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Here’s What You Need to Know About Injectable Fillers

Posted on April 30, 2015

Unlike topical lotions and creams, fillers can target the signs of aging deep beneath your skin. They can also help replace the youthful fullness that’s slipped away due to age-related fat loss in your face, which can leave you with a sunken look. Concerned about unnatural results? The goal isn’t to get rid of every crease or wrinkle on the face, so don’t overdo it.

With a couple dozen FDA-approved fillers in available, picking the right one that can handle your specific aging concerns is intimidating. Here’s the low-down on everything related to fillers—including which best suits your aging issue.

What’s in these fillers?

Fillers come in 6 different formulations: collagen, fat, hyaluronic acid (HA), hydroxylapatite, poly-L-lactic acid, and polymethylmethacrylate (PMMA):

1. Collagen This protein plays a key role in supporting your skin’s structure. Though collagen fillers were the first type of fillers available they are seldom used to day as their effects fade fastest—results last just three to four months.
2. Fat A potentially permanent option, fat injections are the most invasive of all fillers. A liposuction procedure is performed to remove fat from another part of your body such as the abdomen or hips. Results are immediate but downtime is significant due to swelling and bruising. Another downside is a lack of reliability, in that fat is not permanent in every patient.
3. Hyaluronic acid Hyaluronic acid (HA) naturally occurs in the body, plumping the skin when it binds with water. HA fillers are reversible: If you’re unhappy with results, the filler is easily dissolve by injecting an enzyme called hyaluronidase.
4. Hydroxylapatite Designed for moderate-to-severe wrinkles (like smile lines), hydroxylapatite is a mineral-like substance that naturally occurs in human bones and is suspended in a gel-like solution to create one specific filler: Radiesse. FDA-approved in 2006, Radiesse fills in wrinkles and stimulates the production of collagen in the body. Its effects last 12 to 18 months.
5. Poly-L-lactic acid This man-made material is what’s in the filler Sculptra, which was approved by the FDA in 2009. It’s intended to add lost volume back to the face, and it stimulates collagen production. You’ll need three injections over a period of six months and you won’t see results immediately as it takes a number of months to see the benefits for Sculptra. That said, results can last for a couple of years.
6. Polymethylmethacrylate (PMMA) Another permanent and man-made, PMMA beads are tiny bits of shatter-resistant plastic, which, when used in filler-form, are suspended in a gel-like formula that also contains collagen. These fillers are permanent and offer gradual but lasting results.

What are the risks?

Most filler treatments are quick, lasting between 15 to 30 minutes. And though there’s usually no downtime (applying makeup and doing your normal activities afterward is fine), you may experience some redness, bruising, swelling, and itching. There’s a small risk that a filler will cause skin discoloration and may possibly form tiny bumps under the skin Also, know that there’s a slight risk for infection. Bruising is common with fillers and is more common in areas with thin skin such as the tear troughs. Applying ice for an hour or two after treatment decreases the risk of bruising.

While the pain related to fillers can range depending on the area being treated (lips are the most sensitive). Topical numbing medicine applied prior to treatment is helpful in keeping discomfort down. Most fillers are formulated with an anesthetic to minimize pain and those that aren’t can have numbing medicine added to their syringes. As for results, though you’ll see them immediately (excluding Sculptra), they’ll look even better once the filler has “settled” into place—typically one to two weeks after the treatment.

What does “off label” mean?

When a filler—or any drug for that matter—is approved by the FDA, it has to go through a lengthy process to show that it’s safe and it does what it says it will. This costly and slow-moving process gives the official go-ahead for the filler to be used for a specific purpose (like filling in wrinkles) in a specific area of your face (like around your mouth). So when an FDA-approved filler is used in an area not approved by the FDA, it’s considered an “off-label use”.

Which fillers work best for what?

The filler: Juvéderm Voluma XC (Voluma, for short)

Best for: Boosting cheek volume

How it works: The hyaluronic acid (HA) filler was FDA-approved to plump the cheeks in 2013 and is considered the gold standard for this area. Thicker than most fillers, Voluma, gives sturdy support to the face, and is injected deeply into the skin next to the cheekbone, which allows it to lift the tissue above it. And remember: If you’re not happy with the results, the filler can dissolve the HA filler with hyaluronidase, so you won’t be stuck with over inflated cheeks.

How long it lasts: 12 to 18 months

The fillers: Perlane, Juvéderm, Restylane, Radiesse, or fat injections

Best for: Softening nasolabial folds. Each works differently depending on how deep the lines are. For mild to moderate wrinkles thinner filler work best – Resylane, Juvéderm Ultra, Belotero. For deeper wrinkles, thicker filler are called for – Perlane, Juvéderm Ultra Plus, Radiesse, or fat injections.

How they work: The thinner fillers’ small-to-medium particle size allows them to be placed more superficially for a smoother look but they’re not built to handle deeper lines, which the thicker fillers handle best.

How long they last: Juvéderm Ultra and Ultra Plus, Belotero, Restylane, Perlane 6 to 9 months; Radiesse: 9 to 12 months; Fat Injections: Results can last 5 years or more, in some people.

The filler: Restylane Silk

Best for: Plumping lips

How it works: Another hyaluronic acid filler (paired with a super-fine needle, which minimizes bruising and swelling), Restylane Silk has only recently joined the elite FDA-approved club, in 2014. It can plump your lips and fill fine lines around the mouth. But take note: because your lips are sensitive, this one can be pretty painful. To minimize the pain, topical anesthetic cream and injections to numb your lips are recommended.

Cost: $550

How long it lasts: 6 months

The injectable: Botox, Dysport, Xeomin

Best for: Smoothing frown lines and crow’s feet

How they work: While two other injectables, Xeomin and Dysport, have less recognized names, their effects are, generally the same as those of Botox. This trio of injectables reduces the ability to frown by temporarily relaxing the muscle and also smooths wrinkles. The FDA first approved Botox it in the 1980s to treat spasms in the eyelids and misaligned eyes, but gave it the green light for use on between-the-brows wrinkles in 2002. Botox is also FDA-approved to relax the area around your eyes and smooth out the wrinkles. Apart from bruising, potential risks include a headache, and, in rare cases, eyebrow or eyelid drooping. You’ll generally see the full effect in 1 to 2 weeks. To avoid any chance of a frozen face a light hand with the amount of Botox is recommended.

Cost: $250-$500 for frown lines; $250-$350 for crow’s feet

How long they last: 3 to 4 months