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Dermal fillers are substances that are injected just below the surface of the skin to fill in
lines, wrinkles, and scars. Unlike face lifts that stretch the skin, fillers add volume for a more
natural youthful appearance. Fillers can also increase the fullness of the lips (see section on
lip enhancement) and lessen the downward slant of the corners of lips. The most common areas
treated are the smile lines around the nose and mouth, fine lines above the mouth, frown lines
between the eyes, and acne scars.
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There are two classes of dermal fillers:
Permanent and temporary; the main permanent dermal filler in use today is silicone. There are a
variety of temporary dermal fillers currently in use and several will be discussed below:
Hydroxyappetite (Radiesse), hyaluronic acid (Restylane and Hylaform), sculptra, fat, and collagen.
Temporary fillers are absorbed by the body over time, usually in 2-6 months and require repeated
treatments to maintain the effect.
Silicone Dermal Fillers
The use of silicone fillers has been controversial in the past because of the risk of bumpy scars
called granulomas that can form even decades after treatment. New formulations of silicone and new
injection techniques have reportedly eliminated granuloma formation but long term studies are still
in progress but the FDA has not approved silicone for this particular use. One advantage of
silicone is that repeated treatments are not required once the desired look has been achieved.
Collagen Fillers
Collagen is an abundant natural protein found in the body that provides structural support to skin,
muscle, tendons and bone. In the skin, collagen fibers are woven together to provide texture,
resiliency, and shape but is one of the substances lost during the normal aging process.
Collagen injections are performed in an office setting, take less than an hour to perform, and
require no recovery time. Combinations of fillers are used to achieve a natural, full look.
Because some of the collagen products are made from animals, the main risk of the procedure is an
allergic reaction which is why allergy testing is required prior to use (see below). The effect
lasts between 3-6 months.
Bovine (cow) collagen
Zyplast — Requires skin testing (for deeper wrinkles)
Zyderm — Requires skin testing (for fine lines)
Human (foreskin) collagen
Cosmoderm — No skin testing (for fine lines)
Cosmoplast — No skin testing (for deeper wrinkles)
Radiesse (Formerly called "Radiance")
Radiesse, also used for lip augmentation, is made of a synthetic substance containing microspheres
of calcium hydroxylapetite. There are no allergic reactions associated with this filler and with
proper technique and local anesthesia the injections are not very painful. There may be some
bruising after the procedure but most patients return to normal activities the next day. One of
the advantages of Radiesse is that it can last up to 3 years.
Restylane
Restylane is natural cosmetic dermal filler that is made of non-animal-based hyaluronic acid.
The fact that it is non animal based decreases the risk of animal based disease transmission or
allergic reaction so no pre-testing required. Restylane has been approved by the FDA for use in
moderate to severe facial wrinkles and folds such as nasolabial folds. There is usually no
recovery time required after a Restylane injection and the effect lasts approximately six months.
Hylaform
Hylaform is another hyaluronic acid based dermal filler that has recently been approved by the
FDA for treatment of facial wrinkles. Hylaform is made from avian (bird) origin, and individuals
who have allergies to avian products should not use this filler. It is believed that it last up
to six months and can be combined with bovine and non bovine type injections to address many
parts of an aging skin.
Lipotransfer (fat)
This procedure is unique because it removes fat from one area of your body and transfers it to
the area of concern. The main advantage of lipotransfer is that it eliminates the risk of an
allergic reaction. Lipotransfer is a two step procedure. First, liposuction is performed using
local anesthesia to collect the “donor” fat which is then injected into the face just below
the second layer of the skin (dermis) or into the muscle. Bruising, swelling, and redness are
common afterward and usually last a few days. No good studies have been performed to evaluate
how long fat fillers last but patients report variable results from 3 months to 3 years.
Each is unique and has its own risk profile. In general, however, risks include allergic reactions,
infections, pain, and scar formation. You should talk to your physician to decide if fillers are
right for you. Fillers can be expensive and you may require repeat treatments.
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Fillers are expensive but the pricing varies depending on the number and types of areas being treated
in addition to the amount of filler material required. Treatments can range from several hundred to
several thousand dollars. Remember that temporary fillers last at the most 3-9 months.
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Restylane contains hyaluronic acid in the form of a crystal-clear gel. It is injected into the skin
to lift the lip, wrinkle or fold. Once in your skin it creates volume, resulting in a healthy and
vital appearance. When injected into the lip it can restore a more natural and/or sensuous look.
In contrast to other biodegradable implants, Restylane is not extracted from animals, which means
no risk of an allergic reaction. Therefore, it is perfectly safe to use instantly without
pre-testing.
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Fine lines on the upper and lower lips that are not severe enough to require laser resurfacing fill
nicely with Restylane as well as deeper wrinkles and folds in the cheek areas (nasolabial,
melolabial) and lines at the corners of the mouth. Lip enhancement has up to twice the longevity
of standard collagen implant treatments.
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Yes. Hyaluronic acid occurs naturally in the body and therefore also dissolves naturally with time
and is integrated into your body’s tissues. The synthetic, biodegradable hyaluronic acid known as
Restylane has been used in Europe and Canada for many years and is now approved for use in the
United States. Your doctor will tailor your Restylane treatments according to the depth of the
wrinkles and desired lip enhancement.
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The treatment is performed by injecting Restylane under your skin and, since no pre-test is needed,
your procedure can usually be done in less than one hour. Many patients like the added comfort
provided with an anesthetic cream while others prefer an anesthetic block. This makes the treatment
relatively painless.
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Depending on the area treated, most folds and wrinkles require one treatment and the repeat
maintenance treatment is usually not required for approximately 6 months or even longer.
By experience, these products last almost twice as long as regular collagen injections.
The great thing about Restylane is that you can replenish your natural beauty whenever you feel
the need. Unlike permanent implants, Restylane always leaves you a choice when the effect of the
treatment has worn off so a touch-up can be performed any time you like after the previous treatment.
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Following your injections, normal activities can be resumed immediately. Discomfort is minimal
although the area treated might have a little swelling which may last a few hours. There may also
be some slight bruising which can be covered with make-up. Depending on the area treated,
correction can last up to six months or longer. If the lips are treated, initial swelling and
tenderness may occur within the first several days but subsides after two or three days.
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Cosmetic/Plastic Surgery
