéderm Ultra or Ultra Plus, and the newer Vycross, Voluma, Vollure, Volbella, by Allergan. These types of HA fillers are mixed and cross-linked in a single step. The older hylacross technology consists of all long-chain HA as compared to the mix of long and short-chain HA in Vycross. Vycross technology results in a filler with more lift and longevity.
Another monophasic filler is Belotero, it is a cohesive polydensified matrix (CPM) and goes through two stages of cross-linking. CPM is HA that is cross-linked, then additional HA is added, and a subsequent cross-linking step is performed. These are great in thin skinned areas such as the tear trough.
If a filler goes through a sieving technology, as do products in the NASHA family, Restylane, Restylane-Lyft, and Restylane Silk, it consists of two “phases” of HA and is considered a biphasic gel. After being sieved, cross-linked HA of a specific size is then suspended in non-crosslinked HA acting as a carrier. There is much debate over which is best but each has there own benefits when injected into different layers of the skin.
The newest technology is XpressHAn, Restylane Refyne and Restylane Defyne, that results in fillers with increased flexibility to move naturally with facial expression. Each product has a different cohesivity, concentration, and viscosity that helps us determine which to use for treatment.