Fillers for the Face, Lips & Hands
The available fillers for faces, lips and hands 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 discontinued its use. Recently, changes have been made in the way that Sculptra is diluted, greatly reducing the problems with nodules. Furthermore, we are coming to understand that volume loss is the result of the loss of both soft tissue and bone. Ideally we'd like to replace soft tissue with something that resembles soft tissue, and absorbed bone with something that resembles bone. We currently have good soft tissue replacements but the closest that we have to bone replacement is Sculptra placed immediately adjacent to the bone. This does not produce bone, but the collagen induced by Sculptra can augment bone when it is right next to bone. We plan to soon begin using Sculptra again, primarily for this purpose, at least initially.
Radiesse 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. Radiesse is our preferred filler for bony hands, producing a natural look that is long lasting. Radiesse is also the most cost effective of the current fillers.
Juvéderm and Restylane are the two currently available hyaluronic acid fillers. Juvéderm is a bit thicker and flows more smoothly. When placed into the lip, patients find that Juvéderm feels less lumpy on the inside of the lips, when compared to Restylane, and Juvederm is our current filler of choice for lip filling. Restylane is a stiffer filler than Juvederm and it absorbs less water. That means that there is less associated temporary swelling. Along with Radiesse, Restylane is one of our most used fillers.
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 lasted for about 3 months. Because better fillers have been developed, collagen has been withdrawn from the market. The hyaluronic acid fillers last 6-9 months, or more, while Radiesse lasts 9-12 months or more. The durability of all these fillers increases with repeat injections, so the fillers tend to last progressively longer and smaller amounts are required over time.
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 has been the most closely studied of all fillers, because of problems with previous versions of the material. The currently available formulation does not appear to have a higher rate of adverse reactions compared to the more common fillers. There are some special considerations about dealing with "permanent" adverse reactions and concerns that the filling desired today may not be what is desired in 5 or 10 years. Nevertheless, people who have been injected with Artefill ten years ago still, for the most part, appear to be happy with their filler and there are some people who do not want to come in for annual filler injections. For the benefit of these people, we now do inject Artefill, but only for those people who have considerable previous experience with other fillers.
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