Injectable Fillers
One of the earliest signs of aging is a loss of facial fullness and the development of wrinkles. A non-surgical option to soften these facial lines and restore the volume and fullness in the face is through injection with soft tissue fillers.
Injectable fillers can plump thin lips, enhance shallow facial contours, soften facial creases and wrinkles, or improve the appearance of recessed scars.
While soft tissue augmentation does not stop the aging process, injectable fillers often combined with Botox may help delay the time more invasive procedures, such as a facelift, brow lift or other procedures.
What are the different types of injectable fillers?
Collagen is a natural protein that is the primary component of the second layer of the skin, the dermis. Collagen acts as the support structure of the skin for the growth of cells and blood vessels. Injectable collagen formulas derived from human dermis include, Cosmoderm® or Cosmoplast®. Zyderm® and Zyplast® are forms of purified bovine collagen that, unlike human derived collagen require allergy testing. Evolence® is a filler made from purified porcine collagen. Results from collagen injections generally last three months. Collagen injections historically were the first of the tissue fillers, but because of their short effective period, have largely been replaced by newer fillers listed below.
Hyaluronic Acid is a natural substance found in our bodies. It is effective for plumping thin lips and filing facial creases between the nose and mouth (nasolabial folds) and the jowl area (marionette lines). Hyaluronic acid may also be effective for some surface wrinkles and concave scars, under the eyes (nasojugal grooves) and elsewhere. The common hyaluronic acid products include Juvederm® and Restylane®, with results from these injectables lasting six months or longer depending on both patient variability and location of injection. The hyaluronic acids are currently the most popular of the soft tissue fillers.
Hydroxylapatite (Radiesse®) is a mineral-like compound found naturally in human bones, which is suspended within a gel-like formation. It is the heaviest of facial fillers and is recommended to fill deeper creases such as nasolabial folds, and marionette lines, as well as to enhance fullness of the cheeks and other facial contours. Radiesse’s duration of effectiveness is six months to one year.
Human fat, harvested from your own body, can be reinjected to enhance facial fullness, fill deep creases and to build up shallow contours. Augmentation through fat injections requires a more extensive procedure than other injectable fillers because it uses liposuction techniques to extract the fat prior to injection. Fat injections are somewhat unpredictable in how long they last. Length of action varies from patient to patient and location it is injected.
Poly-L-lactic Acid (Sculptra) was developed and is FDA approved for the treatment of facial wasting, a condition commonly resulting from HIV. It is currently also being used “off label” for facial aging. It functions similar to fat in enhancing facial volume in patients who appear to have lost facial fat.
PMMA (polymethylmethacrylate) fillers contain 20 percent tiny PMMA microspheres suspended in 80 percent purified collagen gel. An FDA-approved PMMA filler is recommended for the correction of facial wrinkles, such as smile lines.
Note: The U.S. Food and Drug Administration reviews and approves pharmaceutical fillers. However, some fillers may be used on an off-label basis, which means they have been approved for wrinkle correction in a given area only, or for some other medical indication, but not directly reviewed for a specific application. For a more detailed discussion of off-label uses of fillers, consult your plastic surgeon or dermatologist.
How is soft tissue augmentation performed?
Injectable fillers are performed during an office visit in combination with topical or local anesthesia. The filler is injected with a fine needle into strategic points on your face.
The injection sites are cleansed with an antibacterial agent, followed by icing or a topical numbing agent to make more sensitive patients comfortable. The filler itself may contain an anesthetic agent, or a local anesthetic or a combination of local anesthesia and conscious sedation (also known as ‘twilight sleep’).
How long do injectable fillers last?
Results from soft tissue augmentation using injectable fillers vary depending on which filler is used. Fillers’ effective period ranges from three months to over one year, depending on the filler used. In some cases, the duration of action or effectiveness of correction depends on the filler uses, the area treated and the individual patient. Because injectable fillers are not permanent, the best way to ensure results is through repeated treatments.
A thorough consultation with a Cleveland Clinic plastic surgeon or dermatologist will help determine the best injectable filler treatment program based on your age, skin condition, amount of sun damage, and genetics.
What are the side effects of injectable fillers?
Injectable fillers offer immediate results. Your initial appearance after treatment with any filler may include:
- Mild swelling or bruising
- Temporary numbness or redness
- Temporary irregularity to touch in the soft tissue or skin
These side effects are easily managed with topical icing and will improve within hours or just a few days.
When fat is used as the filler, these conditions may persist for a week or occasionally more.
Additional rare side effects include, but are not limited to:
- Asymmetry
- Under or over correction of wrinkles
Choosing a plastic surgeon or dermatologist with considerable experience with non-surgical and surgical treatment of aging assures that you can safely benefit from filler treatment.
Who is a candidate for injectable fillers?
The best way to determine if you are a candidate for any injectable filler is through a consultation with a Cleveland Clinic plastic surgeon or dermatologist. Tissue fillers are a good option if you:
- Are physically healthy
- Have mild or moderate degree of facial aging
- Have specific, but realistic goals in mind for the improvement of your appearance
To learn more about your options regarding injectable filler options available at Cleveland Clinic, contact our Dermatology and Plastic Surgery Institute at 216.444.xxxx or 800.223.2273, ext. 4xxxx
