As we age, the collagen and elastin in our skin weakens and gets less bouncy, and the fluid surrounding and cushioning the strands dries up, resulting in the loss of volume in our skin. This can often make us appear older than our actual age. But if you’re concerned about the lack of volume in your face or even wrinkles, dermal fillers might be a good choice for you.
What is a Dermal Filler and How Do They Work?
A dermal filler is a gel injection used to soften folds, wrinkles, and creases on your face, mouth, and lips. Unlike the popular Botox® and Dysport®, dermal fillers are not neuromodulators, which means they will not affect nerves or muscles underneath your skin. Basically, the name says it all: They are injected under the skin to fill the space created by age-related lost volume.
The most popular dermal fillers are made of a hyaluronic acid (HA). This is the same molecule that is already inside our bodies, creating the cushioning and moisturizing environment for our collagen and elastin in the dermal layer of the skin. The injectable gel integrates into your dermal tissue to attract and bind surrounding water molecules for added volume. The consistencies and particle sizes of each differ among products and brands, making each one more or less suitable for certain uses.
What are the Different Types of Hyaluronic Acid Fillers?
Restylane® is a very versatile filler of medium thickness has a smaller particle size, making it an appropriate option for lip augmentation in patients over 21 years of age. Restylane can also be used easily in other areas of the face since it is not as dense or rigid as some of the other HA fillers.
Perlane® is made by the same company, and is their thicker product due to its larger particles, making it ideal for deeper folds and larger areas of volume loss. It is not FDA-approved for use in lip enhancement, though some doctors may use it there in some cases. Restylane-L and Perlane-L are the versions of these products that are pre-mixed with lidocaine topical anesthesia.
Juvéderm® Ultra products are made by a different company which also makes Juvéderm® Ultra Plus and Juvéderm® Voluma. Juvéderm® marketing claims differences from Restylane® and Perlane® in that its formula uses Hylacross™ technology to purportedly achieve a smoother consistency than Restylane®, though this difference hasn’t been clinically proven to be of any significance at present. This also implies that Juvéderm® absorbs more moisture, so it can be trickier to handle as it will swell more than Restylane®. This may be of benefit if it’s the desired effect.
Juvéderm® Ultra Plus and Juvéderm® Voluma also use the Hylacross™ technology, but with different purposes. Juvéderm® Ultra Plus is denser than regular Juvéderm®, so it is used for deeper wrinkles. Juvéderm® Voluma, however, is the first dermal HA filler to be FDA-approved to specifically replace lost volume in your cheeks. The Juvéderm® family of products comes pre-mixed with lidocaine in their “XC” line.
How are HA Fillers Administered? What are the Side Effects?
HA fillers are injected using a small needle, which might cause temporary discomfort. I prefer to use fillers that contain a local anesthetic to make the injection more comfortable, but that is up to you and your doctor. Pain can also be managed through pre-treatment administration of topical anesthetic or local nerve block injections.
It is important to see a board-certified cosmetic dermatologist for this procedure as inexperience with the depth of injections can cause issues. Injections that are too deep may cause unwanted injury to nerve and blood vessel structures, and too superficial might cause the Tyndall effect, which occurs when material is injected too superficially, allowing the clear gel to appear bluish through light refraction. This is especially a risk in the lower eyelid and tear trough area.
It may possible to feel lumps after injections and sometimes this is intended by the physician to create some structural lift, however there should be no visible lumps at all. Uncomfortable lumps should shrink within a few weeks after initial swelling, but your doctor can massage the lumps out if they are particularly bothersome or visibly apparent. I wouldn’t recommend doing this at home as too much massage can cause damage to nerves and blood vessels, which can result in bruising.
How Long Until I see Results? How Long Do They Last?
HA fillers show instant results that are evident usually after just one treatment, but your doctor may require a follow up in certain instances to allow swelling to subside so the effect can be completed with additional injections. Normal swelling can last a few days to a few weeks; in some instances, it might look like all of the filler has disappeared, but this is likely due to the disappearance of residual swelling. Depending on the situation, results should last about six to eighteen months as the filler naturally degrades. Dermal fillers are less invasive than plastic surgery, so there is no down time after treatment.
Bottom Line
Hyaluronic acid fillers are a great option for those looking to replace lost volume by plumping your wrinkles, folds, and sagging skin. The process is minimally invasive, and results are instant, lasting anywhere from six to eighteen months. Risks are low, but can include very rare instances of allergic reaction, and possible injection site problems that are more likely with an inexperienced injector. The type of filler used is entirely dependent upon the patient’s situation, so as always, see your local board-certified dermatologist to discuss what’s best for you.