Soft Beautification®

Injectables fillers include a variety of materials, which last for different lengths of time and have different effects and uses. With so many products on the market, finding the injectable filler most suitable for your condition can be confusing. This information provides an overview of the various types of injectable fillers and their uses.

Human Tissue Derived

A group of human-derived collagen products are currently available in the United States. The tissue, harvested using sterile techniques from donors or grown in a laboratory are processed to form an injectable human collagen matrix. Human-based collagen fillers are biocompatible and produce results that may last for three or more months. But as collagen treatments continue over time, more and more of the collagen remains, and results may last longer, in some cases forever. It is important to note that the treatment area is typically overfilled initially, because up to 40% of the collagen dissipates within a short time.

• Cymetra (Micronized Alloderm)
  injectable human tissue collagen matrix derived from cadaver tissue, screened for contamination. Filler for lips, nasolabial folds, deep wrinkles and lines. Bruising is the most common side effect. Multiple treatments needed; lasts 2 months. FDA approved.
   
• CosmoDerm / CosmoPlast
  Derived from human tissue that has been purified and grown in a laboratory. Doesn't need a skin test. Approved for frown lines, crow's-feet, forehead lines, smile lines, vertical lip lines, marionette lines, lip border and for certain scars. CosmoDerm is used for superficial lines, while CosmoPlast is used for more pronounced wrinkles. The most common side effect is bruising. The results are immediate, lasting up to six months depending on the area treated. FDA approved.
   
• Fascian
  injectable derived from donor-fascia (connective tissue made of collagen) of the thigh muscle. Stimulates collagen formation, adds bulk. Bruising is the most common side effect. Lasts up to 6 months. FDA approved.
   
• Autologen
  injectable collagen prepared from the patient's skin. Small pieces of skin are harvested from the patient, processed and prepared for injection or frozen for later use. An alternative to traditional collagen injections. Bruising is the most common side effect. It is expensive and time consuming. It requires 2 or 3 treatments over a 6 to 8 week period to produce collagen; not permanent. FDA approval is not required.

Bovine-Based Collagen Fillers

Collagen is a naturally occurring protein that supports various parts of the body including skin, tendons and ligaments. Commonly used injectable collagen is made from purified cow skin and is used to fill wrinkles, lines and scars on the face. The primary risk of injectable collagen is allergic reaction - injectable collagen absorbs into the body.

• Zyderm / Zyplast are collagen injections that are FDA approved and typically last 3 months. Because some people are allergic to bovine-based collagen, an allergy test is done before treatment . Results may last for three or more months, but as with human-based collagen, if you continue to have treatments over time, some of the collagen will remain, and results may last a lifetime.
   
• Also, ArteFill (described below) uses a bovine collagen product to suspend polymethylmethacrylate (PMMA, a type of plastic) microspheres that lodge into the treatment area after the collagen dissipates, with the goal of providing a more permanent benefit. Since up to 40% of bovine-based collagen soon dissipates, the treatment area is typically overfilled at first. FDA approved.
  Both human-based and bovine-based collagen are FDA-approved for cosmetic uses.

Hyaluronic Acid-Based Fillers (Restylane, Juvederm, and Perlane)

Hyaluronic acid exists naturally in all living organisms and is a natural component of connective tissues, including the skin. According to the ASPS, more than 1 million hyaluronic acid injection procedures were performed in 2007. Hyaluronic acid fillers are said to offer longer lasting results than collagen-based fillers. These fillers are FDA-approved.

• Juvederm (24HV, 30, 30HV)® Hyaluronic acid gel. Temporarily corrects moderate to severe facial wrinkles and folds. The results are immediate; corrects facial wrinkles or folds for up to six months or longer. Temporary redness, pain/tenderness, firmness, swelling, and bruising at injection site; should not be used in patients with severe allergies, particularly allergies to bacterial proteins. FDA approved.
   
• Restylane®
  Non-animal derived hyaluronic acid. Soft tissue filler that adds volume. Results are immediate, may last 6 months or longer. Side effects include redness, swelling, rare allergic reaction. FDA approved for filling moderate to severe wrinkles around the nose and mouth. All other use considered off label.
   
• Perlane®
  Non-animal derived hyaluronic acid. Soft tissue filler that adds volume. Results are immediate may last 6 months or longer; subsequent injections may require less Perlane®. Most common side effects are pain, redness, swelling, itching, discoloration, and tenderness at the point of injection. FDA approved.

Synthetic Poly-L-Lactic Acid (Sculptra)

Synthetic Poly-L-Lactic Acid, also known under the brand name of Sculptra, is a synthetic but biocompatible material derived from natural sources. Sculptra treats skin folds, indented chin, hollowed cheeks, and sunken eyes. Most common side effects are redness, bruising, lumping and granulomas. Results are gradual and typically last two years or more. People usually require multiple initial treatments to obtain a fully satisfactory outcome and then receive maintenance treatments in order to continue to see results. Initially approved by the FDA to be used to reconstruct HIV patients suffering from facial lipoatrophy, it is now approved to restore volume in healthy adults.

Synthetic Polymethylmethacrylate Microspheres (PMMA) in Bovine-Based Collagen (ArteFill)

75% percent bovine collagen and 25% polymethyl-methacrylate microspheres (non-silicone, carbon-based polymers). Artefill's manufacturer claims the injectable is permanent, as the microspheres do not absorb into the body. The body forms collagen around the microspheres that adds bulk. Possible complications include lumping, granulomas (localized skin reactions to foreign bodies, which can appear as hardness or a rash), micro-spheres can possibly move to other areas of the body. Results are immediate, need to wait 3 months between injections. FDA approved. Contraindicated for lip augmentation.

Radiesse™ Calcium Hydroxylapatite (CaHA)

Under the brand name Radiesse, each syringe contains CaHA particles that are suspended in a water-based solution (available in (0.3, 1, or 1.3 ml) to reduce the appearance of wrinkles and skin folds around the mouth and nose as well as fill certain scars. The body forms collagen around the micro-spheres that adds bulk. Little risk of allergic reaction. The filler is biocompatible, non-toxic, and non-allergenic; results last for up to six months or more. It is not recommended around the lips because of its larger particle size.

Fat Transfer

Fat injections have been used for years to add volume, fill wrinkles, lines and enhance the lips. More than 75,000 fat injection procedures were performed in 2008, according to the ASPS. Unlike bovine collagen, allergic reaction is not a factor as the fat is harvested from the patient's own body.

In a fat transfer procedure, fat cells are extracted from a discreet area of your body, prepared for injection, then transferred via a cannula to the lip area, above or below the eyes, crow's feet, nasolabial fold areas, cheeks and/or frown lines. The injections are made by placing ‘micro-droplets’ of fat in multiple layers from deep to superficial planes resulting in larger volume restoration. Not all transferred fat survives but the fat that reforms its blood supply survives and will last for years. Fat fillers do not require FDA approval for cosmetic use.

Silicone Microdroplet Injections

In 1992, the FDA banned the use of injectable silicone when it stopped the use of silicone gel-filled breast implants. Patients requesting treatment besieged physicians who had been using the material with good results. In 1998, a court-appointed panel of scientists concluded there was no credible evidence linking silicone implants to chronic fatigue syndrome, lupus or any other disease. Recently, the FDA approved the use of injectable silicone for certain cases of retinal detachment. This approval has paved the way for the renewal of microdroplet silicone injection therapy as an off label use of an approved device. This allows patients and their physicians to use their discretion in the use of the device for a purpose not intended by the manufacturer.

Tiny amounts are injected on a monthly basis until the desired results are obtained. Usually four to eight treatments are required. It is not the silicone that leads to the enlargement. Instead, each microdroplet of silicone that is injected stimulates the development of collagen that surrounds the silicone droplet. Much as a grain of sand in an oyster leads to the formation of a pearl, the silicone induced collagen production is what leads to the filling or enlargement. For this reason, it is essential to wait several weeks between each injection session since it is hard to predict the exact amount of collagen formation that will take place.

A full treatment program can take from six to twelve months. Patients do not complain of pain during or after treatment, but swelling occurs for a day or two, and bruising can last a week. With each subsequent treatment, the amount and duration of bruising declines. Adverse reactions have been attributed to adulterants, or to the use of nonmedical-grade silicone. Almost all other problems result from poor technique: failure to use the microdroplet technique, overfilling or superficial placement.

In spite of problems that resulted from injection of large amounts of liquid silicone when used as a tissue filler, the injection of small amounts in a controlled fashion proved to be a very successful and permanent filler. The procedure is technique sensitive and must be used carefully, but years of experience, including our own, demonstrates excellent results with minimal problems. It is very well suited to lip augmentation and soft tissue filling. Small nasal defects can be corrected, often avoiding the need for secondary surgery following less than ideal rhinoplasty results.

Next to oxygen, silicon is the second most common element in the earth's crust. Silicone comprises a family of chemical compounds called polymers. Silicone polymers are widely used in industry. In medicine, these polymers coat sutures and lubricate disposable syringes, needles and venous catheters. An insulin-dependent diabetic may receive 5 cc of silicone per year via daily injections.

Off-Label Treatments

In many medical treatment areas, including cosmetic injectables and fillers, you will often hear the term "off-label." When the FDA approves a substance for medical or cosmetic purposes, it is for a very specific use. That FDA-specific use is printed on the label. But the FDA also allows physicians to use their own judgment. Physicians are allowed to prescribe fillers for newly discovered uses that were not originally included in the FDA-approval specification. For example, Botox is FDA-approved for cosmetic use for lines between the eyes, but is commonly injected off-label for other areas of the face.

During the course of your cosmetic treatments, you may be prescribed a filler for a use that is not printed on the label. Cosmetic fillers are commonly used off-label, as many new applications are constantly being found. Doctors may also use a combination of fillers customized to fit the facial conditions of each patient.

FAQ Learn more about facial fillers.

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