• Introduction to soft tissue fillers
• Types of dermal fillers

INTRODUCTION TO SOFT TISSUE FILLERS

Soft tissue fillers are substances that are injected or implanted under the skin to plump up a hollow contour, soften wrinkles, and fill in furrows and some depressed scars on the face. Generally, thicker substances are best for deeper creases, and recontouring areas like cheek hollows and lips. Thinner substances work better for fine lines and superficial wrinkles or thin-skinned areas around the eyelids and the lip lines.

Restylane, Perlane, Juvaderm, and Radiesse are some of the products available for filling creases and wrinkles not associated with facial animation. The products are injected after topical or regional anesthetic and gradually resorb over the course of four to six months and may last up to nine months. Compared to the collagen products of the past, the currently used dermal fillers do not require pretesting. Radiesse lasts for approximately 12 to 18 months. New dermal fillers continue to be under clinical investigation all the time. The duration of dermal fillers is very variable and depends on the formulation of the material, how deeply it is injected, and how much is used. Most dermal fillers are only temporarily effective so that repeat treatments will be needed every three to six months on average but may last up to nine months.

In some cases, laser skin resurfacing, or chemical peels which help to soften wrinkles by removing and smoothing the outer layers of the skin, may be more effective than adding volume to the face with dermal fillers. Each patient needs to be evaluated individually, and the appropriate treatment is based on assessment of the skin tone, the location, depth and extent of the creases, and the degree of skin laxity.

TYPES OF DERMAL FILLERS

Hyaluroinc Acid Gel
Hyaluronic acid is a natural polysaccharide (sugar like substance) that is commonly found in the connective tissues of the body. The source of the material can be from animals (avian protein; i.e., roosters or poultry), or bacterial fermentation which is non-animal. Its normal function in the body is to bind water and to lubricate moving parts like joints. The most common areas for treatment are the nasolabial folds (creases from the nose to mouth), the nasomental creases (corners of the mouth) and around the lips, as well as cheek and chin contours. Since there is no anesthetic supplied in the syringe, a topical anesthetic or local block may be needed to maximize comfort. Aside from expected temporary redness/puffiness for the first day or two, there are few complications to report and we are seeing longevity of four to six months and even longer in some patients. As the substance naturally occurs in humans, allergic reactions are rare.

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Restylane®
The FDA approval of Restylane marked the beginning of a wave of new bioengineered substances for the treatment of lines, depressions, and wrinkles. Our male patients are very satisfied with the results of Restylane, which lasts six months or longer in most cases. Because it is a gel, it offers a soft, natural-looking correction.
Restylane and Perlane are all the same material packaged in a different particle size. Perlane has a large particle size while the size of Restylane particles is small. We use the larger particles when I need to fill deep wrinkles and the smaller ones when I need to fill superficial ones. We have been surprisingly pleased with this family of products and our patients love the variety and durability that they offer.

We use Restylane to treat nasolabial creases (smile lines) most commonly but it can also be used for other deep creases around the mouth and between the eyebrow when Botox is not effective. Perlane is great for restoring volume. It is used for deep creases including the nasolabial creases and for facial sculpting.
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Restylane Sub Q®
The latest addition to the expanding Restylane family of hyaluronic acid fillers is SubQ, a revolutionary new injectable treatment for facial sculpting. It can produce the high cheek bones or a more defined chin and jaw line. Restylane SubQ is based on the same patented hyaluronic acid gel formula used in the other Restylane products but it has much larger gel particles, three times as thick as Perlane. The gel safely biodegrades on its own. SubQ can also be used for restoring facial volume where cheeks have hollowed from weight loss and the inevitable breakdown of collagen and elastin fibers. The gel is injected deeply under the skin under a local anesthetic in one treatment, and the newly enhanced contours are immediate.

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Perlane®
The makers of Restylane® recently received FDA approval for their next generation product, Perlane®. Perlane® is made from the same natural, biocompatible substance as Restylane®, but the particles are larger, making the gel thicker. This allows our doctors to achieve a deeper, smoother correction that may potentially be longer lasting! The most common areas that Perlane® is used to correct are the nasolabial folds, the areas around the mouth as well as in the tear troughs (the hollows under the eyes). Results are immediate!

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Juvaderm
Juvederm has been used in Europe and is a major step forward for the hyaluronic acid fillers. It is a homogenous gel that does not contain gel particles. It is manufactured and is not derived from animals. Three versions are presently available and they are well suited to a broad range of applications. There are three varieties of Juvederm 18, 24, and 30 that vary in the concentration of hyaluronic acid contained. The variety of concentrations allows a broad range of uses for this filler ranging from filling crow’s feet with a less dense product to smoothing nasal furrows with a more dense variety.

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Radiesse FN™
Radiesse FN™ (BioForm) is composed of calcium hydroxyapatite, which has been used in the body for multiple applications including cheek and chin implants. Radiesse™ is injected into the face adding volume through microspheres that are suspended in polysaccharide carriers until encapsulation occurs. Calcium hydroxyapatite has been used for many years for other medical purposes in both injectable and solid implant forms, such as facial reconstruction. It is only FDA approved only for vocal cord paralysis and urinary incontinence, however, off-label use is permitted in the US. Radiesse FN™ is a pure, synthetic calcium hydroxyl apatite composed of calcium and phosphate ions which occur naturally in the body so they are biocompatible. The particles are in a gel carrier made up of cellulose, glycerin and purified water. The product manufacturer claims that Radiesse FN™ will remain soft and pliable as it permeates soft, fibrous tissue. As with any long term filling agent, there is a possibility of a foreign body reaction which can cause lumps or granulomas, and migration.