Wrinkle Fillers

Dermal fillers are substances injected at varying depths within the skin and soft tissues to fill facial imperfections such as wrinkles, creases and concave scars, as well as to enhance the fullness, or volume and shape of facial tissue.

Dermal fillers are generally classified in two main categories:

Temporary dermal fillers include two categories: collagen and hyaluronic acid fillers. Collagen is a naturally occurring connective tissue component that provides strength and structure to the skin. Hyaluronic acid is a naturally occurring substance between the skin cells that binds moisture and provides fullness. Both collagen and hyaluronic acid injectable dermal fillers are created in a lab to mimic these natural substances.

Semi-permanent and permanent dermal fillers are those used to correct deeper facial creases and in larger volume restoration. These fillers generally include microsphere particles suspended into a liquid or gel formulation or compounds that do not readily absorb, injected deep within the soft tissue for more long-lasting and large volume correction.

Treatment Benefits

Treatment with temporary dermal fillers can fill fine lines, wrinkles and deeper facial folds or other depressions such as concave scars.

Temporary dermal fillers can also add volume and improve the shape of facial features such as the midface and chin.

Temporary dermal fillers can enhance the fullness of the lips and define the lip border, or create a "Cupid's bow".

Treatment with semi-permanent or permanent dermal fillers is appropriate for deeper facial folds or other depressions such as concave scars.

Semi-permanent dermal fillers can also add volume and improve the shape of facial features such as the cheeks, midface and chin.

U.S. FDA-Approved Dermal Fillers

Comoderm and Cosmoplast are U.S. FDA-approved collagen dermal fillers.

Restylane is a hyaluronic acid filler approved by the U.S. FDA in 2004.

Sculptra was approved by the U.S. FDA in 2004 to treat lipoatrophy (loss of facial fat) as the result of HIV (human immunodeficiency virus). Sculptra is comprised of poly-L-lactic-acid, a synthetic material similar to that used in absorbable medical sutures.

ArteFill was approved by the U.S. FDA in 2006 as the first non-absorbable dermal filler. It is based on a formulation of 20% synthetic microspheres comprised of PMMA (material used in medical implants) and 80% bovine (cow) collagen with added anesthetic.

Radiesse was approved by the U.S. FDA in 2006 for cosmetic indications. It is based on calcium microspheres suspended in a gel. The technical name for the microsphere substance in Radiesse is calcium hydroxylapetite, a primary component of teeth and bones.

Juvederm Ultra and Juvederm Ultra Plus are hyaluronic acid fillers approved by the U.S. FDA in 2006.

Elevess is a hyaluronic acid filler with added anesthetic that was approved by the U.S. FDA in 2006.

Perlane is from the Restylane family of hyaluronic acid fillers approved by the U.S. FDA in 2007.

Prevelle Silk is a hyaluronic acid filler with added anesthetic that was approved by the U.S. FDA in 2008.

Evolence is a collagen-based filler approved by the U.S. FDA in 2008.

Treatment Process

Your Injections

The area to be injected will be cleansed, commonly with alcohol swabs. A topical anesthetic cream, icing to the injection sites or a local anesthetic via injection (such as a dental block) may be used for your comfort.

  • Once your treatment region is numbed, your doctor will make injections in several locations, placing the dermal filler where correction or volume enhancement is desired.
  • You doctor may massage or manipulate the area where the filler has been placed. The treated area may be cleansed again.
  • You may be given ice or cold packs to place on the treated area to minimize swelling and bruising.
  • The entire treatment process may take 20 to 30 minutes or more.

After Your Injections

Your enhancement will be visible immediately after your injections. However, due to swelling, you may look a little fuller than you might expect. This will improve rapidly over the next few days.

  • You may experience mild swelling or bruising from any type of injection. Ice or cold packs can help to minimize swelling or discomfort.
  • You can generally apply make-up over the treated area immediately.
  • Collagen fillers may result in 2-3 days of swelling and are less likely to result in bruising or redness.
  • Hyaluronic acid fillers may result in 3 to 7 days of swelling, redness and post-injection bruising.
  • Semi-permanent or permanent dermal fillers may result in 5 to 7 days of swelling, redness and post-injection bruising.
  • If you have received Sculptra treatment, your results will develop over the coming weeks. You may require 2 to 3 treatments several weeks apart to gain the improvement you desire.

Your Results

Your results are visible immediately. However, due to swelling, you may look a little fuller than you might expect. This will improve rapidly over the next few days.

  • The improvement from Cosmoderm and Cosmoplast begins to diminish within 2 to 4 months after treatment.
  • The improvement from Evolence begins to diminish within 6 to 12 months after treatment.
  • The improvement from hyaluronic acid fillers (Restylane, Juvederm, Elevess, Perlane, Prevelle Silk) begins to diminish within 6 to 12 months after treatment.
  • The improvement from a Restylane or Perlane injection begins to diminish within 18 months after treatment, upon reinjection.
  • The improvement from Radiesse begins to diminish within 24 months after treatment.
  • The improvement from Artefill begins to diminish within 2 to 4 years or more after treatment.
  • The improvement from Sculptra begins to diminish within 18 to 24 months after treatment.

If you do not repeat treatment once your results have begun to diminish, or as directed by your doctor, your appearance will return to its pre-treatment state.

Commonly injected sites

Cosmoderm and Cosmoplast are U.S. FDA approved to enhance the lips and to improve skin imperfections such as fine lines and scars.

Restylane and Perlane, Juvederm Ultra and Juvederm Ultra Plus, Elevess, Prevelle Silk and Evolence are U.S. FDA approved to treat mild to moderate facial creases and signs of aging in the mid- to lower face, namely the nasolabial folds or creases that develop from the nose to the outside corners of the mouth.

Restylane and Perlane, Juvederm Ultra and Juvederm Ultra Plus, Elevess, Prevelle Silk and Evolence are commonly used in facial rejuvenation: to enhance the lips and to add volume and shape to the midface, the jawline and chin. These fillers can also be used to improve hollows and depressions below the lower eyelid, often called the tear trough. Although less common, dermal fillers can provide temporary correction to a pinched or asymmetric nasal tip, or fill depressions at the nasal bridge.

Radiesse and Artefill are U.S. FDA approved to treat mild to moderate facial creases in the mid- to lower face, namely the nasolabial folds or creases that develop from the nose to the outside corners of the mouth.

Radiesse and Sculptra have been used to improve the volume in the midface and cheeks and to enhance the chin and jawline. In addition, semi-permanent fillers may be used to fill concave scars, and to enhance a nasal tip.

Questions to Ask Your Doctor

Doctor

  • What is your board certification?
  • How were you trained to do injectable treatments?
  • Do you regularly provide dermal filler treatments?
  • How many people have you treated with a condition similar to mine?
  • Will you personally inject me? If not, what are the qualifications of the person who will?

Brand

  • Exactly what name brand of injectable do you recommend for me?
  • Is it U.S. FDA approved specifically for cosmetic purposes?
  • May I see the packaging to verify the brand name?

Safety

  • Are there any precautions I should take before my injectable treatment?
  • What type of anesthetic is available, and what is your preferred means of anesthesia?
  • What can I expect to experience after my treatment?
  • What are the potential risks of treatment?
  • How long will my results last?