Types of fillers

Injectable fillers can enhance the appearance of facial skin, giving it a more youthful look for a fraction of what a traditional facelift can cost. Wrinkle fillers have a cosmetic purpose, filling hollows, lines and wrinkles, and are often done in less than 30 minutes.

Fillers are essentially ‘volumisers’ that plump and lift facial features – cheeks, chins, jawlines, temples, thin lips and even sagging skin around the hands.

Fillers are injected beneath the skin to make it fuller or plumper. The materials injected work to make the skin appear younger by shrinking wrinkles. The oldest and best-known cosmetic filler is collagen. There have been advancements over the years to introduce other types of natural and synthetic products that offer longer-lasting and even semi-permanent results (between 4 months to more than a year).

Any filler used comes with its own set of advantages and disadvantages, so it is best to ensure that you are well informed by your dermatologist, plastic (cosmetic) surgeon or otolaryngologist (physicians trained in the medical and surgical management and treatment of ear, nose and throat disorders - ENT, as well as related structures of the head and neck) before opting to have a filler treatment.

Cosmetic / injectable wrinkle fillers available include:

• Bovine Collagen Fillers: As the name suggests, bovine collagen is processed from the skin of cows. It has been widely used as a cosmetic filler for the effective treatment of wrinkles. These injected fillers are often less expensive than other treatments. It is possible to have adverse reactions to the injected material. Allergy skin testing is highly recommended before any treatments begin as at least two to four injections per year will be required to maintain results. Testing is usually done by injecting [milliletres:0.1] of Zyderm into the surface of the skin in the arm. The body also naturally breaks down the injected collagen and is another reason why numerous injections are required if you wish to maintain the results.
• Human Collagen Fillers: Since around 2002, cultures of human cells have been formulated to produce human collagen fillers, primarily for the treatment of wrinkles. Human collagen has been found to result in far less allergic reactions than bovine collagen and have a more natural looking result. For this reason, skin testing is not as essential. The downside is that it does tend to be a more expensive treatment than bovine collagen, and injections are required every three to six months.
• Porcine Collagen fillers: An alternative to bovine and human collagen is Evolence, which comes from pigs (pig tendons). It is more similar to human collagen than bovine. One benefit of this is that is does not require allergy testing. This filler is effective for the treatment of moderate-to-deep facial wrinkles and folds. Results are virtually immediate, with little or no downtime and can last up to six months.
• Hyaluronic Acid Fillers (Juvederm, Restylane, Perlane, Prevelle Silk, Elevess, Belotero): A natural part of the skin is hyaluronic acid (HA). As we age, the skin produces less of it. HA injections work to fill the space between the collagen and elastin fibres within the skin. These fibres normally replenish the skin’s natural volume, which is gradually lost with aging. There are various natural and synthetic product variations available where the HA molecule is modified to breakdown at a slower rate. This means that results can last for longer periods (up to nine months or longer with less tissue injury or inflammation). Some materials are thicker and can provide significant structure and volume, while others are thinner and able to flow more consistently. There have been very few allergic reactions to this type of injectable filler. These fillers are effective in filling shallow areas, such as the deeper folds around the nose, the fine lines above the lips and ‘marionette lines’ (creases that run downward from the corners of the mouth). HA injections also restore volume to cheeks, add definition to a slackening jawline, plump up thinning lips and fill hollows under the eyes or forehead lines. HA fillers pose no risk of infection and help to attract and bind water in the skin, which maintains fullness where it is injected. Repeated treatments are required to maintain results. Results do vary and it is possible that you may not be satisfied. HA fillers can be reversed with an injected enzyme, hyaluronidase.
• Fat Injection (Autologous) Fillers: These fillers offer us an opportunity to do what so many would (jokingly) wish for: taking fat from an unwanted part of the body and using it for positive effects elsewhere. Fat (in small amounts) is removed from problem areas such as thighs, stomach (belly) or buttocks, treated (fat purification) and then injected under the surface of the skin of the face. This means that two procedures are required with this treatment, but are done in one visit. The additional fat purification process done in the lab can be time-consuming and costlier. Results vary but this procedure can help to shrink the appearance of wrinkles by expanding the skin. As the fat is your own tissue, there are usually no adverse reactions and results can last for quite some time. Several injections may be required to maintain lasting results.
• Poly-L lactic Acid (Sculptra) Fillers: Poly-L lactic acid (PLLA) is a non-toxic, bio-degradable synthetic material that is injected under the skin to replace lost facial fat. PLLA stimulates skin cells to produce collagen and has been approved as a cosmetic treatment of certain skin conditions in people with HIV. Synthetic polymer material has also been used in dissolvable stitches and bone screws for many years.  PLLA doesn’t provide instant plumping and volume. It gradually stimulates the body to produce its own collagen instead. It is most effective in filling deep creases around the mouth and plumping up hollowed or sunken cheeks. It can also be effectively used to treat wrinkles with semi-permanent results (lasting a few months or years) as it promotes the body’s ability to produce collagen. Three to six injections sessions, approximately a month apart, may be required for results lasting up to two years.
• Calcium Hydroxylapatite (Radiesse) Fillers: This injectable filler is made of the materials that give bone its strength and texture. Minerals are ground into tiny particles and then suspended in a water or aqueous gel solution. This product is then injected beneath the surface of the skin to increase soft tissue and reduce even the most severe of wrinkles. Thicker than Hyaluronic Acid, this filler is most effective where volume is needed. Typical areas that can benefit from this treatment include a weak chin or jawline, sunken cheeks, and the filling of deep wrinkles. Results have been found to work significantly better than collagen injections and last for a longer period of time. This filler is a collagen stimulator which improves the surface texture of the skin, enabling the effects of the product to last longer.
• Polymethyl Methacrylate (PMMA) Fillers: This semi-permanent cosmetic filler was first used by medical professionals as a ‘cement’ during bone surgery. Unlike more biological materials, PMMA does not readily break down, thus producing a semi-permanent result. PMMA microspheres are tiny round, smooth plastic particles that aren’t absorbed by the body, Natural sources of these beads or microspheres are used to add volume. Synthetic microspheres made from 80% cow’s collagen and 20% PMMA microspheres (marketed as Bellafill) are used to improve the skin folds around the nose and lips.

Alternative injectable options to improve the appearance of wrinkles are:

• Botulinum toxin (Botox Cosmetic, Xeomin and Dysport): Botulinum toxin A is not an actual wrinkle filler as such, but does improve the underlying cause of lines and wrinkles by relaxing the muscle beneath. It has been successfully used to improve eyebrow furrows, crow’s feet and forehead creases. The toxin is injected into the facial muscles to immobilise the underlying causes of wrinkles and facial creases, but does not actually fill them.
• Platelet-rich plasma injections: This is another type of autologous filler or volumiser, often referred to as the ‘vampire facelift’. Blood is drawn from the arm, treated to form platelet rich plasma (PRP) and then injected into the face. Results can last for between 12 and 18 months.