dermal fillers

Injections such as Botox and similar products like Dysport that temporarily freeze muscles, are popular injections for lines and wrinkle repair. Other injections known as “Dermal Fillers” are also used for lines and wrinkles but instead of temporarily freezing muscles they are used to add volume or plump up the skin making wrinkles appear less noticeable.

Dermal fillers can be used to plump thinning lips, give the eyebrows a bit of a lift, enhance cheekbones, decrease hollowing under the eye to help reduce dark circles, decrease the appearance of smile lines and overall just give you a well-rested and rejuvenated appearance.

They can be done in less than an hour and have little to no downtime. In some people, dermal fillers may cause some mild bruising, temporary swelling, or temporary redness at the injection site. Rarely, a person might experience an allergic reaction. The major disadvantage of dermal fillers is the effects are indeed temporary. For the most part, however, the effects can last from a few months up to a year and a half.

Don’t confuse dermal fillers with Botox and Dysport, which are wrinkle relaxers. While dermal fillers and wrinkle relaxers are both considered “injectables,” they are in two entirely different categories.

Botox and Dysport are used to paralyze muscles and stop the motion of muscles that cause wrinkles. They are not used to fill, plump, or enhance an area. However, they can be used along with fillers.

With all the dermal fillers on the market, it can be quite confusing to determine which should be used when. In the United States, the list of available fillers is long.

Below you will find an overview of those available in the U.S.”

Juvéderm XC / Juvéderm Ultra XC

Main Ingredient: Hyaluronic Acid

Uses: Juvéderm Ultra is good for fine lines and not so deep wrinkles of the face. It’s also good for adding volume to facial tissue, especially wrinkles and fine lines. Juvéderm Ultra can be used closer to the surface of the skin and areas with thinner skin, such as the parentheses around the mouth and nose.

Juvéderm Ultra XC can be injected into the lips and used for lip augmentation.

How It Works: When injected, the hyaluronic acid acts like a sponge. It absorbs water and as a result plumps up the area in which it was injected.

How Long Will It Last: Reported to last from six months to a year. Less material is usually needed for touch ups. Juvéderm Ultra XC can last up to one year.

Price: One syringe of Juvéderm Ultra or Juvéderm Ultra XC will run you about $450 to $700.

Reversal Agent? Yes. The volumetric effects of Juvéderm Ultra can be reversed with hyaluronidase.

Special Notes: The XC version of Juvéderm adds lidocaine. Lidocaine is an anesthetic that helps reduce pain with injection.

Juvéderm Voluma XC

Main Ingredient: Hyaluronic Acid

Uses: Good for adding volume and contour to the cheeks.

How It Works: The hyaluronic acid absorbs water and augments the injected area.

How Long Will It Last: The effects of Juvéderm Voluma XC lasts about two years.

Price: One syringe of Juvéderm Voluma XC is priced around $900 to $1,400.

Reversal Agent? Yes. Hyaluronidase can be used to reverse the effects of Juvéderm Ultra.

Special Notes: The XC version of Juvéderm Voluma includes the addition of lidocaine. Lidocaine, an anesthetic, reduces the pain associated with injection.

Perlane / Perlane-L

Main Ingredient: Hyaluronic Acid

Uses: Perlane is used to add volume to flattened areas, to plump up lips, and to help reduce the appearance of fine lines and deep folds. It is manufactured by the same company that makes Restylane. Perlane is thicker than Restylane, thus it is better for deeper or more prominent folds.

How It Works: Water is absorbed by the injected hyaluronic acid. This has the effect of building up the area of injection.

How Long Will It Last: Some people find Perlane to be longer lasting than Restylane. However, the FDA commentary is that it lasts up to six months.

Price: One syringe of Perlane runs between $500 and $900.

Reversal Agent? Yes. Hyaluronidase is the antidote to Perlane.

Radiesse

Main Ingredient: Calcium hydroxylapatite in the form of microspheres.

Uses: Radiesse is used to treat moderate to severe facial wrinkles and folds, such as the nasolabial folds. It can also be used to plump up cheek bones. It is not used in the lips.

How It Works: Radiesse stimulates the body to form new collagen. This is supposed to make the produce last longer, thus reducing the need for a touch-up. Additionally, the gel and calcium-based microspheres add volume to the injected area.

How Long Will It Last: Results are clinically proven to last a year or more.

Price: Radiesse normally costs approximately $600 to $800 per syringe.

Reversal Agent? No.

Restylane Silk / Restylane / Restylane-L

Main Ingredient: Hyaluronic Acid

Uses: Restylane is used to improve moderate to severe facial folds and wrinkles. Restylane Silk is designed especially to enhance the lips, as it is made with smaller particles than the other products.

How It Works: The area of injection is enhanced due to absorption of water by the hyaluronic acid.

How Long Will It Last: Restylane’s manufacturer claims results can last to up to 18 months. That is, however, with repeat injections at 4.5 months or 9 months. Without repeat injections, Restylane may last up to 6 months. Restylane Silk may last up to 6 months.

Price: Restylane products cost approximately $600 per syringe.

Reversal Agent? Yes. Hyaluronidase is the antidote to Restylane.

Special Notes: Restylane and Perlane are made by the same manufacturer. Perlane is the thicker/more viscous of the two products and is used for more heavy-duty rejuvenation.

Sculptra

Main Ingredient: Poly-L-Lactic Acid

Uses: Sculptra was initially limited to use in patients with HIV who had loss of facial fat caused by antiviral medications. Now it is approved for cosmetic use in non-HIV infected individuals for building up the cheeks, filling in hollows or sunken areas of the face, and increasing skin thickness which decreases the appearance of folds and lines. It is not used to enhance the lips.

How It Works: Unlike the hyaluronic acid based fillers, Sculptra’s mechanism of action encourages the forming of new collagen in the injected area and the effects are not immediate. Multiple treatments are required, approximately 4 weeks apart. The number of treatments needed depends on the severity of the facial aging. The skin thickness increases gradually.

How Long Will It Last: In a clinical study, the effects of Sculptra lasted up to 2 years after the first treatment session. A full treatment consists of an average of three injections approximately 4-6 weeks apart.

Price: Sculptra comes in a vial as opposed to a syringe. One vial will cost anywhere from $750 to $1,000.

Reversal Agent? No.

Special Notes: The results from Sculptra are not immediate and are more subtle. It can take months to notice improvement, but it is long-lasting.

Choosing a Filler
Finding the right dermal filler for you will depend on your budget, your doctor’s experience and preference, and your individual skin nuances (e.g. amount of sun damage, skin elasticity) and facial features. What works for your friend may not be the best option for you. It is best to select dermal filler type on a case-by-case basis.

Whether you’re one of those rare people who has developed an “immunity” to Botox, you’re getting tired of facing the needle every three months to maintain your results, or if you just don’t like the idea of regularly injecting poison into your face, you may wonder what alternatives you have for keeping your face youthfully smooth. So just what is a Botox-resistant person with stubborn frown lines to do?

Alternative Injectables to Botox:

Whether you’re one of those rare people who has developed an “immunity” to Botox, you’re getting tired of facing the needle every three months to maintain your results, or if you just don’t like the idea of regularly injecting poison into your face, you may wonder what alternatives you have for keeping your face youthfully smooth. So just what is a Botox-resistant person with stubborn frown lines to do?

Myobloc (Botulinum Toxin Type B)

It seems that some doctors who are aware of the problem are offering Botox-resistant patients another option in the form of botulinum toxin type B (which is sold under the brand name Myobloc).

This form of the botulism toxin has proven effective in patients suffering from cervical dystonia (a painful neuromuscular condition affecting the head and neck), pediatric urinary incontinence, migraine headaches, and other medical problems—even in patients who have developed resistance to botulinum type A (Botox). Although it is not approved for cosmetic use, some doctors do offer this off-label use as an alternative for Botox-resistant patients.

Besides its non-approved status, one concern is this: For Botox-resistant patients, what’s the likelihood that they will develop antibodies to other types of the toxin? The same type of toxin-blocking antibodies which are responsible for Botox-resistance have shown up in patients participating in clinical studies with Myobloc. However, no studies have been done on the off-label cosmetic use, which uses much smaller doses than are used to treat patients with cervical dystonia (the only condition for which the use of Myobloc is currently approved). The only answer anyone seems to have at this point is that it could certainly happen, but the use of careful (minimal) dosing may be able to prolong its usefulness in cosmetic patients.

Dysport (Abobotulinumtoxin A)

Like Botox, Dysport is a neuromodulator, which means that it blocks a nerve.

And while the two work the same, they are different at a molecular level. The molecule of Dysport is a smaller than that of Botox, and as a result tends to spread away from the injection site. This spread appears to be more of an issue when larger volumes of the product are used, especially in the forehead. Excess spread here can lead to a heavy eyebrow temporarily. Because of this it may be paired with Botox or another filler to corral it and prevent the risk of spreading and weakening the forehead.

Collagen (Bellafil)

Another popular filler is inspired by our own skin: collagen. This semi-permanent filler tends to be a mixture of collagen and PMMA microspheres.

Polymethylmethacrylate beads, or PMMA microspheres, are not absorbed by the body though they are made from cow or bovine collagen. The results may last five years and are usually used for acne scars.

To learn more about injectable dermal fillers, read this post about Non-Surgical Face Lifts.