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Submitted by Dr Gail Humble on June 29, 2011

There is a lot of confusion about all of the soft tissue fillers that are available in the US today.  Below is a summary of what is available.  They are classed into temporary, semi-permanent and permanent.  Each product has its own special benefits.  We hope you enjoy this guide to fillers.

Temporary Hyaluronic Acids: This group includes Perlane , Restylane , Juvederm (Ultra and Ultra Plus) and Hydrelle. How they work:  Hyaluronic acid is a natural occurring substance in our bodies.  It is used to lubricate our joints.  Injectable hyaluronic acids are similar to that substance already found in our body but suspended in a gel form. HAs are hydrophilic so they attract water.  In other words, they act as little sponges bringing water into the desired area.  The difference between the injectables depends on the amount of cross linking of the product (longevity), the concentration of the hyaluronic acid per milliliter of the product (longevity and result), and whether the HA is fully saturated at the time of injection (will more correction occur with time).  Basically, HAs can plump up wrinkles in areas that have become hollow. These fillers are great for a first introduction to fillers because a simple injection of Hyaluronidase can make the results go away if you don’t like it.  Allergic reactions are very rare and no skin testing is required. Where it can be used:  HAs are great for filling lines and wrinkles as well as volume loss that occurs under the eyes and in the cheeks Length:  6 months to one year (longest under the eyes) Cost: $550 Benefits:  Instant gratification and can be removed Drawbacks:  Can turn blue if it is too superficial under the skin Evolence: This product was a porcine based collagen filler.  It has been temporarily pulled from the market but expect its sister Evolence Breeze to come along soon.  Evolence breeze is a lighter version of the same and probably the best lip margin filler.   Semi permanent Radiesse: Calcium hydroxylapitate crystals in a methylcellulose gel. How it works: Calcium hydroxylapitate crystals in a methylcellulose gel are the key ingredients in Radiesse.  This product has been around for quite awhile and has a strong safety record.  When it first came out it was under the name of Radience.  This product boasts a clinical satisfaction rate of 99% when the correct amount of product is used and 18 months.  This product is considered semi permanent because it has been proven histological to also act as a collagen stimulant.  Remember with this product the low point is at 6 to 10 weeks after the initial injection.  This is when the methylcellulose gel is absorbed and before the collagen production has begun. Where it can be used:  Radiesse is best when placed supra periostial or above the bone. It is excellent for volumizing and lifting the cheek area and accentuating other boney prominences such as the brow bone or the mandible. It can also be used to augment the chin or fill the temples and can be used to fill and revolumize the hands. It can also be used to fill nasolabial lines and support the marionette lines.  It is not good for use in areas where the skin is thin or on top of sphincter muscles such as under the eyes or in the lips. It can be used to augment the nose as well. Longevity:  One year Cost: $650 Benefits:  Length of duration and collagen production.  Also this product can give boney shape. Disadvantages:  Has to be surgically removed   Sculptra Aesthetic : Poly L Lactic Acid How it works:  Sculptra has been approved for years for use in patients with lipoatrophy. This is the loss of facial fat.  It was recently approved for cosmetic re-volumization with an indication of 25 months. It is best used for real re-volumization in the temple, periorbital cheek and lower face.  Multiple treatments are required and it is important you realize this is a gradual process of re-volumization with the final results not occurring for six months. Where it can be used: Sculptra is the best true revolumizer.  It can be used to return the youthful contours to the temples, the brow bone, the cheeks, the infraorbital area, the lower cheek area the preauricular areas as well as the jaw and the chin area. It can also be used in other areas of the body such as the hands as well as knees, décolletage and buttocks.  It can not be used in the lips. Longevity:  Two years and longer Cost: $750 for one vial $1400 for two Benefits:  This product gives you back your youthful contour Drawbacks:  You have to wait for results. Six months after the final treatment you see your final results.  Also there are reports of nodules if it isn’t injected correctly.   Permanent Artefill How it works:  Artefill is composed of Methylmethacrylate Beads (joint cement) in a bovine collagen base.  An allergy test is required four weeks prior to the injection.  The Collagen absorbs leaving the Metheylmethacrylate Beads.  The longevity of this product is estimated to be about five years despite the label which says twelve months. Where it can be used: Artefill is excellent at rebuilding bone structure and restructuring the jaw line.  In soft tissue areas it also works well, but must be placed deep. It is not for use in the lips or under the eyes. Longevity:  Five years Costs:  $1300 per syringe Benefits:  Can do boney augmentation and soft tissue filling. Drawbacks:  This must be surgically removed and can not be placed superficially. Silicone Where it can be used? Silicone can be used in lip augmentation. How it works: It has to be done with a micro-droplet technique in a series of injections.  The results are permanent and lips feel full and soft.  Thirty days must lapse between treatments. Cost: $650 per treatment Benefits:  Truly permanent results Drawbacks:  If too much silicone is injected at one time granulomas or lumps may form.   What is coming in the future? There are over 140 fillers approved in Europe many will make their way to the United States.  There are several new ones coming within the next year.  There will be new Hyaluronic Acids approved for injection into body contours as well as new collagen stimulants.

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