Over the years we have come to understand the importance of augmenting or replacing volume in tissues. The most common area of the body injected for volume restoration is the face, however, a number of other areas of the body have also been injected with fillers as well. We now know that along with the relaxation and loosening of the skin and deeper tissues of the face, one of the most important aspects of facial aging that can be improved is loss of volume, both in the skin as well as the deeper tissues. Oftentimes, it is more important to replace lost volume than it is to tighten loose tissues to produce a more natural, youthful appearance. It requires a trained eye and careful assessment to accurately determine the best approach to rejuvenating a face. In addition to rejuvenation of the face, fillers are often used to simply change the contour or volume of areas of the face, even in younger people, in order to create more pleasing proportions and symmetry. Examples of this might be making lips or brows fuller, cheeks higher and rounder, noses straighter, or chins larger. With the selection of the proper filler for the job and expert technique, beautiful, natural, and long-lasting improvements in appearance can be created non-surgically with filler injections all without the expense or recovery of a surgical procedure. With the recent addition of a number of excellent fillers to his tool box, Dr. G can help you arrive at a plan that will meet your needs.
To help us understand the nature of the different fillers available and guide our use of them to optimize results, we can think of the fillers as falling into a few broad categories.
Types of Dermal Fillers
While the original temporary filler, collagen, is still available, newer, longer lasting options are now available. The most widely used temporary fillers are Juvederm®, Restylane®, Perlane®, and Belotero®. They are all made of a clear gelatinous substance called hyaluronic acid (HA), which is a naturally occurring substance found in our skin, eyes, and cartilage. It is smooth, soft, and it depending upon the specific filler used and the location where it is injected, it can last anywhere from 6 months to a year. While they are made of the same substance, there are some differences in the individual products, and they are frequently used for slightly different purposes.
These fillers eventually lose their volume over time, but because they typically last anywhere from a year to two years or longer, they are considered semi-permanent. The two most commonly used semi-permanent fillers in the United States are Radiesse® and Sculptra®. Both of these fillers are also categorized as “bio-stimulatory” fillers, which means that they stimulate the body to form its own collagen around the injected filler substance, thereby increasing volume. This is the primary reason why they last longer than the HA fillers too. Although these fillers are similar in time course and mechanism of action, there are some important features of each which distinguish them and how they should be used for the best results.
There are only two injectable fillers in the United States which are approved by the FDA to produce permanent results, that is, results that can be expected to last indefinitely. Artefill® is one, and autologous fat is the other. While liquid silicone has been approved for use in the eye for the treatment of retinal detachment, its safety for cosmetic purposes has not been established outside of research protocols, and therefore, it should not be used for cosmetic injections at this time. Artefill® is approved by the FDA for use only in the nasolabial folds, and when used properly in this area, it can produce excellent permanent correction of nasolabial fold creases. Over the past several years a large volume of research has been completed on autologous fat injections. Essentially what this means is that some of your own fat is harvested with a liposuction procedure, prepared specially as a graft, and then injected back into a certain area of your body. This can be your face, your breasts, your buttocks, or really any other area that has contour irregularities or deficiency of volume. Typically a majority of the fat survives permanently, and when prepared and injected properly, this can be upwards to 70 – 80 % of the volume. While there are times that a second fat grafting procedure may be required to reach the desired goal, in the majority of instances a single treatment is sufficient. One of the most exciting things we have learned over the past several years is the importance of stem cells and other rejuvenative cells (ADRC’s) that are found in the fat. These cells have shown a remarkable ability to improve the “take” of grafted fat cells an enhance the overall result after fat transfer. Thus, Cell Enriched Fat Transfer (CEFT) has become an excellent option for volume replacement. As a charter member of the Cell Society, an educational organization dedicated to the advancement of stem cell and regenerative treatments around the world, Dr. G is positioned at the cutting edge of fat transfer technology and the use of fat grafting for cosmetic improvements.