Finding the Dermal Filler That’s Right for You

An exciting category of treatments that has greatly benefited from remarkable medical and scientific advances in recent years is facial rejuvenation using injectable dermal fillers.

Dermal fillers have been around in various formulations (of human origin, animal origin, or synthetically-produced substances) for more than a quarter of a century.  They were commonly used in surgical procedures to restore lost volume and structure in the soft tissues of the face following an accident or wasting disease.  It is only since the mid 990s that dermal fillers have enjoyed increased popularity for use in facial rejuvenation and wrinkle repair. 

Dermal fillers are now most commonly used to fill in facial lines, wrinkles, and creases, to give a lifting effect to the outer eyebrows, to fill in lower eyelid depressions, or to redefine and/or enhance the lips.

A dermal filler is a substance in gel form that is injected using very fine needles into the mid-dermis layer of the skin to restore volume and to lift and smooth lines and wrinkles. Whether used alone to correct small facial areas or in conjunction with other surgical or non-surgical procedures it is probably the most popular treatment being used today in the skin care field. 

The Right Filler for the Right Wrinkle

Dermal filler injection gels are technique specific.  Since not all dermal fillers do the same thing, it is very important to understand before you undertake any treatment what can be expected from a specific product or procedure.  

It is also of utmost importance for the dermal filler to be injected by an experienced and licensed professional, ideally a Board Certified Plastic Surgeon or licensed Cosmetic Dermatologist.  Besides having the expertise to stratigistically position the injection sites to achieve the best aesthetic results, your plastic surgeon or dermatologist also has the knowledge and training to choose the dermal filler that best suits your skin characteristics, age, health, and goals.  An artistic eye and an understanding of your personal goals are also characteristics to look for in the professional you choose to perform your injection treatment.

An Overview of Dermal Fillers Available 

Dermal fillers can be roughly categorized into animal-based, human-based, and synthetic-based gel formulations of varying denseness.  They can have either temporary or permanent effects and are manufactured in various formulations containing substances such as hyaluronic acid, human or animal collagen, microspheres, and local anesthetics.

Depending on the formulation and the injection site, the cosmetic effects of dermal fillers are usually temporary - lasting from as short as one month to just over a year.

In general, follow up injections require less dermal filler and the effects become longer lasting with repeated treatments.  However, the latest generation of dermal fillers recently approved for use in the US are formulated to achieve semi-permanent to permanent results. 

Dermal fillers which have been granted US FDA approval have been shown to be safe and effective. 

HA Gel Dermal Fillers 

Injectable Gels Containing Hyaluronan, or Hyaluronic Acid (HA)

      Hydrafill™, Restylane®, Radiesse®, Juvederm®,  Captique®,  Hylaform ®

This type of dermal filler gel is injected into the skin using an ultra-fine needle, so that gel is carefully placed under each wrinkle or crease.  The gel adds volume and lifts the wrinkle, restoring a smoother skin surface. 

The active ingredient is hyaluronan, or hyaluronic acid (HA).  HA is a natural substance that is produced by our bodies and is plentiful from the time we are born up to about the age of 20.  From age 20 on HA begins to gradually deplete. 

HA occurs naturally in the dermis layer of the skin and is a ‘humectant’, meaning it retains water.  HA has the remarkable ability to retain up to ,000 times its own weight in water, so it helps to keep skin smooth and plump.  It is also found naturally in all human connective tissue, and in addition makes up about 80% of the human eye. 

HA acts to lubricate joints and plays a critical role in wound repair, and also assists in vision. Hyaluronic acid supports formation and maintenance of collagen, an important connective tissue that is vital to skin health.

After the age of 20 the body begins to produce less hyaluronic acid and by the age of 40 the skin begins to lose its elasticity and wrinkles appear.  The loss of moisture and the degradation of collagen cause a gradual degrease in skin tone and elasticity.

It is interesting to note that cigarette smoke is known to degrade hyaluronic acid, while estrogen treatment increases the activity of HA.  People who have been on any blood medication within the last five years should not inject this drug until the five year span is over.  

In 2003 the US FDA approved hyaluronan for cosmetic injections into subdermal facial tissue to treat skin defects such as facial wrinkles.  Restylane® is the common trade name for the specific non-animal source formulation of hyaluronic acid.

The effect of HA injections is temporary as it is gradually absorbed into surrounding tissue, and the smoothing effect typically lasts for six months, although that can vary greatly from patient to patient.

Hydrafill™ gel derma filler is manufactured by INAMED Aesthetics, a company with over 20 years experience creating safe and effective dermal filler treatments. It was approved by the FDA in April 2004 and is widely used.  It provides immediate results and does not require a pre-treatment skin test. The most common areas of the face treated are smile lines around nose and mouth, marionette lines at the corners the mouth, frown lines between the eyes, and fine vertical lines above the upper lip.  Hydrafill gradually breaks down and is naturally reabsorbed by your body. Therefore, depending on your skin type and age, you would probably require touch-up treatments two or three times a year to maintain the desired appearance.

Restylane® is a dermal gel filler manufactured and introduced in 996 by Q-Med, Upsulla, Sweden, which contains non-animal, stabilized hyaluronic acid (NASHA).  It has been used in over 4 million treatments in 70 countries. Medicis Aesthetics provides Restylane to the US market.  Since it does not contain animal protein it doesn’t require a skin test prior to treatment.  This dermal gel filler is used to reduce wrinkles and folds and enhance facial contours.  The effect lasts from 6-2 months on wrinkles and creases and about six months on lip enhancements.  Side effects are temporary redness and swelling at the injection sites which disappears in a day or two.

Radiesse® is a dermal gel filler developed and manufactured by BioForm Medical, Inc. of San Mateo, California.  Radiesse® is made of calcium-based microspheres suspended in a natural aqueous gel.  Over time, these microspheres form a scaffold to support sagging tissue and the microspheres stimulate the production of the body’s own collagen.

In December 2006 Radiesse® was granted US FDA approval for application to correct facial lines and wrinkles such as nasolabial folds (laugh lines). Radiesse® was also granted approval for a second application �" to restore and correct the signs of facial fat loss (facial lipoatrophy), including sunken cheeks and indentations which occur in some cases of human immunodeficiency virus.

Radiesse® is fast replacing the traditional dermal fillers (such as Restylane®) and setting new standards in facial rejuvenation as it often achieves better tissue distension and the effects last considerably longer than many other fillers available �" 2 to 5 months.  Since it does not contain animal protein, Radiesse® doesn’t require a skin test prior to treatment.  

Juvederm®, is another of the new generation of dermal gel fillers, obtaining US FDA approval in June 2006.  Juvederm® is manufactured by Allergan, the firm that also created Botox® Cosmetic.  The Juvederm formulation is claimed to have the highest concentration of hyaluronic acid on the market and to have a smoother consistency (as compared to other formulations based on gel particle suspension).   The smoother consistency is said to cause less discomfort in injecting and less chance of visibility once in place.  It is a biosynthetic and of non-animal origin so does not require a pre-treatment skin test.  The effects last six months or longer.

Captique® Manufactured by INAMED and approved by the FDA in December 2004, this dermal filler is a non-animal stabilized hyaluronic acid dermal filler. Captique® is a clear gel containing a purified form of hyaluronic acid which adds volume lost during the aging process by temporarily smoothing out facial lines and wrinkles. It is often used in combination with other dermal fillers of slightly different charactistics. The effects last from 4-6 months.  Side effects are minimal and temporary.  Being a non-animal formulation, no pre-treatment skin test is required. 

Hylaform® (hylan B gel) - Approved by the Food and Drug Administration (FDA) in April 2004, this dermal filler adds volume to your skin by mimicking the skin's natural hyaluronic acid. Hyaluronic acid is a natural sugar found in all living cells that attracts and binds water, hydrating the skin and giving it volume.  Artificial cross linking of the hyaluronic acid molecules slows down the rapid absorption so that the cosmetic effects last 3-5 months.  Hylaform provides immediate results and does not require a pre-treatment skin test.

Are HA Gel Injection Dermal Fillers Right For You?

Every skin has its particular characteristics and every person ages differently.  What worked wonders for a friend may not work in the same way for you.  To avoid having unrealistic expectations or disappointment with the results, it is important to have an expert opinion of what you can expect to achieve using a HA gel filler.

One way to get an idea of the effect you can expect from injections of a hyaluronic acid dermal filler is to gently pull aside the skin on either side of a specific wrinkle you’d like to see disappear.  If you can smooth out the skin but you still see a line then that line will probably still be apparent even after the wrinkle has been lifted from underneath by injection of an HA gel filler.

 In most cases, the resulting smoothing of the skin’s surface is a dramatic improvement and the fine line becomes almost unnoticeable.  If the wrinkle is especially deep or skin particularly dry, an alternative treatment may better achieve your desired result.

Collagen is a protein synthesized by fibroblasts found in the dermis layer of human skin.  Collagen is the substance responsible for the skin’s structural support. With ageing and exposure to sun and weather, the amount of collegan produced naturally diminishes leaving the epidermal layer of the skin without support, causing lines and wrinkles to form.

Collagen injection therapy is in effect simply replacing lost collegan into the inner layers of the skin, thus shoring up the outer skin layer and effecting a smoother, more youthful skin surface.  Since the body gradually absorbs the collegan injected the effects are temporary so follow up treatments are required to maintain the effect.

Animal-based Collagen Injectable Dermal Fillers 

Zyderm® and  Zyplast®

Animal-based injectable collagen dermal filler is generally derived from the hides of cows especially bred for that purpose or from pigs’ skin.

Zyderm® and Zyplast®, introduced by INAMED in 998 and 985 respectively, are made of highly purified bovine (cow) collagen. Because it is animal based a skin test is required 28 days before treatment.  Both have been used safely for many years by plastic surgeons and dermatologists to smooth facial lines, wrinkles, and scars, and to define lip borders.  The effects last around 3-6 months.

Human-based Collagen Injectable Dermal Fillers

CosmoDerm® and CosmoPlast® 

Manufactured by INAMED Asthetics and approved by the FDA in March 2003, these collagen-based dermal fillers restore skin structure, smoothing away unwanted lines and wrinkles by replenishing collagen lost with time, exposure to sunlight and other factors. The collagen in CosmoDerm® and CosmoPlast® is purified from human dermal tissue that is grown under controlled conditions.  Because it is human based and not animal based it is unlikely to cause allergic reactions in humans so they do not require a pre-treatment skin test.  This means they deliver immediate results with no down time. 

CosmoDerm® is formulated to fill superficial wrinkles, frown lines on the forehead, worry lines between the eyebrows, and crow’s feet at the outer edges of the eyes. 

CosmoPlast® is formulated to fill in more pronounced wrinkles, such as the deeper creases that form on each side of the mouth between the nose and the mouth.  CosmoPlast® is also used to fill the vertical lines which form on the upper lip and to enhance and redefine lips.    

CosmoDerm® and CosmoPlast® are generally used in combination during a treatment session.  Both are also used to treat acne scars and other soft tissue contour deficiencies of the face.  They are formulated with a built-in anesthetic for patient comfort.  The effects last from 3-4 months, but can vary according to skin type, age, lifestyle, and general health.

Permanent Facial Rejuvenation Injectable Dermal Filler

 ArteFill®     (Artecoll® )

ArteFill® is the first US FDA-approved non-resorbable aesthetic injectable implant dermal filler especially formulated for the correction of laugh lines (nasolabial folds), the deep creases that appear between the nose and mouth on either side of the mouth.  

ArteFill® is manufactured by Artes Medical, a California company, and received FDA approval in October 2006.

ArteFill® is injected using very fine needles directly under the crease lines to bolster and support the epidermis layer, thus filling in and smoothing the crease.
 
ArteFill® is a combination of homogeneous precision-filtered microspheres suspended in a solution of purified bovine collagen gel and 0.3% lidocaine (a local anesthetic).  Since these PMMA microspheres are not absorbed by the skin, they remain in place to support the upper layer of skin, thus creating a permanent effect.

Because ArteFill contains bovine collagen a skin test is required 28 days before treatment.

A product of the same formulation called Artecoll®is manufactured and distributed in Europe by a company in The Netherlands (not related to Artes Medical).