What Are Dermal Fillers and How Do They Work?

Dermal fillers are injectible, soft tissue implants that can be permanent, semi-permanent, and temporary. They are used to replace lost volume after age or disease-related bone, fat, and collagen loss. They can be used in many different aesthetic regions throughout the body, especially the face and hands. This discussion will focus on the application of dermal fillers to the face.

Permanent fillers, such as silicone, are rarely used in the face. At first it may seem like the most economical way to go. However, a well placed filler today becomes a not-so-well placed filler years later as the face changes shape. A permanent filler is not easy to remove.

Semi-permanent fillers can last 1-2 years and have some important uses in the face. Examples include Radiesse and Sculptra. Radiesse is a calcium hydroxylapetite in an aqueous carrier. It is used for precise placement in deep tissues where bone loss has occurred. It is particularly effective along the jaw bone, nasolabial folds, and along the inferior rim of the orbit (eye socket). Sculptra is polymerized lactic acid, similar to the material used for skin sutures (Vicryl). It is the opposite of Radiesse, in that it is used for non-precise large-area volume enhancement. It does have a small, but real risk of allergic reaction.

Temporary fillers are by far, the most commonly used fillers in the face today. Collagen filler was quite popular for awhile,but only lasts 3-6 months and has a risk of allergic reaction. Collagen has largely been replaced by the hyaluronic acids (HAs). Hyaluronic acid is a naturally occurring substance and is found in the eye, joints, and skin. HAs are safe, have a very low incidence of allergic reaction, and typically last 6-12 months. Restylane/Perlane and Juvederm Ultra/Ultra Plus are examples of HAs. Restylane and Juvederm Ultra have smaller molecular structures, which is more effective in filling in finer lines, and building volume and definition in the lips. Perlane and Juvederm Ultra Plus have larger molecules, and thus more “horsepower” in building volume and filling deeper lines.