Up until 2002, only one type of facial line and wrinkle filler was available - injectable collagen derived from cow proteins. While it lasted only a few months, due to its animal origins, it was the only treatment option available. Since 2002, six (6) new injectable fillers have been approved for use in the United States, all of which are made up of different (and better by the way) materials which last longer with fewer pot7ential skin problems. This has resulted in a great amount of confusion and misinformation for patients. (and some doctors as well) With the certainty that more new injectable fillers are on the way in the next few years, it is important for patients to have some basic understanding of the similarities and differences between the choices that they have.

Two basic types of injectable soft tissue fillers are currently available: hyaluronic acid (HA or hyaluron) and particulated (particle-containing) compositions. Just because they are injectable does not make the different fillers the same. Traditional collagen injectable fillers have been replaced by the longer-lasting HAs since 2002. Since they are synthetic 'knock-offs' of natural human hyaluronic acid, the patient does not need a skin test prior to injection and they last at least twice as long as collagen. The alleged differences between the four commercially-available HA injectates (Restylane, Hylaform, Captique, and JuvaDerm) is largely marketing-driven and no clinical studies has ever compared how long all of them last compared to each other. Hyaluronic acid fillers can be injected without fear of excessive lumpiness as they have the consistency of 'warm Jello'. JuvaDerm and Perlane are touted as lasting the longest currently and my observations is that it appears to be true. Newer more concentrated forms of HA are being developed that have the promise of greater longevity. The particulated fillers contain synthetic beads or particles (plastic or ceramic) in different liquid carriers. (Radiesse and ArteFill) Due to the non-resorption of the beads (which usually make up less than 25% of the solution), longer-lasting effects are seen than with the HAs. The beads that partially comprise the particulated fillers do not resorb, so theoretically over time, some permanent volume is acquired. The lips should not be injected with the particulated fillers due to the risk of lumpiness and foreign-body reactions. the common problem of deep nasolabial folds is an ideal location for the particulated injectable fillers.

Since no injectable filler is ideal for every patient or type of facial line or wrinkle, the best plastic surgeons usually work with two or three different ones to custom treat each facial problem. It would not be uncommon for me to use, for example Radiesse in the nasolabial folds and Juvaderm in the lips, in the same patient. Knowing the properties of each type of injectable filler allows them to be used to their best advantage.