What You Need to Know About Dermal Fillers

By Stephen M. Schleicher, MD, Director, DermDOX Center for Dermatology

Although Botox is very effective in minimizing forehead lines and crow’s feet, it cannot restore fullness, particularly to the lower face, lost as a consequence of the aging process. Indeed, volume loss is one of the hallmarks of an aging face and dermal fillers are ideally suited for this purpose.

The first dermal fillers approved by the FDA were Zyderm and Zyplast. Introduced over two decades ago, these injectable compounds revolutionized the treatment of lines and creases. Zyderm and Zyplast are made from bovine (cow) collagen. Collagen, of course, is one of the foundations of the dermis.

Two drawbacks associated with Zyderm and Zyplast are allergy and duration. Both agents may infrequently induce an allergic skin reaction, necessitating skin testing prior to use. Further, duration of treatment is short, ranging three to six months.

Fat transplantation was developed as one way of bypassing the need for allergy testing, since the fat injected under a crease was derived from fat cells taken from the same individual (abdomen or backside). One drawback was the need to suck fat from another body part (using a big needle!). Another was again longevity. The fat cells rarely lasted more than a few months.

The dermal filler market exploded in 2003 with FDA approval of Restylane. Restylane is non-animal-derived hyaluronic acid; this a normal component of the body substance that surrounds skin cells. Prior allergy testing is not required, allowing for same-day administration. Unlike collagen products, syringes of Restylane do not contain a numbing medicine and are somewhat more painful. Duration is six to twelve months.

Additional FDA-approved collagen-based fillers are CosmoDerm, CosmoPlast, and Evolence. Evolence provides greater longevity and is injected deeper into the dermis. These fillers do not require allergy testing either. Additional hyaluronic fillers are Perlane, Juvederm, Elevesse, and Prevelle Silk. Longevity is about twelve months. Some fillers also come in a thicker (ultra) version as well as a thinner (fine line) variety

Radiesse is a filler composed of calcium. This product has no allergic potential, and the correction should last twelve months or longer. Radiesse has been shown to not only replace collagen but to stimulate production of new collagen as well. Sculptra is not a conventional replacement filler. Small amounts are injected over time, and the end result is stimulation of collagen. Visible results are gradual and take weeks to develop. A substance that acts in similar fashion is medical-grade silicone, which must be administered as micro-droplets.

As a rule, the longer a filler lasts, the more careful (and experienced) a provider should be in administering it. The choice of filler often depends on the area to be treated.

Nasolabial folds (the two creases running from the nose to the corners of the mouth) and marionette lines (creases from the mouth corners to the chin) are amenable to the majority of fillers. Factors to consider are price, longevity, and the experience and preference of the medical provider performing the injections. Lip augmentation requires a less viscous filler to avoid the complication of persistent bumps. Corrections about the eye entail minute amounts of a thinner filler, whereas depressions of the mid-cheek region are best handled with a thicker volumizer or dermal stimulator.