Juvederm, Restylane, Radiesse, Belotero, Voluma, Silk, Sculptra, Bellafill…So many choices for filler, how do you know which one is the right one? Fillers can be broken up into a few categories that will help simplify things.
The most common fillers are Hyaluronic Acid fillers. There are several reasons that these fillers are popular, both with patients and with doctors. First, they produce immediate results. It is very easy to see whether you need more filler in each area and to make sure that augmentation is even. Second, they are reversible. If you’ve never done fillers before, it can be very reassuring to know that if you hate it, it can be undone. Hyaluronidase will dissolve away injected fillers within a matter of hours to days. Within the Hyaluronic Acid Fillers there are several distinctions:
The thickest fillers are used for volumizing. This is what you want if you’re looking to build up your cheek bones. These robust fillers can mimic your bone structure along your cheekbones, nasal bridge or jawline. Because they are thicker, it takes your body longer to break them down and they are among the longest lasting of the fillers. Voluma and Restylane Lyft are in this category. These fillers, though they last longer, are not typically used for filling more superficial areas like the lips and fine lines because they will generally look or feel unnatural when used in these applications.
These fillers are of a medium thickness/weight. They do a nice job filling in smile lines around the mouth. Juvederm, Belotero and Restylane fall into this category. They offer good staying power while looking and feeling natural.
Volbella & Restylane Silk are fine fillers that work well for plumping the lips and filling fine lines and wrinkles. They feel soft and look natural in the lips. Because they are a thinner filler, they don’t last as long.
Restylane Refyne and Defyne are flexible fillers. These fillers work well for filling the lines that show up when your face moves (like lines on your cheeks when you smile). They move with your face, so that they look natural with any facial expression.
Radiesse is a Calcium Hydroxylapatite filler. It tends to be a more robust filler, lasting a year or more. The downside to Radiesse is that it cannot be reversed, so if you don’t like it you have to wait it out. Also, not being able to reverse it increases the risk for bad outcomes from serious complications.
Sculptra (Poly L Lactic Acid) is a collagen stimulator. It does not act as a filler on its own, but rather it causes the production of collagen which essentially is your body’s own filler. The downside of Sculptra is that results take 3 months to fully develop. The upsides are that it lasts longer than most fillers (2 years for most patients) and that you get more “bang for your buck” in terms of volume per dollar.
Bellafill is a combination of polymethyl methacrylate (PMMA) and bovine (cow) collagen. The collagen acts as an immediate filler and the PMMA stimulates your own collagen production to give you long lasting results. Complications from Bellafill can include serious allergic reactions (it requires a skin test before injection) and granulomas. Bellafill is a permanent filler, so the results are not reversible. I personally don’t feel that permanent fillers are beneficial for my patients. The reason for this thinking is that no one can predict what your face will look like in 30 years, where you will need volume and where you will be sagging. To that effect, placing volume that will remain there forever may not be well placed in the years to come. The only permanent filler that I recommend to my patients is fat. As a bioactive substance, the transplanted fat changes with your body, just like the native fat does.
…and speaking of fat, fat transfer is a great, cost effective option for many patients. You can get larger volume replacement with fat and the results are essentially permanent. There is no risk for allergic reaction or rejection since the fat comes from your own body. It works well in almost all applications of fillers with the exception of the fine lines and wrinkles. I find that in this instance the smooth gels work much better than the globular fat.
In summary, it depends on what you’re using the filler for, your personal preferences and experiences and the experiences of your injector. The best way to know which filler is right for you is to speak with an experienced physician who injects multiple fillers. If they only carry one product then that’s what they’ll sell you. There’s also cost differences to consider, which vary among clinics, and the rewards programs that the companies offer (Brilliant Distinctions and Aspire).