nonsurgical skincare treatments

Reviews of Dermal Fillers

If you’re considering dermal fillers, you may be wondering which type is best. We’ll help you narrow down the overwhelming amount of options and give you a play by play of the most popular dermal fillers so you can make an informed decision.

In This Article:

If you’re considering dermal fillers, you may be wondering which type is best. Each has its own unique pros and cons including cost, potential complications, and how long it lasts. On top of that, there are also some fillers that are meant for specific needs or for specific areas of the face. [1] We’ll help you narrow down the overwhelming amount of options by giving you a play by play of the most popular dermal fillers… even those harvested from your own body or from someone else’s (yes, that does have its own gross-out factor but it’s safe).

As you go through the options below, keep in mind that your dermatologist may recommend more than one kind of filler, depending on your specific areas of concern. For example, one type of filler may be used for lines around your mouth, while another is used to correct wrinkles elsewhere on the face. A single filler might be able to correct your every concern—but some doctors take a multi-pronged approach and get great results, so it’s something to keep in mind. Dermal fillers are as much art as they are science—one more reason finding a dermatologist experienced with various types of fillers is essential!

Now, let’s get to the most common filler options out there, presented in alphabetical order by brand name:


Alloderm (and Cymetra)

Alloderm is processed from donated human cadaver tissue prepared in such a way that it retains its underlying structure but without any cells that could cause rejection. It has been used for a variety of surgical reconstructive procedures to replace lost, damaged, or diseased tissues. It’s considered safe and stable for wrinkles, and may last from 1 to 2 years, though there are no controlled studies substantiating that claim. [2]

A micronized form of Alloderm called Cymetra is also available. This material is rehydrated with lidocaine in the physician’s office before injection so the procedure is considered less painful.


Artefill

Artefill consists of a synthetic ingredient known as polymethyl methacrylate (PMMA) mixed with animal-derived collagen. It’s considered to be semi-permanent to permanent. Because of its potential permanence, injecting Artefill requires greater skill. Risks include lumping of the product after injection; inflamed, hardened, grain-sized nodules at the injection site; and migration of the filler. Unlike fillers that dissipate over a year or two, Artefill sticks around almost indefinitely. That means any problems last as well unless the filler is removed which is not an easy process. The tradeoff for potential long-term side effects is, not surprisingly, long term results. And because Artefill lasts, you don’t need to adhere to a regular maintenance schedule as you would for naturally-derived dermal fillers such as hyaluronic acid. [3]


Autologous Fat (Fat Grafting)

Autologous Fat (fat grafting) is produced from fat taken from a part of your body via liposuction. No allergy testing is required because you won’t reject material taken from your own body. Harvesting fat is an involved, complicated process but is done regularly now, right there in the doctor’s office. There’s no consensus on longevity (which is true for most injectables as they vary from person to person) but generally it lasts from 12 to 24 months. The major risk is migration; the injected fat can move and “bunch” creating a lumpy appearance. Even though the fat material is taken from your own body when you have problems they are not easily corrected. [4]


Belotero Balance

Belotero Balance is a hyaluronic acid-based filler that’s positioned as a multi-purpose filler due to its ability to "adapt within the skin for soft and even correction". Its softer, more malleable texture means it can be used to treat several areas of concern, including nasolabial folds (aka smile lines), vertical lip lines, lines at the corners of the mouth (that make you look like you’re always frowning), and the so-called marionatte lines which run from the outer corners of the lower lips down the sides of the chin toward the jaw.

All hyaluronic fillers employ some degree of crosslinking in order to keep the hyaluronic acid from being broken down too quickly by naturally occurring enzymes in our skin. Belotero’s design uses random crosslinking, with links that are stronger and those that are weaker, resulting in its more malleable properties. This makes Belotero Balance an intriguing option for some off-label uses, including filling of indented acne scars and very fine forehead lines. Generally speaking, this filler isn’t ideal for deeper lines, as the thicker, more highly crosslinked fillers tend to produce better results. [5, 6]

Results from Belotero can last between 6-8 months, though there are case reports of patients whose results lasted twice as long.


CosmoDerm 1 and 2 or CosmoPlast

CosmoDerm 1 and 2 or CosmoPlast are fillers made from human-derived collagen, which is considered to be safer than cow-derived collagen. CosmoDerm is used for superficial wrinkles and CosmoPlast is used for deeper wrinkles. Overcorrection (injecting more of the dermal filler substance than what is typically needed to produce a positive outcome) is usually needed to achieve ideal results as well as touch-ups through the year. Whether you have CosmoDerm or CosmoPlast, results last about 3 to 9 months, which is on the short side for fillers available today. As a result, these fillers aren’t used as often as they once were. [7]


Juvederm Ultra and Juvederm Ultra Plus

Juvederm Ultra and Juvederm Ultra Plus are popular fillers derived from lab-synthesized hyaluronic acid. The differences between Juvederm Ultra and Juvederm Ultra Plus is that the Ultra Plus is made for deeper and more depressed folds of skin while Juvederm Ultra is for plumping up finer surface lines.

Both fillers can last between 6 months and up to 2 years in some instances depending on how your face continues to age, how you take care of your skin, and how much of the product was injected. This “brand” of filler also includes Juvederm Ultra XC and Juvederm Ultra Plus XC. Both of these are made up of the same filler material with the anesthetic lidocaine added to the formula to reduce pain as it is being injected into wrinkles. [8]


Juvederm Voluma XC

Juvederm Voluma XC differs from the Ultra versions above in that it is a much thicker hyaluronic acid gel which is used for filling in age-related volume loss that occurs in the cheekbone (midface) and chin areas. It is not meant to be used around the eyes, frown lines, or lips. Results can last up to 2 years. Some dermatologists offer the various types of Juvederm for each one’s effect on various parts of the face. Depending on your concerns, this can be a very wise way to go. [9]


Perlane

Perlane is a sister product to Restylane (discussed below). Both are composed of transparent, viscous gel particles of hyaluronic acid derived from bacteria grown in a lab. Perlane is injected into facial tissue to provide volume in or just under the skin. This smooths wrinkles and folds, especially around the nose, mouth and under the edges of the mouth (areas known as nasolabial folds and oral commissures). Because Perlane’s particle size is larger than Restylane, it is considered better for deeper wrinkles and depressions in skin. Perlane can last for 6 months to a year. [10]


Radiesse

Radiesse is a synthetic material made up of calcium hydroxyapatite (30%) suspended in a cellulose gel carrier (70%). Calcium hydroxyapatite is a type of “bone cement” and has been used for years to repair many types of skeletal defects. It has been shown to have stable results, ease of use, and is easily adapted for use as a dermal filler. Because Radiesse is a thicker substance it’s used for deeper wrinkles rather than superficial ones. Radiesse is considered a semi-permanent filler, with results lasting 12–18 months, on average. [11]


Restylane

Restylane is a form of hyaluronic acid lab-derived from bacteria. It’s used for more superficial wrinkling but research has also shown it can be used for overall filling of deeper winkles and to build volume. Its sister product Perlane is meant for use on deeper wrinkles. Restylane can last from six months to one year. A dermatologist may use Restylane and Perlane depending on your concerns and which filler will work best in key areas. [12]


Sculptra

Sculptra is not technically a filler because it doesn’t add volume but rather stimulates collagen production in the areas where it is injected. Sculptra is a synthetic filler derived from poly-L-lactic acid (PLLA) which is distantly related to alpha hydroxy acids (AHAs). It can be used for wrinkles and indented, “ice pick”-type acne scars as well as for general improvement in facial depressions, especially where fat loss is problem. Results are not immediate and usually require multiple, biweekly treatments to obtain the desired improvement and then routinely to maintain the appearance. [13]


Zyderm I, Zyderm II, and Zyplast

Zyderm I, Zyderm II, and Zyplast are different combinations of cow-derived collagen. Zyderm was the first injectable filling material to be approved by the FDA. It has been used for more than 20 years and the injection technique has been standardized. All these materials are absorbable and, therefore, overcorrection (injecting more filler than needed to fix the issue) is necessary to maintain results. Duration is limited, ranging from 3 to 9 months. Allergy testing is mandatory because about 5% of patients may experience hypersensitivity to injectable bovine (cow) collagen. [14]


Common Risks and Complaints for Dermal Fillers

The most common issues for dermal fillers in general are initial discomfort that lingers or temporary swelling and bruising that lingers. Fillers can also result in cysts, bumps, lumps (called nodules), skin irregularities, and/or inflamed tissue that persist, even with semi-permanent fillers. Allergic reactions can happen, but are rare, especially among today’s newer fillers. If you tend to get cold sores, dermal fillers can trigger a new breakout. Infection also can result, but it’s extremely rare and easily treated. [15]

Not surprisingly, the most typical complaints about dermal fillers involve the results of the procedure. Problems such as poor or inaccurate placement, unevenness, and overfilling the area are not unusual. Skilled doctors can correct some of these complications; for shorter term fillers, you just have to be patient and wait for the filler to dissipate as it is absorbed by your body.

Although, we’ve pointed out potential issues, we must follow that up by saying the reward can be great and many find the potential risks are worth it! Using dermal fillers to correct signs of aging such as deep wrinkles, gaunt areas of the face, thinning lips, as well as evening out depressed scars can bring about beautiful improvements.

Of course, as with any cosmetic corrective procedure, daily use of well-formulated skincare products and sun protection (365 days per year, even when it’s cloudy) are part of the anti-aging package that will keep your skin looking younger and healthier for a very long time!

References Cited:

  1. Wollina U, Goldman A. Dermal fillers: facts and controversies. Clin Dermatol. 2013;31(6): 731-736.
  2. Jansen et al. The Evidence Base for the Acellular Dermal Matrix AlloDerm: A Systematic Review. Annals of Plastic Surgery. 2013;70(5):587–594.
  3. Lemperle G., et. al. ArteFill® Permanent Injectable for Soft Tissue Augmentation: II. Indications and Applications. 2010;34(3): 273–286.
  4. Marwah M. et. al. Fat Ful‘fill’ment: A Review of Autologous Fat Grafting. J Cutan Aesthet Surg. 2013;6(3): 132–138.
  5. Lorenc ZP. et. al. Review of key Belotero Balance safety and efficacy trials. 2013; Plast Reconstr Surg;132(4 Suppl 2): 33S-40S.
  6. Sundaram H., Cassuto D. Biophysical characteristics of hyaluronic acid soft-tissue fillers and their relevance to aesthetic applications. 2013; Plast Reconstr Surg;132(4 Suppl 2): 5S-21S.
  7. Hotta T. Dermal fillers. The next generation. Plast Surg Nurs. 2004;24(1): 14–19.
  8. Lupo MP., Thomas JA., et. al. Effectiveness of Juvéderm Ultra Plus dermal filler in the treatment of severe nasolabial folds. Plast Reconstr Surg 2008;121(1): 289–297.
  9. Few J., Cox SE., et. al. A Multicenter, Single-Blind Randomized, Controlled Study of a Volumizing Hyaluronic Acid Filler for Midface Volume Deficit: Patient-Reported Outcomes at 2 Years. 2015;35(5): 589–599.
  10. Brandt F., Cazzaniga A. Hyaluronic acid gel fillers in the management of facial aging. Clin Interven Aging 2008;3(1): 153–159.
  11. Jacovella, P. Use of calcium hydroxylapatite (Radiesse®) for facial augmentation. Clin Interv Aging. 2008;3(1): 161–174.
  12. Rohrich RJ, Ghavami A., and Crosby MA. The role of hyaluronic acid fillers (Restylane) in facial cosmetic surgery: review and technical considerations. 2007; 120(6 Suppl): 41S–54S.
  13. Bauer U., Graivier M. Optimizing injectable poly-L-lactic acid administration for soft tissue augmentation: The rationale for three treatment sessions. Can J Plast Surg. 2011;19(3): e22-27.
  14. Lafaille P., Benedetto A. Fillers: Contraindications, Side Effects and Precautions. J Cutan Aesthet Surg. 2010;3(1): 16–19.
  15. Funt D, Pavicic T. Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Clin Cosmet Investig Dermatol. 2013; 6,295–6,316.
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