What types of dermal fillers are available?

There are several different types of dermal fillers. The most common types are:

Calcium hydroxylapatite

Brand names include: Radiesse

Calcium hydroxylapatite is found naturally in human bones and is a mineral-like compound. It's often used to:

• Moderate-to-severe creases such as nasolabial folds, marionette lines and frown lines
• Enhance fullness of the cheeks and other facial contours
• Improve volume in areas of facial wasting such as can occur in HIV-positive people taking certain medications

Calcium hydroxylapatite is biosynthetically produced, which means that no animals or animal products are used. This lowers your risk of an allergic reaction and no skin testing is required. This type of dermal filler is known to produce a very natural result, doesn't migrate and side effects are rare. This dermal filler was first used in dentistry and reconstructive surgery and has a long safety record.

Hyaluronic acid

Brand names include: Captique, Esthélis, Elevess, Hylaform, Juvéderm, Perlane, Prevelle, Puragen, Restylane

Hyaluronic acid injections can be used to improve the skin's contour and reduce depressions in the skin due to scars, injury or lines. You can see potentially dramatic improvements for:

• Acne scars
• Cheek depressions
• Crow's feet at the corner of your eyes
• Deep smile lines that run from the side of the nose to corners of the mouth (also known as nasolabial furrows)
• Frown lines between the eyebrows
• Marionette lines at the corners of the mouth
• Redefining lip border
• Scars including burns, acne and those caused by wounds
• Smoker's lines; vertical lines on the mouth
• Some facial scars
• Worry lines that run across your forehead

Hyaluronic acid is a natural substance found in your body. High concentrations are found in soft connective tissues and in the fluid surrounding your eyes. It's also in some cartilage and joint fluids, as well as skin tissue. It is extracted and reformulated and now has become one of the most popular kinds of injectable fillers. If the term sounds familiar, it's because the same substance is often injected into the aching joints of people with arthritis to ease pain and provide extra cushioning.

Polyalkylimide

Brand names include: Aquamid

Polyalkylimide is a semi-permanent dermal filler and is often used by plastic surgeons to:

• Treat deeper wrinkles such as nasolabial folds or depressed scars
• Plump thin lips
• Enhance cheekbones and the jawline, and to replace facial volume lost due to age
• Treat facial wasting from HIV medications

Polyalkylimide has very little reaction with human tissue, meaning it's biocompatible, and no allergy test is required. It is radio transparent, meaning it won't interfere with x-rays.

After the injection, a thin layer of collagen slowly forms around it over the course of about a month. The gel is eventually completely surrounded. A single procedure can inject large volume. This product, which is thought to be quite stable over time, can even be removed if necessary.

Polylactic acid

Brand names include: Sculptra

Polylactic acid is a synthetic dermal filler that is injected into your face, causing your body's own production of collagen. This type of dermal filler is known as a stimulator. This non-toxic, biodegradable substance has been used for more than 40 years as suture material.

Polylactic acid is known to work particularly well in the lower half of your face, and is used to:

• Fill the lines caused by laughing
• Plump thin lips
• Treat deep nasolabial folds

This substance is unlike other dermal fillers because it doesn't produce immediate results. Instead, it stimulates your own body's collagen production, so results appear gradually over a period of a few months.

You will likely need about three monthly treatments to achieve your desired results. With each treatment, there is re-stimulation of your own collagen. Then it can take four to six weeks to see the full effect. While this type of dermal filler is considered semi-permanent, you may still need occasional touch-ups.

Polymethyl-methacrylate microspheres (PMMA)

Brand names include: Bellafill

PMMA is considered a semi-permanent filler and is most often used to treat medium-to-deep wrinkles, folds and furrows, particularly nasolabial folds. It can also be used to fill out pitted scars and to augment thin lips.

When a more permanent solution to facial wrinkles is desired, PMMA is often used instead of collagen replacement therapy or hyaluronic therapy. PMMA has been used for many years in permanent surgical implants. Because of this, your surgeon will likely under-fill on the first treatment, adding more later if needed.

One of the downsides of PMMA is that a number of injections are needed to create volume and it can take up to three months to realize the full effects. It may also be visible under the skin. To avoid any unwanted results, it's key that your plastic surgeon is familiar with the proper technique, which involves injection at the dermal subcutaneous junction using threading or tunneling methods.

Summary

Dermal fillers differ in chemical makeup, longevity and have varying degrees of softness. Softer fillers are used in the lips, for example, while sturdier fillers might be desired to enhance cheekbones.

Your surgeon will determine with you the best type and volume of filler needed for your particular areas of concern.

For many people, the use of "off-the-shelf" fillers can be a simple office-based procedure that can nicely enhance their appearance. These dermal fillers are very predictable and have relatively minimal risks and side effects. These fillers are often injected in the surgeon's office or medical spa.