Facial skin Fillers

Facial fillers have been undergoing a steady development and evolution since the early days of collagen injections. Hyaluronic acids such as Juvederm and Radiesse are now in common usage with excellent, immediate, cost-effective results.

Facial lines

Facial lines are different from skin wrinkles, which tend to be smaller and finer. Facial lines that can be improved by skin fillers are in these areas:
  • Nasolabial
  • Marionette
  • Glabellar
  • Infra-orbital
  • Supra-orbital
  • Lips – enlargement
  • Lips – smoker’s lines

Types of skin fillers


Before the mid-90s, only collagen was available to fill in indentations of the face. Although we have plenty of collagen in us as a major structural protein of the skin, the type used for injections was derived from cow collagen. There was a 20% rate of sensitivity or allergy once it was injected into some patients. You needed an allergy test done first to see if you could be injected. Though an easy material, the small syringes did not have enough volume and multiple injections were necessary. It also only lasted three months!

Hyaluronic acid

Another component of our skin started being used in the late 1990s. This material is a glycosaminoglycan (a complex sugar molecule with a nitrogen atom on it). Last year, over 1 million injections of hyaluronic acid were performed. Hyaluronic acid has several advantages over collagen:

  • It retains 10 times its volume in water, so you need less of it
  • It is non-allergenic, so no skin test is needed
  • It can be made in a a lab without the need for animal proteins
  • It lasts longer than collagen—up to nine months with no other additions
There are a number of common usage hyaluronic acids available, such as Restalyn, Belotero, Juvederm and Radiesse.

1.  Restalyn

The first hyaluronic acids, such as Restalyn and Hylaform, lasted only six months after injection and have given way to a newer class of materials.

 2.  Belotero/Juvederm

Juvederm is a hyaluronic acid that has been chemically cross-linked so as to make it last longer—up to nine months. Juvederm is a clear, jelly-like material that is ideal for small areas of injection or for use in the lips, where other materials are not as effective. Juvederm comes with an anesthetic already in the material, which makes injection less painful. At this date, Belotero, mu current favourite, costs about $600 for a syringe of 1 cc. Lower or higher amounts are available depending on whether a board-certified plastic surgeon is injecting it or a nurse.

3.  Radiesse

Radiesse is a cross-linked hyaluronic acid (like Juvederm) with small additions of hydroxy appatite, a small crystal from which our bones are made. This addition makes it more difficult for the normal turnover of materials in the body to “digest” the Radiesse. It lasts longer—up to 1.5 years. The cost of Radiesse is about $750-$850 for a 1.5 cc syringe, again depending on whether a board-certified plastic surgeon is injecting the material. Since you get almost double the volume  with Radiesse, you get a 50% longer duration for only 50% more cost; this is ideal for patients with deeper lines who would otherwise need two syringes of Juvederm. It’s a better deal. However, Radiesse cannot be used in the lips, as the material has a white color and the consistency of toothpaste and can show through thin skin. You also have to be careful when injecting Radiesse into the thin skin of the peri-orbital area.

There are a number of other hyaluronic acids available, though they are not as popular as the ones discussed here. These include Macrolane (common in Europe but not in the US) and Perlane (which comes in three different varieties depending on the deepness of the lines).

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