A dermal filler is a material that is injected into the deep layer of the skin (i.e. the dermis) to camouflage, or fill in, wrinkles, skin folds, depressions, and scars or augment the lips. These materials can be injected anywhere on the body, but are mainly used on the face and hands to soften the signs of aging. The introduction of bovine collagen as the first dermal filler in 1981 coupled with today’s demand for immediate results following “lunch-time procedures” has spurred tremendous growth in this area of plastic surgery. The ideal dermal filler would be inexpensive, easy to inject, natural feeling, long lasting (but reversible if results are unsatisfactory), and not associated with complications, allergic reactions, or pain. While not quite there, current dermal fillers are closer to this ideal than ever before. Interestingly, the United States Food and Drug Administration (FDA) has very limited indications for the use of facial dermal fillers; most modern applications of dermal fillers are considered off-label use. However, Dr. Perez does make the injections nearly pain free. Prior to most injections he performs a nerve block to numb the area of the face being treated; the anesthesia lasts several hours.
Video: Dermal Fillers
Dermal fillers can be used to treat undesirable lines and wrinkles to help patients achieve a more youthful appearance. Fillers can be injected to reduce creases between the eyebrows, around the mouth and jowls, or into the lips. Injections and fillers can be used for older women looking to achieve a rejuvenated look, or to give a younger woman a sexy, more glamorous appearance.
Restylane is a synthetically produced protein, hyaluronic acid, normally found in skin and joint fluids. Its chemical structure makes it attract large amounts of water and, thus, when injected into the deeper layer of skin it not only fills out wrinkles but can also help with hydration. The molecule is identical across all animal species and does not cause immunologic sensitization, does not require “pre-testing, ” and there is virtually no risk of allergic reactions. Restylane is a form of hyaluronic acid has a moderate particle size, flows through a small needle, and is approved for use in the mid-dermis to correct deeper wrinkles, folds, lip augmentation, and camouflage bags under the eyes. Restylane products are not permanent, and depending on location of injection, last six to twelve months (with reports of effects lasting two years in regions of the face that undergo little movement). Side effects may include local bruising, swelling, and pain with injection, all of which are temporary. Patients with very thin skin may see a bluish discoloration under the skin or have palpable nodules following injection of Restylane; this is usually temporary and resolves with light massage. In the rare instance a bluish discoloration or palpable nodule does not resolve, an enzyme, hyaluronidase, can be locally injected to dissolve the areas of concern.
Restylane Fine Line
As the name implies, Restylane Fine Line has a smaller particle size that Restylane, is injected through a very tiny needle, and is approved for thin, superficial wrinkles in the upper dermis.
Perlane is in the same family as Restylane and Restylane Fine Line but has the largest particle size, is injected through a small needle, and is approved for use in the deep dermis for facial contouring, deep folds, and lip augmentation.
Like Restylane, is also a synthetically produced hyaluronic dermal filler that works by integrating into dermal tissues and attracting water. Juvederm Ultra is primarily used in the mid-dermis for treatment of deeper wrinkles and folds. No skin testing is required prior to use and there is virtually no risk of allergic reaction. Results are not permanent and last six to twelve months, depending on area treatment. Like all dermal fillers, side effects may include local bruising, swelling, and pain with injection, all of which are temporary. Similar to Restylane, patients with very thin skin may see a bluish discoloration under the skin or have palpable nodules following injection of Juvederm; this is usually temporary and resolves with light massage.
Juvederm Ultra Plus
Juvederm Ultra Plus is identical to Juvederm except there are more chemical bonds between the molecules, causing it to be slightly more thick and viscous. This viscosity makes Juvederm Ultra Plus ideal for injection into the deep dermis where it is better able to augment and restore areas of lost volume (e.g. upper cheeks) and treat deep wrinkles and folds. Juvederm Ultra Plus is ideally formulated for treating nasolabial folds and for lip augmentation. The increased thickness also makes the effects Juvederm Ultra Plus visible for up to nine to twelve months, and maybe longer depending on area of injection.
The recently introduced Juvederm Ultra XC and Juvederm Ultra Plus XC are similar to their original counterparts except that the newer versions are formulated with 0.3% lidocaine (a local anesthetic) to provide a less painful injection experience.
Radiesse is a synthetically produced filler consisting of 30% calcium hydroxyapatite and 70% carrier gel. Although traditionally thought of as only a bone replacement, the ability of hydroxyapatite to stimulate collagen formation makes it a promising soft tissue filler. Radiesse is designed to be injected just underneath the dermis (i.e. deeper than true dermal fillers); thus, it is not actually a dermal filler but rather a soft tissue filler. Because of its depth of injection, Radiesse is ideally used for the correction of very deep wrinkles, acne scars, and volume restoration around the cheeks. No pre-testing is required and allergic reactions have not been reported. Results are semi-permanent, lasting at least two years in most patients. However, the gel carrier, compromising 70% of Radiesse, is absorbed by the body by approximately six months causing a depreciation of initial results. However, this is balanced by the formation of new collagen stimulated by the calcium hydroxyapatite particles. Side effects may include local bruising, swelling, and pain with injection, all of which are temporary. Radiesse should not be injected into the lips or in the superficial dermis, however, because of the anecdotal reporting of cyst and scar formation.
Like Radiesse, is also synthetically produced filler composed of a protein, poly-L-lactic acid. It is believed to stimulate the formation of collagen, increasing facial volume, but interestingly, results are not often seen for four to six weeks. Because of the somewhat unpredictable nature, most patients require two to three treatments, four to six weeks apart, to obtain the desired results. Sculptra is also injected underneath the dermis and is used for correction of deep skin folds and volume restoration, usually in patients with signs of facial fat loss (e.g. loss of fat or changes in position of fat associated with certain medical conditions and aging). Results last approximately one year. While no pre-testing or allergic reactions have been reported, the incidence of long-term cyst formation, palpable nodules, and complications is higher than with other soft tissue fillers.
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