Dermal Fillers Explained: Types, Leading Brands, Longevity, and More

As we age, our faces undergo natural changes such as the loss of subcutaneous fat, hyaluronic acid (HA), collagen, and elastin. This results in decreased facial volume and the formation of wrinkles and furrows due to repeated movements and reduced moisture.

Dermal fillers are biocompatible substances that, when injected into the dermis or subcutaneous tissue, seamlessly integrate with surrounding tissues. They augment HA levels, immediately boosting skin hydration. By attracting and binding water molecules, dermal fillers temporarily add volume, filling in depressions like scars and areas affected by fat loss.

Permanent Dermal Fillers

Bellafill, previously known as Artefill, is an FDA-approved permanent dermal filler composed of Polymethylmethacrylate (PMMA) microspheres. It is designed to address nasolabial folds, acne scars, and forehead furrows. Permanent fillers like Bellafill are suitable for patients seeking extended results after prior experience with temporary fillers.

Injection Techniques for Dermal Fillers

Dermal fillers and other cosmetic products like Botox are injected at varying depths depending on their viscosity and the treatment area. It is crucial to exercise caution, especially in thin-skinned facial regions like glabellar lines and the vermilion border of the lips, as these areas are susceptible to vascular occlusion and necrosis. Here are some common injection techniques employed by doctors:

• Serial Puncture: Sequential injections placed along the targeted area.
• Linear Threading: Continuous, linear injections along a wrinkle or fold.
• Cross-Hatching: Crisscross pattern of injections to evenly distribute filler.
• Fanning: Multiple injections fanned out from a central point.
• Depot: Concentrated deposit of filler in strategic areas.

Composition of Dermal Fillers

Dermal fillers utilize a variety of naturally sourced and synthetic compounds, each offering distinct advantages and considerations in clinical practice:

Top dermal filler brands include:

1. Juvéderm: An FDA-approved filler containing non-animal stabilized hyaluronic acid, injected into the mid-dermis by the makers of Botox. Juvéderm effectively corrects mid-to-deep wrinkles and facial irregularities.
2. Restylane: The leading filler in the United States, with over 10 million procedures since 2004. It treats lips, nasolabial folds, and hollow under-eyes.
3. Radiesse: Popular for non-surgical nose jobs, Radiesse stimulates collagen production, providing longer-lasting results compared to other fillers.
   

These fillers offer various benefits but also have specific limitations and potential side effects, emphasizing the importance of careful product selection and patient assessment in achieving optimal outcomes.

Side Effects

Side effects of dermal fillers are a primary concern in cosmetic procedures. These adverse reactions can arise from the procedure itself and the expertise of the administering physician. Fortunately, severe or delayed reactions are uncommon.

Possible adverse reactions to soft-tissue fillers can vary in severity and onset. Immediate reactions, though more common, are typically transient and may include redness, swelling, itching, bruising, and lump formation at the injection site. 

Subacute reactions such as abscess formation and persistent hypersensitivity reactions are rare but possible. Delayed reactions, also rare, can manifest as discoloration, local necrosis, nodule formation, granuloma formation, or ulceration. Monitoring for these reactions post-procedure is crucial for prompt intervention if needed, although severe complications are uncommon.

Available Treatment Techniques

There are several techniques available for injecting soft-tissue fillers, each chosen based on the specific product and treatment area. Physicians typically select from three correction types based on the amount of filler used:

1. 1:1 Correction: This approach involves using an equal amount of filler to the volume of the area being treated, ensuring balanced augmentation.
   
2. Overfilling: Sometimes used in areas like the lips where slight swelling post-procedure is desired for optimal results.
   
3. Underfilling: Commonly employed with Sculptra injections, where multiple sessions are needed to gradually build up volume. This technique allows for a more subtle and natural enhancement over time. Each technique is tailored to achieve the desired aesthetic outcome while minimizing risks and ensuring patient satisfaction.

Treatment & Longevity

The cost of dermal filler treatments ranges from $500 to $1,200 per injection, depending on the treated area and desired outcomes. Before the procedure, patients receive counseling on filler details, expected results, potential side effects, and contraindications. 

They must provide written consent and a comprehensive medical history. Blood thinners, vitamin E, warfarin, and other anticoagulants should be avoided beforehand. Mild redness or swelling may occur for a day or two post-procedure. 

Patients can resume normal activities immediately but should avoid strenuous exercise and prolonged sun exposure. The duration of filler effects varies: temporary fillers last 3-6 months, semi-permanent fillers 9-12 months, and permanent fillers more than 2 years.

Conclusion

Navigating the diverse array of dermal fillers available today can be daunting. Understanding the distinctions and approved uses of each filler type is essential. 

Successful outcomes hinge on meticulous product selection, precise injection techniques, and the expertise of a qualified practitioner. Temporary fillers are often preferred for their gradual absorption by surrounding tissues, offering flexibility and tailored solutions for various cosmetic needs.