Fillers for Lips & Cheeks

The available fillers for lips and cheeks are in a state of change, and as new fillers become available and we learn more about the strengths and weaknesses of older fillers, we sometimes modify the fillers we use. Previously we used a lot more Sculptra, but as we observed its tendency to form nodules long after the time of injection, we have almost discontinued its use. The advantage of Sculptra was its longevity, but that becomes a disadvantage if there are problems.

Radiesse, on the other hand, is a filler that we are using more frequently. Radiesse is more durable than the hyaluronic acid fillers (Restylane and Juvederm) and it is also somewhat thicker, producing more filling per cc of filler. Radiesse is not suitable for the lips and cannot be placed immediately beneath thin skin. For these purposes the hyaluronic acid fillers are better.

Juvéderm and Restylane are the two currently available hyaluronic acid fillers. Juvéderm is a bit thicker and flows more smoothly. It is difficult to get Juvéderm to flow through a very fine needle, although we have learned how to do this. When placed into the lip, patients find that Juvéderm feels less lumpy on the inside of the lips, when compared to Restylane. However, the manufacturer has packaged Juvéderm so that a syringe contains only 0.8ml vs one ml in a syringe of Restylane. The syringes are priced the same. Unfortunately that 25% of additional material in the Restylane syringe frequently makes the difference between needing one or two syringes to do the job. That makes the Juvéderm much more expensive for the patient, so we use much more Restylane than Juvéderm.

Other fillers worth mentioning are collagen and Artefill. Collagen was widely used in the past; it has very nice flow and filling characteristics. However, it only lasts for about 3 months. The hyaluronic acid fillers last 6-9 months, or more, while Radiesse lasts 9-12 months or more. We no longer inject collagen.

Artefill is a permanent filler consisting of polyethelene beads suspended in collagen. As the collagen is absorbed, the body reacts to the beads by producing fibrous tissue. Artefill appears to have a higher rate of adverse reactions compared to the more common fillers. Also there are considerations about dealing with "permanent" adverse reactions and there are concerns that the filling desired today may not be what is desired in 5 or 10 years. We currently do not inject Artefill.