In contrast to Botox, which reduces wrinkle formation by stopping the muscles beneath the skin from working, wrinkle fillers plump up the wrinkles without effecting the muscles beneath. There are multiple types of wrinkle fillers available. Wrinkles commonly treated with fillers are the nasolabial lines or “smile lines”, the labiomental lines or lines extending from the corner of the mouth to the chin edge, cheek, forehead or glabellar wrinkles. Fillers are also used to give volume to an area of the face. This could be an area where a patient has always desired more volume such as the lips. Or this could be an area where a patient has lost volume from aging. Fillers are also used in the hollow of the lower eyelid to rejuvenate this area without surgery.
Human and collagen products were the first wrinkle fillers developed and are still used today, but are the shortest lasting fillers available with an approximate three to six weeks duration. Hyaluronic acid fillers are the most commonly used fillers and are made from Hyaluronic acid, which is a chemical naturally produced in the skin, but is chemically produced for the filler. Common names of Hyaluronic acid fillers are Restylane and Juvederm. Fillers are injected within or just beneath the wrinkle, through several needle sticks to plump up the wrinkles. The more extensive the wrinkles, more product will be needed to get the best results. Patients will notice swelling and possible bruising for a few days after the procedure. They may notice redness, which can be covered with makeup. They also will occasionally notice firmness in the area, but if placed properly this will be minimized. Ice can be used after the injection to help swelling. The hyaluronic acid fillers last anywhere from 6 to 9 months, lasting longer in areas which there is not a large amount of movement. Patients do not need to have a skin test before the injection as the chance of allergic reaction is quite rare.
Other commonly used fillers include Radiesse and Artefil. Radiesse consists of calcium hydroxyapatite and is injected in a deeper plane then the hyaluronic acids. It works well for deeper wrinkles as well as restoring volume back to the cheeks. Radiesse lasts 9-18 months. Artefil is considered a permanent filler lasting up to 10 years. It is made up of polymethylmethacrylate in bovine collagen which requires a skin test to check for allergies. Its use is similar to Radiesse and is often considered by patients who are happy with Radiesse but want a longer lasting result.
The patient’s own fat is becoming a much more common filler as well. It is considered a permanent filler but can be less predictable because there is no way to gauge or guarantee the survival of the fat once injected. Usually 30-50% of the fat survives but it can vary, therefore symmetry can be an issue. What does survive is permanent. The fat injection may need to be repeated for symmetry or further correction.