What are dermal fillers?Soft Tissue Fillers, also known as injectable implants, dermal fillers, or wrinkle fillers are approved by the Food and Drug Administration (FDA) for use in helping to create a smoother and/or fuller appearance in the face, including nasolabial folds, cheeks and lips and for increasing the volume of the back of the hand Dermal fillers help to diminish facial lines and restore volume and fullness in the face. As we age, our faces naturally lose subcutaneous fat. The facial muscles are then working closer to the skin surface, so smile lines and crow’s feet become more apparent. The facial skin also stretches a bit, adding to this loss of facial volume. Other factors that affect the facial skin include sun exposure, heredity, and lifestyle. Uses of Dermal Fillers: Dermal fillers can be used to:
- Plump thin lips
- Enhance shallow contours
- Soften facial creases and wrinkles
- Improve the appearance of recessed scars
Dermal filler Materials
Most soft tissue fillers have a temporary effect, because they contain materials that are absorbed by the body over time. The FDA has approved only one product made from a material that remains in the body and is not absorbed. Some soft tissue fillers also contain lidocaine, which is intended to decrease pain or discomfort related to the injection. The materials used in soft tissue fillers include: Absorbable (temporary) materials Collagen
Collagen is a type of protein that is a major part of skin and other tissues in the body. Sources of purified collagen used in soft tissue fillers can be from cow (bovine) or human cells. The effects of collagen fillers generally last for 3-4 months. They are the shortest lasting of injectable filler materials. Side effects of collagen injections include some risk of allergic reaction (mostly for those still using cow sources), as well as bruising and redness at the site of the injection
Bioengineered human collagen
Because of the risk of allergy with bovine-derived collagen fillers, several companies were motivated to develop human-derived collagen dermal fillers. Because these agents do not contain any bovine collagen, no allergy testing is required prior to treatment. Therefore, immediate treatment can be performed. Furthermore, no cross-reactions have been documented in patients with a history of allergy to the bovine collagen fillers, so any patient with a documented allergy to bovine collagen may be treated with bioengineered human collagen.
Dermal fibroblasts are harvested from bioengineered human skin and placed into a 3-dimensional mesh. These fibroblasts synthesize collagen and extracellular matrix proteins, which are then used as a dermal filling agent. In March 2003, the FDA approved 3 bioengineered human collagen dermal fillers, CosmoDerm I, CosmoDerm II, and CosmoPlast. These human-based dermal fillers probably have the least patient downtime of any dermal filler available.
Hyaluronic acid is a type of sugar (polysaccharide) that is present in body tissues, such as in skin and cartilage. It is able to combine with water and swell when in gel form, causing a smoothing/filling effect. Sources of hyaluronic acid used in dermal fillers can be from bacteria or rooster combs (avian). In some cases, hyaluronic acid used in dermal fillers is chemically modified (crosslinked) to make it last longer in the body. The effects of this material last approximately 6 – 12 months.
Hyaluronic acid is the most prominent glycosaminoglycan in the skin. Hyaluronic acid potently binds to water and, when injected into the skin, volumizes, softens, and hydrates the skin. In addition to these benefits, it plays a role in cell growth, membrane receptor function, and adhesion.
Hyaluronic acid stabilizes intercellular structures and produces the viscoelastic network for collagen and elastin fibers to bind together. As seen with photoaging, these connections fail, thus resulting in disorganized clumps of collagen and elastin. These benefits make hyaluronic acid an excellent dermal filling agent. In February 2003, the FDA approved Restylane, a cross-linked, nonanimal source hyaluronic acid. This dermal filler was quickly found to be relatively long lasting, have minimal adverse effects, was easy to use, was ready to use out of the box, did not require refrigeration, was cost effective, and did not require skin testing prior to treatment.
Because hyaluronic acid is identical in all species, the risk of allergy is remote. hyaluronic acid fillers emerged as the leader of dermal filling agents for soft tissue augmentation, owing to their superior cosmetic results.
In the uncommon circumstance when an undesirable outcome occurs with hyaluronic acid, correction is possible with the injection of commercially available hyaluronidase, which breaks down the unwanted hyaluronic acid dermal filler
Calcium hydroxylapatite is a type of mineral that is commonly found in human teeth and bones. For wrinkle filling in the face or for the hand, calcium hydroxylapatite particles are suspended in a gel-like solution and then injected into the wrinkle in the face or under the skin in the back of the hand. The effects of this material last approximately 18 months. While in the body, calcium hydroxylapatite will be visible in x-rays and may obscure underlying features.
Poly-L-lactic acid (PLLA)
PLLA is a biodegradable, biocompatible man-made polymer. This material has wide uses in absorbable stitches and bone screws. PLLA is a long lasting filler material that is given in a series of injections over a period of several months. The effects of PLLA generally become increasingly apparent over time (over a period of several weeks) and its effects may last up to 2 years.
Non-absorbable (permanent) materials Polymethylmethacrylate beads (PMMA microspheres): PMMA is a non-biodegradable, biocompatible, man-made polymer. This material is used in other medical devices, such as bone cement and intraocular lenses. PMMA beads are tiny, round, smooth particles that are not absorbed by the body. When used as a soft tissue filler, PMMA beads are suspended in a gel-like solution that contains cow (bovine) collagen and injected into the face.
Uses of Dermal fillers
Approved UsesSoft tissue fillers made from absorbable (temporary) material are FDA-approved for the correction of moderate to severe facial wrinkles and skin folds, such as nasolabial folds. Nasolabial folds are the wrinkles on the sides of your mouth that extend towards the nose. They are commonly referred to as “smile lines” or “marionette lines.” The soft tissue filler made from non-absorbable (permanent) material is FDA approved only for the correction of nasolabial folds. Some soft tissue fillers are approved for the restoration and/or correction of the signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus (HIV). The FDA has approved two absorbable soft tissue fillers for lip augmentation, and one filler for cheek augmentation, in patients over the age of 21. The FDA has also approved one filler for hand augmentation. Patients may need more than one injection to get the desirable smoothing/filling effect. Successful results will depend on the health of the skin, the skill of the doctor, and amount and type of filler used. The time that the effect lasts depends on the filler material used and the area where it is injected.
Unapproved UsesThe FDA has NOT approved soft tissue fillers to:
- Increase breast size (breast augmentation)
- Increase size of the buttocks
- Increase fullness of the feet
- Implant into bone, tendon, ligament, or muscle
Information for PatientsBefore deciding to have a procedure using soft tissue fillers, the FDA recommends that:
- You seek a specialist in the fields of dermatology or plastic surgery.
- Select a doctor who is trained to perform the soft tissue filler injection procedure. Having filler injected should be considered a medical procedure, not a cosmetic treatment. Ask your health care provider about their training and experience injecting soft tissue fillers in the face.
- Before deciding to have soft tissue filler injections, talk with your health care provider about appropriate treatment injection sites and the risks associated with the procedure.
- Be aware that FDA reviewed andapproved different products for use in certain areas of the face. The FDA may not have reviewed the use of certain soft tissue fillers for all locations in the body.
- Manage expectations by researching the available products and the benefits they provide. Discuss the amount of smoothing/filling effect that you expect, as well as, the amount of smoothing/filling effect that your doctor expects to be able to achieve based on your situation.
Frequently asked questions
What is the difference between Botox injection and dermal filler injections?
Botox injections relax the muscle under a wrinkle while the injectable wrinkle fillers, fill the line, crease, or area with one of several different substances (Collagen, elastin, hyaluronic acid).
Dermal fillers add volume to the face, whereas Botox relaxes the muscles underneath the wrinkles to reduce their appearance. For instance, dermal fillers are great for plumping thin lips and adding volume back to nasolabial folds (marionette lines), while Botox may be a good option for relaxing frown lines.
Can we get the Restylane treatment every year? Will it have any side effects?
It is recommended to undergo repeat Restylane treatments in order to maintain the most ideal results. Restylane can last for a year or more depending on the area being treated. Regular touchups can be done as needed. Our experience has demonstrated that additional treatments usually lead to enhanced and prolonged results since Restylane also promotes your own production of collagen and elastic fibers. It is always best to undergo Restylane treatments from a board-certified dermatologist who is an expert injector.
Can dermal fillers be used to correct an asymmetrical upper lip?
Well-placed lip injections can help to even the appearance of asymmetrical upper lips. Hyaluronic acid fillers such as Juvederm or Restylane can give volume without appearing overdone. It is important to see an expert dermatologist with experience in dermal filler treatments in order to get the best results.
Are dermal fillers safe?
When done by expert board-certified dermatologists, fillers are not only safe, but effective. Be sure to discuss any concerns with your doctor during your consultation.
How long do dermal filler results last?
Depending on the type of filler used, your results will last anywhere from several months to a couple of years. The results of Juvederm, Restylane, Perlane, and Radiesse tend to last about 9 months, while Sculptra and Fat Grafting can last 2-3 years.
What is the average recovery time after a dermal filler procedure?
A: There is no recovery time! Dermal fillers are non-invasive procedures that allow you to get back to your normal routine almost immediately. Some people may notice slight redness or mild discomfort at the injection sight, though this will diminish over the course of the next few days.
Which filler is best for plumping thin lips?
A: While several dermal fillers can be used to plump lips, Restylane & Juvederm are commonly used for this purpose. Discuss your desires with the doctor during your consultation, and he/she will develop a completely custom treatment for your unique needs.