20th October 2021

The Ultimate Guide to Dermal Fillers: Everything You Need to Know About Fillers

Dermal fillers, also known as facial fillers, soft tissues fillers or injectable wrinkle fillers, are highly praised for their ability to make someone look rejuvenated, more rested and younger. But exactly what are they?

Dermal fillers are gel-like substances that are injected underneath the skin to add volume and reduce the appearance of wrinkles. These shouldn’t be confused with other injectables like Botox or Azzulure, which paralyzes facial muscles to minimize wrinkle formation. 

Some benefits of using dermal filler include:

  • Smooth out lines around nose and mouth 
  • Enhance and restore volume to sunken cheeks or temples 
  • Plump and enhance the lips
  • Smooth out nose bumps
  • Define the jawline
  • Augment a small or receding chin
  • Improve facial symmetry

Once people have the definition of fillers figured out, the next question is: Are Dermal Fillers Safe? I can’t count how many times I have heard this question. That’s why I wrote an entire post tackling this very legitimate concern. You can read it here.

The Most Common Types of Dermal Fillers

There are many types of dermal fillers currently used for non-surgical cosmetic treatments. In general, these fillers are categorized by the substance they are made from. The list below features injectable fillers that have received FDA approval.

Hyaluronic Acid (HA) Fillers

Hyaluronic acid (HA) is a naturally occurring sugar found in the body with the highest concentrations in the skin, joints and eye sockets. Just a single gram of hyaluronic acid has the impressive ability to hold up to six litres of water!

Combine this with the innate ability to regulate that moisture within the cells and you have skin that's hydrated, plump and healthy. 

However, just like collagen and elastin, the amount of naturally occurring hyaluronic acid in our bodies gets depleted with age. As a result, the skin loses volume and wrinkles are more likely to appear.  

To counter this, scientists developed plant-based hyaluronic acid that can be injected directly into the skin. The HA then acts like a sponge to attract water into the skin cells and plumps up the area in which it was injected. 

In addition to producing instant smoothing results, research shows that HA injections can also boost the skin's own production of collagen.

Hyaluronic acid is gradually broken down by the body's own mechanism and disappears without any residue. This means the results are temporary are you’ll need a follow-up treatment down the road. The average time is 6 months to 2 years depending on the specific filler used.

dermal filler nasolabial fold laugh line ijection

Juvéderm 

This is the world's number-one selling brand of dermal fillers. Since its first formula received FDA approval for the treatment of facial wrinkles in 2006, Juvéderm has expanded to include more specialized formulas to address particular areas of the face. 

The current Juvéderm injectable fillers are scientifically proven to reduce fine lines and wrinkles, restore facial symmetry, and plump up areas suffering from age-related volume loss. 

Juvéderm Volbella XC and Juvéderm Ultra XC – Used for lip augmentation and correction of perioral lines, often called "lipstick lines".

Juvéderm Vollure XC and Juvéderm XC – Formulated to tackle moderate to severe lines facial wrinkles and folds, such as nasolabial folds. 

Juvéderm Voluma XC – Targets midface volume loss and adds a subtle lift to the cheek area. This helps correct a hollow appearance and fill in fine lines and wrinkles.

The results typically last for six to 18 months, depending on the product and the injection location.

*As with any cosmetic treatment, results will vary.

Juvéderm injectable fillers

Restylane

Restylane received its first FDA approval in 2003, three years before Juvéderm. Currently, it's the second most popular dermal filler brand in the market. Similar to Juvéderm, Restylane also offers a portfolio of dermal fillers that are designed to help restore, enhance and refresh your skin.

Restylane – Smoothes away wrinkles and folds and can also be used to add volume to thin lips.

Restylane Lyft – Used to correct severe wrinkles and folds like the nasolabial folds, as well as volume loss in the cheeks. It's also FDA approved to add fullness to the backs of ageing hands.

Restylane Silk and Restylane Kysse – Explicitly designed to provide a subtle enhancement to the lips.

Belotero Balance

Belotero Balance is another popular hyaluronic acid filler brand. However, it is formulated and structured differently from the previous two. While it can be used to treat deep wrinkles, Belotero is primarily designed to treat exceptionally superficial fine lines, creases, and wrinkles. It's also a fairly new HA filler, having received FDA approval in 2011

Calcium Hydroxylapatite (CaHA) Fillers

Calcium hydroxylapatite is a type of mineral naturally found in human teeth and bones. Calcium Hydroxylapatite fillers help stimulate the skin's natural collagen production. The CaHA used in fillers is biosynthetically produced with no animal products used. 

This process greatly lowers the risk of side effects or allergic reactions. This dermal filler was first used in dentistry and reconstructive surgery and has a long safety record.

Its consistency is thicker than hyaluronic acid fillers, meaning calcium hydroxylapatite fillers will last longer than hyaluronic acid fillers. The anti-ageing effects of injectable CaHA typically last about 12-18 months vs 6-9 months for HA fillers. 

However, a downside to note— CaHA fillers cannot be dissolved if a patient does not like the results or there's a complication.

Radiesse

Radiesse fillers are made from microscopic calcium Hydroxylapatite particles suspended in an aqueous gel carrier. Collagen is the main structural protein in our skin. It helps the skin feel and look tight, taught, and youthful. However, as we age, the production of collagen slows down, causing the skin to sag or form wrinkles. Radiesse slows down these signs of ageing by replenishing lost volume while also stimulating collagen production in the skin tissues for more long-term improvement.

It's often used to:

  • Smooth moderate-to-severe facial 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 patients
Radiesse fillers

Poly-L-lactic acid (PLLA) Fillers

Poly-L-lactic acid (PLLA) is a biocompatible (meaning it is safe to use in the body) synthetic compound that was initially used for many years in medical devices, such as dissolvable stitches.

For non-surgical cosmetic procedures, a PLLA filler is injected into the skin to stimulate the body to produce new collagen gradually. 

The collagen will consequently smoothen lines and replenish facial volume. Unlike hyaluronic acid, whose results are immediate, poly-L-lactic acid takes several treatments, about four to six weeks apart, for results to become evident. The exact number of treatments is dependent on the extent of facial volume loss.

Also, unlike calcium hydroxylapatite fillers, the PPLA filler dissolves completely within a few days after treatment. 

Sculptra Aesthetic

Sculptra initially was used in patients with human immunodeficiency virus (HIV) who had extensive loss of facial fat. Now it's approved for non -surgical cosmetic treatments to build up cheeks, fill in hollows or sunken areas of the face, and increase skin thickness to diminish the appearance of folds and lines. Sculptra shouldn't be injected into the lips or used around the eyes.

Sculptra Aesthetic

Making Filler Injections Less Painful: Lidocaine

One of the most significant developments in non-surgical cosmetic treatments was the introduction of lidocaine mixed in with the dermal filler. Lidocaine is a local anaesthetic that is used to numb the treatment area to help reduce pain or discomfort caused by needle punctures.

Prior to this advancement, none of the dermal fillers had a numbing component. Instead, many facial filler injectors numbed the treatment area with ice or a topical numbing agent. Also, because lidocaine is a vasodilator, there were some initial concerns about bruising. However, this proved to e a minor concern this any bruising that occurs, dissipates within a few days after the treatment.

Now, most dermal fillers have lidocaine added during manufacturing. This enables facial filler products like Restylane and Juvederm to have a uniform consistency of numbing medicine throughout the entire filler. 

During facial filler injections with lidocaine, most patients feel that initial pinch; then, subsequent injections are less painful as the lidocaine takes effect.

Nevertheless, some practitioners still topical numbing medicine in addition to using the fillers with lidocaine to minimise discomfort even further. This is an option we offer at Dr Aesthetica for all our dermal filler patients

Another Dermal Filler Classification: G Prime

Another way fillers can be categorised based on their G prime. This refers to the general density or thickness of a filler. It describes how the filler is able to retain its shape when a force is applied.

  • A high G Prime – indicates a thicker and firmer filler that maintains its shape better. Examples include Juvéderm Voluma XC and Restylane Lyft, which are used in areas that need more structure (like the cheekbones and jaw). These also tend to be longer-lasting fillers. Patients can often see the anti-ageing effects of their injections for up to two years.
  • A low G Prime –- indicates a softer and more 'liquid' filler that spreads easily through the skin tissues. Examples include Belotero Balance and Restylane Silk which are used for very subtle enhancements that don't affect the structure or contour of the face. 

Injecting a high G prime filler like calcium hydroxylapatite into lips or under the eyes can cause lumpy nodules that cannot be dissolved. On the other hand, using a low G prime filler for lifting the chin or cheeks is a waste of the client's time and money as it will do nothing to achieve their desired cosmetic result.

An experienced injector will know the right volume and type of filler to use to achieve optimal results in every scenario.

Which Filler Should You Get?

As you can see, there are many different dermal filler products on the market. Each filler is designed to have a different texture, density, and injection depth. Certain fillers work better for certain areas than others. 

The best dermal filler for you will depend on your specific preferences and aesthetic needs, as well as your medical history. Your provider will determine which filler is best for you.

On that note, it can't be stressed enough how important it is to receive your dermal filler injections from a trained and experienced dermatologist or aesthetics doctor. In the UK, dermal filler treatments are not regulated injections, so you have to be extra careful when choosing an injector. And always stay away from illegal and extremely dangerous do-it-yourself (DIY) filler injectables.

Contact Us:

To schedule a consultation with our qualified cosmetic practioner, don't hesitate to get in touch with us today.

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