Had Your Fill?

Created on 22nd February 2012

Confused at all the different dermal fillers on the market? Not sure what the difference is between temporary, semi-permanent and permanent? Cosmetic Surgery & Aesthetics Magazine discuss all the different options on the market

Lines, wrinkles and loss of face volume are the biggest tell-tale signs of ageing and our faces give us away more than any other part of our bodies. The support structure of your skin is formed by natural proteins and our levels of these proteins decrease as we age.

Lifestyle factors such as smoking, alcohol consumption, sun exposure, pollution and our health all accelerate the ageing process and can lead to premature ageing. As we all strive to look younger or maintain our looks it is no surprise that the wrinkle-busting filler injections are now incredibly popular.

There are many different types of dermal fillers available in the UK which can be used to smooth out fine and deep wrinkles on the face as well as give you a more luscious pout or add definition to your chin or cheeks. Fillers have become one of the most talked about and popular options for those wanting to turn back the clock without option for surgery.

But which one do you choose? What is the difference between permanent, semi-permanent and temporary dermal fillers?

Permanent fillers
These are fillers that can give a longer lasting, or even permanent, effect and are often a better option for a more mature patient or in particular parts of the face.

Dr Alan Kingdon, Medical Director of Cosmetic Surgery Clinic, uses the filler Aquamid and he believes that Aquamid "is an excellent choice for clients that have previous experience with a biodegradable filler and want to reproduce a long lasting effect. Client satisfaction is extremely high and my clients are happy with the results years after having Aquamid. It is useful wherever you want to add volume such as the cheeks, reshaping the nose, the chin or filling out the naso-labial lines or glabella. It is also excellent for the lips."

Aquamid is a permanent filler which contains about 2-3 per cent of polyacrylamide gel and 97-98 per cent water. The cross-linked polyacrylamide forms a real gel, which does not contain any solid microparticles. This makes it soft and uniform. Being mostly water, the body accepts the gel readily and forms a thin membrane around the implant which helps to keep it in place; as the gel is very elastic it moves with all facial expressions.

Permanent fillers include ArteSense, Bio-Alcamid and Aquamid. They can last up to ten years or more.

Pros: Patients are often frustrated with the short-term nature of temporary fillers, with the need for frequent repeat injections with associated cost, discomfort and inconvenience, and permanent fillers can provide the answer. Particularly good if the patient is of a certain age.

Cons: There has been much negative press in the media about permanent products causing lumps or migrating but problems have often been down to poor practitioner technique. When undertaking any aesthetic procedure it pays to do research to find an experienced practitioner with a strong safety record.

Semi-permanent fillers
These are the fillers on the market which can last up to two years, reducing the need to have the follow-up treatments that temporary fillers need to maintain the results.

Radiesse is a temporary filler made using calcium hydroxylapatite. This has similar chemical and structural characteristics as bone and teeth and is compatible with the body. It is used most for the deep folds that run from the nose down towards the corners of the mouth and for depressions under the mouth. Radiesse has an excellent safety record, even compared to the more shorter-lived fillers.

Sculptra is an injectable filler material that adds volume to facial areas such as the cheeks, temples, the depressions under the eyes, and around the chin. Instead of plumping up the skin itself, Sculptra initiates an expansion of the body's own collagen. It usually requires at least two treatments and the results are not immediately apparent but the effects can last several years.

Pros: Lasts longer than temporary fillers.

Cons: Some semi-permanent fillers can cause allergic reactions so it is important that you research between the different products on the market. Some components of the filler can last for a much longer time in the body.

Temporary Fillers
Dr Patrick Bowler, Medical Director of the Court House Clinics and Fellow of the British Association of Cosmetic Doctors, only uses temporary fillers and his view is that "any problems with permanent fillers are serious and very long lasting so the vast majority of cosmetic practitioners use temporary agents. Even so they have the capacity to last one to two years so for most people this is perfectly acceptable and the risk of any significant side effects is very small."

Temporary fillers are usually made from collagen, which comes from either a bovine or porcine source, or are synthetically produced in a laboratory and are derived from hyaluronic acid.

Hyaluronic acid is a substance that exists naturally in the body and its most important function is to carry and bind water so the dermal fillers ‘plumps' the skin and temporarily removes wrinkles. Because hyaluronic acid is naturally present in human skin, it does not require a pre-treatment skin test. It usually lasts for approximately 12 months, although different people reabsorb the filler at different speed, and well-known hyaluronic acid fillers with lengthy safety records are Restylane and Juvéderm.

Collagen injections were developed in the USA in the 1970s and specially treated bovine and porcine protein is used which is similar to human collagen. Skin tests are carried out to test patient tolerance before the product is used. It usually lasts up to six months before a top-up is needed and collagen dermal fillers in the UK are Zyderm, Zyplast and Evolence.

Pros: Less likely to have a reaction, particularly to the hyaluronic acid fillers.

Cons: Will need to have repeat follow ups as they usually only last up to twelve months - and in some patients or in very mobile areas on the face such as the lips it can break down even faster - so there are cost implications.
CS&AM