The Filler Maze

Created on 16th March 2009

Dr Ross Perry, Medical Director of Cosmedics Skin Clinics, guides us through the confusing array of fillers that are on offer.

Cosmetic surgery and other cosmetic skin treatments in the UK have risen exponentially for men and women in the past ten years. In the USA since 1997 there has been a 754% increase in non-surgicalcosmetic treatments. Trends now are for less invasive procedures to eliminate or delay the need for corrective surgery.

The popularity of these treatments has been due to the fact that they are safe, create great results and are quick and convenient. The other major factor about these ‘feel good and look better’ treatments are that they are now becoming more publicly acceptable.

Injectable fillers, now commonly termed ‘fillers’,entered mainstream cosmetic edicine with the development of bovine collagen injections in the 1980s. The availability of improved fillers that are less allergenic and longer lasting has resulted in a renaissance in the number and type of fillers.

Fillers, or dermal fillers or facial fillers as they can be sometimes known, are now the second most popular cosmetic skin treatment after Botox with millions of injection treatments now performed worldwide.

The name is descriptive due to the fact that most of these products are an injection to ‘fill the skin’ resulting in the wrinkle or line being removed.

The problem with having a general term such as fillers is that you are really in the hands of the practitioners choosing the filler for you. If your doctor or practitioner is well qualified you would expect they would advise you on the correct one to achieve the result you want;however as some practitioners an be inexperienced or not very well qualified you could end up with problems such as Leslie Ash if the wrong filler is chosen.

Hence your first question as a patient should be; is the filler temporary, semi-permanent or permanent?

The end result you want to achieve has a huge impact on the type of filler you and the practitioner should be choosing and I will provide a quick glossary of each.

Temporary fillers

These last 6–12 months and are the most popular type of filler. These are mainly made from hyaluronic acid which is a natural substance already found in our skin. It works by simply replacing the lost skin volume and removes lines and wrinkles as well as enhancing lips.The most commonly used products Restylane and other types include Juvéderm, Teosyal or Hydrafill.

The real positive of this treatment is that temporary fillers are without a doubt the safest treatment in this category and that has to be a major consideration when choosing a product. They dissolve with time (up to a year) and the effect can then be readjusted as your face changes with time.

Products like Restylane can be safely used for enhancing facial lines and wrinkles as well as being very popular for lip enhancements. There are now over 50 different types in this category and choosing the type should be discussed carefully with your doctor.

Semi-permanent fillers

These can last up to a few years. These products are made from very different chemicals and create results in different ways.This is where the generalisation of the word filler starts to fall apart. The best known are Radiesse (calcium hydroxylapatite crystals), Sculptra (polylactic acid) and autologous fat (i.e. your own harvested fat from a different part of your body).They each last around the same length of time but work completely differently.

Radiesse is a true filler in that it fills the skin and is more popular in the USA than the UK. It has proven to be safe and relatively long lasting.It should only be used by experienced doctors as the injection technique needs to be very exact otherwise the results can be suboptimal and very difficult to correct. Ideal for longer lasting correction of nose to mouth lines but very operator dependent.

Sculptra is classed as a ‘filler’ out works differently in that it creates a colllagen stimulating effect that takes place over months. It requires multiple treatments 3–4 weeks apart and therefore does not have the instant filling effect of other fillers. It is ideal for sunken cheeks and patients who are over 40 where the skin in the cheek and jowl area is becoming thinner and laxer. It can occasionally have side effect known as granulomas (lumps in the skin) which can present up to six months after the initial injections.

Autologous fat is a natural filler as it is your own fat. It is taken from either your buttock or abdominal area and placed into areas of your face. It can be unreliable in terms of longevity as some can only last a few months while in other patients it can last for 1–2 years. It is more invasive and expensive and, even in the best doctors’ hands, can be a little unpredictable in the amount of correction that is achieved.

Permanent fillers

These last a lifetime. These are the type that caused Leslie Ash’s problems. In my opinion they should only be used as a last resort and for procedures here there is severe facial disfigurement and/or the need for reconstruction. Not for vanity.Products include Artefill formerly Artecoll (polymethylmethacrylate) an Silicon.

They are products that can only be removed surgically, if at all. They have a higher risk of causing granulomas, hypersensitivity reactions and chronic inflammation which require specialist medical treatment.

Rules and regulations

What regulation is there for fillers? There is in the European Union a CE mark that is applied to these filler products however this is not a guarantee of safety as the testing process for this category is not rigorous. A lightly better guide is the FDA approval in the US; Restylane, Radiesse and Sculptra are all approved as facial fillers with minimal side effects.

Ultimately it is a decision between you and your doctor, but one in which
you should have full knowledge and expectations of what the filler product is best for, how long it will last and above all else the safety profile. The person you choose should be an experienced doctor or nurse that has done many treatments before and is able to correct any problems should they occur.