Facial fillers have become increasingly popular over the past two decades to provide rejuvenating effects to the face and enhance facial features by increasing volume to such areas of the lips and cheeks. Over the years our face will decrease in overall volume and increase in laxity of facial ligaments, leading to descent of facial features including descent of cheeks and loose skin. These changes will result in more prominent facial lines, including the nasolabial folds and smile lines. There are also increasing wrinkles about the face and lips more superficial in the skin presenting as superficial wrinkles and lines.
These wrinkles and folds that develop on the face can be filled by both products off the shelf or injection of fat taken from your own body. Common products off the shelf include hyaluronan (also referred to as hyaluronic acid) and will immediately increases volume, Sculptra® Aesthetic or poly-L-lactic acid which progressively increases facial volume with induction of collagen, RADIESSE® composed of small spears of hydroxyapatite, and products made from collagen. Facial volume filling can also be performed by injecting fat cells obtained by your own body and is referred to as fat grafting.
Hyaluronan is found in products including JUVÉDERM®, Restylane®, and Perlane®. These are synthetic products that do not require skin testing and result in instant volume enhancement to areas including the lips and nasolabial folds. Hyaluronan is a substance naturally found in our skin which enhances facial volume by binding to water to increase hydration of tissue and result in more volume and plumping to the skin. Common areas of for use of hyaluronan include the lips, nasolabial folds, and fine wrinkles throughout the face.
Sculptra® Aesthetic is composed of poly-L-lactic acid and used to increase generalized facial volume, as well as folds and wrinkles about the mouth. Sculptra® will impact a long term increase of facial volume by creating production of collagen within the skin and subcutaneous tissue beneath the skin. Effects from Sculptra® injection will often last two years and longer.
Collagen is a natural substance found in the face that adds to the volume of skin and dermis. As we age, the amount of collagen in our skin decreases, contributing to the increase in facial wrinkles and enhancement of skin folds. Collagen fillers off the shelf include COSMODERM® (derived from human source), Zyderm® (derived from bovine source), and EVOLENCE® (Porcine source). Collagen fillers derived from animal sources will require skin testing to check for potential allergy to the product. Another form of collagen filler is Bellafill®, which is a combination of bovine collagen and a synthetic polymethylmethacrylate scaffold to provide both immediate and long term results lasting years.
Fat Grafting uses fat harvested from a variety of sites on your body including the thighs, flanks or abdomen. Fat grafting is a method to enhance volume with your own tissue. There is no risk for developing an allergy. Fat grafting can make enhancements to facial volume but may require multiple procedures to get the desired results and will have limited benefit in areas such as the lips where movement limits the ability for fat to take permanently. It may have short term results. Fat grafting to areas of the face, including temporal hollowing generalized facial volume, will have long term results.
Ultimately, you should discuss your desired results with your surgeon to find out which dermal filler is a good choice for you. Each filler has its benefits for different areas of the face and should be tailored to the patient’s needs.