Fillers are a group of products that are less invasive than surgery and used to augment the soft tissues of the face. They can help to smooth out lines and creases. They can fill out depressed scars. They can help to restore volume which has become ptotic (droopy) with aging.
Common locations to use fillers include the deep creases areas around the mouth (melolabial folds/nasolabial folds, marionette lines), the fine wrinkles around the mouth, adding volume to the lips, the area between the eye and the nose and cheek called the tear trough, and improving the fullness of the cheeks. They can also be used for any fine lines around the face with a few exceptions.
There are many different types of filler material. The original fillers involved using collagen derived from cows. The problem is that about 5-10% of people would have an allergic reaction and they did not last that long. A novel approach was developed using the cells in your own body to create new collagen. This helped to eliminate the risk of a reaction but as you can imagine, it was difficult to harvest the cells, grow them in a laboratory, have the collagen sent back, and the injected. This also was not permanent so more permanent options were developed. The problem, in my opinion, with permanent fillers is just that, they are permanent. Your body will continue to age and what looks good at the time of augmentation may not look good in 10 years as the surrounding tissue ages. This included options like Silicone and Artefill (although micro droplet silicone still has a utility). Working with these fillers led to the development of some of the more commonly used and safest HA (hyaluronic acid) fillers. This is a material that is found naturally in the body and with new, purer formulations since 2000, they have almost eliminated the risk of a local reaction. They are not permanent, but the life of the fillers has improved from a few months to a few years depending on the filler chosen. The different characteristics of the various HA fillers affects how smooth they feel, where they can be injected, and how long they last.
Juvederm Ultra XC
Juvederm Ultra XC is a very versatile HA based filler. Like the other more commonly used hyaluronic acid based fillers, it includes lidocaine to improve the comfort of injection. Studies have shown its effects can last up to one year. This does depend in large part on the area of injection and how metabolically active the person is being injected. I like to use it in the lips to add volume as it tends to pull in more water and add more fullness with less product. I also like to use it in the melolabial fold (commonly called the nasolabial fold) as well as the marionette lines. These are the lines that are found around the mouth. When used in the lips it will last around 3-6 months. The reason it doesn’t last the year is that the lips are very mobile which tends to make any filler go away faster than a less mobile area such as the cheeks. Because it tends to pull in more water (hydrate more) than some of the other fillers, it is ideal for adding fullness to the lips and softening the deeper folds around the mouth. However, this makes it less than ideal for very fine lines or the tear trough area because in these areas it tends to look too full and lumpy.
Juvederm Voluma XC
Juvederma Voluma XC is another product from the same company as Juvederm Ultra XC. The difference between the two products is in how thick the product is and how well cross linked (essentially how the parts holds hands) they are. Voluma XC is a thicker product that is very well cross linked. This allows it to add more of a lift. It also makes it last longer with studies showing it lasting up to two years in the cheek area. Because of the thickness it is ideal for deeper injections with cheek augmentation. By augmenting the cheek, it also improves the deep folds around the mouth. Just like Juvederm Ultra XC, it also contains lidocaine to make for a more pleasant experience. Because of its thickness, it is not meant for superficial injections such as the lips or fine lines.
Volbella is one of the newer products from the family of Juvederm. It has the new cross linking as Voluma but is a thinner product with less lifting ability. It is a very nice option for the lips in patients who aren’t looking for as much augmentation. It is also sold in half syringes which helps those looking for a conservative treatment on a budget.
This is the newest product from the Juvederm family. It is based on the same cross linking technology as Voluma and Volbella. It is also an intermediate thickness so it can be used in the folds around the mouth without pulling in as much water as Juvederm Ultra XC
This is a calcium hydroxylapatite (CaHa) filler. It is more firm than the HA based fillers and therefore is only injected into deeper areas. It can be useful to augment the areas of the cheek and the deep folds around the mouth. Because it can be felt if injected superficially, it should not be used in fine lines or the lips. It has been shown to last a year or more. It can also be mixed with lidocaine to improve the comfort of the injection.
Restylane is an HA based filler from Galderma. Similar to how Allergan has its Juvederm line of products, the Restylane family includes Restylane, Restylane Silk, Restylane Lyft (formerly known as Perlane), Restylane Refyne, and Restylane Defyne. Restylane is an ideal filler for the tear trough area because of its thickness and fluidity of injection. It tends to pull in less water than Juvederm Ultra XC. We use this to our advantage in the tear trough because it is less likely to lead to prolonged swelling and lumpiness in the thin skin of the tear trough.
Restylane is silk is one of the newer products from Galderma. It is also the thinnest filler they offer. This makes it an ideal option for a superficial injection into the fine lines around the face and mouth. It is also an ideal injection for adding definition to the lips without adding much volume. If you are looking for more volume then Juvederm Ultra XC is my preferred filler for lip injections.
Restylane Lyft is the thickest product from Galderma. It was formerly known as Perlane. It was rebranded when it received FDA approval for augmentation of the cheek area. Similar to Juvederm Voluma XC, it lasts longer than the other products from Galderma because of the cross linking. It is an excellent option for helping to provide a more youthful cheek.
This is based on the newest technology from Galderma. It is designed to be more stretchy than conventional fillers. This helps avoid any lumpiness or fullness with motion of the areas around the mouth while still providing fullness at rest. This is an excellent option for the more active lines around the face and one of Dr. Guy’s favorite injections for the melolabial folds.
Defyne is similar to Refyne with the exception that it provides more fullness but not as much stretching. It can be used in the same locations as Refyne but only when the area needs more volume than can be provided by Refyne. This is helpful for the deeper folds around the mouth.