Dermal fillers are substances that are injected under your skin to smooth out wrinkles, restore volume or enhance a feature. If you are thinking about getting dermal fillers, you may have noticed that there are many different products out there – so many that it can be a little overwhelming! This is because along with there being several different manufacturers of filler products, different areas and results require different types of fillers.
Fillers can vary in what they are made of, as well as their consistency. For example, if you were to get filler in your lips you would want it to be soft, and that would require a different type of filler than what would be used for the cheeks or jawline, where you would want a dermal filler that provides more structure. Before looking at the different types of fillers that are available, it is important to understand how fillers can be used to enhance your appearance. Once you know if and where you would like to be treated with dermal fillers, then you determine which filler would be best for your desired results.
What is the Triangle of Youth?
There are 3 unique features that a youthful face has, which are high cheekbones, full cheek volume, and a well-defined jawline. These three things are what is often called the “triangle of youth.” The base of this triangle goes across the cheeks and the point is at the chin. As we age, this triangle becomes inverted as our face becomes more oblong, the cheeks begin to flatten and jowls start to appear. These are what we have come to recognize as signs of aging, but fortunately, now they can be minimized with strategic dermal filler injections placed with the triangle of youth in mind.
During the aging process, the reversal of the triangle of youth is caused by the loss of collagen, elasticity and hyaluronic acid, causing a decrease in the quality of the skin. At the same time, bone starts to be reabsorbed in the areas around the eyes, cheeks, and jawline. Our face also has fat pads that begin to diminish, leading to hollowing in the under eye areas (tear trough), downturned mouth corners and flattening of the cheeks. These things can cause an aging face to often look sad and/or tired.
Dermal fillers restore the triangle of youth that is often lost with aging. An artistic eye and skillful hand can augment facial structure, improve volume and turn back the clock. There are several types of dermal fillers in the US market today. Fillers are chosen based on the amount of volume needed and the area being treated. Some fillers offer robust lifting to simulate bone in areas like the cheeks or jawline. Other are best when used to soften lip lines or areas around the mouth. Fillers can be used to add volume to sunken temples, hollowing under eyes, deflated cheeks, downturned mouth corners and improve weak jawlines. Advances in facial aesthetics allow us to restore the triangle of youth with a natural look. There’s no need to look done or different, but just refreshed for your age.
What are the different types of dermal fillers?
The majority of dermal filler products on the market today are made of a substance called hyaluronic acid (HA). The hyaluronic acid that is used in these fillers is identical to the naturally occurring hyaluronic acid in our bodies. HA is a sugar molecule that works to hydrate the skin, and since it is found in your skin already these types of fillers make a great option for patients looking for a more natural product.
The benefits of HA fillers include:
- A smooth, gel-like consistency for a natural feeling when it is placed under the skin
- Plumping effect due to the HA drawing moisture
- They are reversible with injections of something called hyaluronidase, which is an HA-eating enzyme
HA fillers are the most common type of filler used to plump lips, fill in lines and restore volume to soften the signs of aging. Each HA product has a unique consistency, and therefore a unique purpose, depending on the size of the hyaluronic acid molecules and how they are “cross-linked,” or bonded together. If you were to imagine a railroad track with two parallel pieces of metal and many beams holding them in position, that is what cross-linking does.
- Juvéderm VOLLURE & Restylane Defyne are moderately thick and excellent for smoothing deeper nasolabial folds for an up to one year or more
- Juvéderm VOLUMA & Restylane Lyft are the thickest, longest lasting HA fillers. These are the only two that are ideal for enhancement in the cheeks, chin and jawline.
- Juvéderm ULTRA, Juvederm ULTRA PLUS, Restylane, & Restylane Refyne are moderately thin gels. These are perfect for smoothing the nasolabial folds, laugh lines and parentheses. (Refyne is a slightly thicker than the other two, which means it can be injected a little deeper.)
- Juvéderm VOLBELLA & Restylane Silk are thinner fillers, which makes them great for smoothing vertical lip lines and subtle lip enhancement.
- Belotero Balance is another thin filler that not in the Juvederm or Restylane families, but is great for a natural-looking enhancement under the eyes, or what is called the tear trough area, to reduce under-eye circles and bags.
Radiesse is one of the commonly used fillers that is not made of hyaluronic acid and instead is made from Calcium Hydroxylapatite (CaHA). Calcium hydroxylapatite is known to produce a very natural result and does not migrate. It was first used in dentistry and reconstructive surgery with a long safety record, and side effects are rare. Radiesse is best used for deeper lines, including the folds that run from the lower nose toward the corners of the mouth. It can also be used give more volume over cheekbones, the chin, along the jawline and to fill in hollow areas of the cheek. Like with hyaluronic acid, CaHA is a natural substance and is identical to the mineral content of human bone.
One of the biggest advantages of Radiesse is its how long it lasts. It consists of a gel with particles of calcium hydroxylapatite (CaHA) suspended in it. This gel immediately fills in lines, folds and areas of lost volume, while the CaHA particles trigger natural collagen production. As the gel slowly gets absorbed, the new collagen your skin has produced helps you maintain your results.
Radiesse can be great for:
- Smoothing nasolabial folds, indented scars, and other volume-related imperfections
- Rejuvenating aging, bony hands (it’s the only filler FDA approved for the hands)
- Moderate-to-severe creases such as nasolabial folds, marionette lines and frown lines
- Enhance fullness of the cheeks and other facial contours
- Improve volume in areas of facial wasting such as can occur in HIV-positive people taking certain medications
HA vs. CaHA-Which is better?
- Both HA and CaHA fillers have their own benefits, and one is not necessarily better than the other. During your consultation, Dr. Okwuje will help you determine which filler will be the best for you based on the area you would like to enhance, your own facial structure and desired results.
- Both of these types of fillers are biosynthetically produced, which means that no animals or animal products are used. This lowers your risk of an allergic reaction and no skin testing is required.
- HA fillers can be reversed relatively easily through the extrusion of the product by using a substance called hyaluronidase to dissolve them. With Radiesse, hyaluronidase cannot be used, but the product can be removed by extrusion, or broken up by injecting saline. Both products will be broken down and reabsorbed over time.
- Radiesse syringes contain 50% more product than most other fillers, which allows a syringe to go further for your money with this product.
- Radiesse, due to its composition, stimulates collagen, whereas HA fillers do not. However, HA Fillers, like Juvederm Voluma, draw water toward themselves more so than Radiesse.
- Each filler material has an optimal application. Restylane and Juvederm both have fillers that are ideal for filling in superficial-to-moderate wrinkles. Radiesse is well suited for filling in deeper lines and can also be used to add volume to hollow areas of the face, as well as the cheekbone, chin, and jawline areas.
- Most fillers now, whether they are HA or CaHA, have the option to include lidocaine. This helps to reduce pain during and immediately following your treatment.