The different filler products and substances
The fast development of the different artificial substances for tissue filling (fillers) had lead there to be a vast amount of different filler products available on the market. The most well known are Restylane, Juvederm and Evolence.
The different products are produced in different ways and therefore have different characteristics. As a consumer it is important to know about these in order to assure that one gets the correct treatment and the best possible results.
The different filler products differ in terms of:
- Content and manufacturing process
- Consistency and particle size
- The quantity that can be injected
- The amount of fullness it produces
- The duration of the fill
There are principally four main types of fillers. The greatest difference between the different substances is how long they last in the skin after treatment.
You can read more about the different types of fillers in the following information.
Collagen based fillers
Injection products based on natural collagen is used primarily to minimise facial wrinkles and fill the lips but can also be used to strengthen facial contours. Collagen is a natural protein (albumin) which composes an important part of the skins natural connective tissue. The cutis is made up of firm connective tissue that contains collagen and elastic threads/fibres (elastin).
The collagen and elastic threads together with normal water content provides the skin with its fullness, elasticity and tension. With age the elastic threads in the connective tissue degenerate and the skin becomes wrinkled and loses its fullness.
There are several examples of cosmetics with collagen and elastin (creams, lotions, shampoo etc). They are marketed as life giving, wrinkle restraining and as having a rejuvenating effects on the skin. However, collagen consists of large molecules and probably isn’t even absorbed by the skins outer layer (horned layer) and instead just lies on the outside of the skin until being washed off. Hence, to have an effect collagen must be injected into the skin.
The collagen that is used for injections is primarily harvested from excess produce from the slaughter industry such as connective tissue from young pigs and cows. Since there is a risk for allergic reactions when using such collagen an allergy test may be done before treatment.
The achieved results from collagen injections last normally for 3-12 months.
Examples of collagen based injection products are Evolence, Zyderm, Zyplast, Dermalogen, Cymetra, Autologen, Fascian, Cosmoderm and Cosmoplast.
Hyaluronic acid based filler products
Dermal fillers based on laboratory produced Hyaluronic acid are used to strengthen facial contours (chin, cheek bones, jaw line, lips), increase the volume of chosen body parts (breast, calves, bottom etc.) fill out and minimise wrinkles & lines in the face and smooth skin unevenness (scars, deformations).
As previously mentioned, the connective tissue that builds up our skin and makes it elastic consists to a large extent of collagen fibres. Between these fibres there are large fluid carrying molecules that fill out the tissue. The most important of these molecules is Hyaluronic acid which is produced naturally in the body.
When artificially produced Hyaluronic acid is injected locally into the body’s tissue it binds water molecules which results in increased volume into the injected area. This effect is also well documented and has made Hyaluronic acid injection products very popular lately.
Treatment results are obtained after 1-2 injections of Hyaluronic acid products and last for 6-12 months depending on how high the muscle activity is in that area. Thereafter a top-up treatment is done. Hyaluronic acid based products with different molecule size are used for treatment of different areas.
Examples of Hyaluronic acid based injection products are Juvederm, Restylane, Macrolane, Prevelle, Teosyal, Hylaform, Esthelis, Matrigel, Captique, Puragen and Rofilan.
Hydroxylapatite based filler products
Dermal fillers produced from Hydroxylapatite are the most powerful filler products and are used primarily to treat deep wrinkles/furrows in the face, skin unevenness or to reinforce facial contours (chin, cheek bones, and jaw line).
Hydroxylapatite is a mineral substance that exists naturally in our bones and in our teeth. The injection products are manufactured artificially and consist of 30% Hydroylapatit and 70% water based gel.
The most well known injection product based on Hydroxylapatite is Radiesse. The result of one of these injections lasts for 12-18 months which makes it the non-permanent filler with the longest lasting results.
Lactic acid based filler products
Lactic acid based cosmetic fillers are a relatively new injectable product which, unlike other products that plump the skin, works by stimulating the skin to plump itself. The most well known of these products is Sculptra.
Lactic acid fillers contain micro particles of Poly-L-Lactic acid which is injected under the skin where they stimulate collagen production which in turn leads to increased fullness. The result is reached gradually after 2-3 treatment periods with an interval of 4-6 weeks and lasts for up to 18 months.
The area of use for lactic acid based products is primarily filling wrinkles and creases on the face.
Permanent filler products
Permanent fillers have been developed with the aim of producing injectable implants which can achieve the same results as with other filler products but with a permanent effect. To achieve the permanent result one mixes collagen filler with different plastics that the body cannot break down.
Injecting permanent cosmetic fillers activates the body’s natural defence mechanism which is to encapsulate foreign materials (the microscopic plastic beads). The capsule of scar tissue which is created around the foreign material increases the tissue volume and becomes the actual “implant”.
This process involves a number of uncertainties. Firstly it is difficult to determine how much scar tissue the body will create around the foreign material which in turn makes it hard to assess the final degree of fullness. Secondly it is hard to assess how the implant will look once the body and skin ages. Thirdly any possible complications due to the implant growing into the body are very hard to treat.
The above facts cause many clinics and qualified plastic surgeons not to offer and advice against treatment with all types of fillers that contain plastic and other substances that the body cannot break down naturally.
Examples of permanent fillers are Artecoll, Dermaliv, Aquamid and Agriform.