• Fillers

    Fillers, also known as soft tissue fillers, injectable implants, dermal fillers, or wrinkle fillers are used to give fuller appearance or changing the shape of different parts of the face. Younger people often use fillers to augment their lips and cheeks while older people use them to remove wrinkles.

    The figure below shows parts of the face where fillers can be injected.



What are different types of fillers?

Fillers are usually made of tissue-friendly materials to avoid unwanted reactions in the body. Depending on their durability or decomposability, fillers are classified into three groups: temporary, semi-permanent, and permanent fillers. Temporary fillers are decomposed by enzymes in the body and have more transient effect compared to the other two types. While they have many advantages over semi-permanent and permanent fillers, their main drawback is costly frequent injections. The second type is gradually decomposed and has effects that remain for a longer time compared to the first type. And finally, permanent fillers contain durable indecomposable substances.

Temporary fillers initially introduced to the market were taken from animals. They are absorbed by the body once injected. In some cases, these fillers create allergy or topical complications. To overcome this problem, temporary fillers are currently produced in labs to reduce unwanted effects. Initial types of permanent fillers also resulted, in long term (several years), in a number of unnatural conditions in the form of abscess or concentration at unwanted parts of the face.

These fillers were later removed from the shelves. A major reason for greater demand for permanent fillers is their lower cost and longer effects. Although most permanent fillers have been approved by relevant health authorities, I advise you not to use this type of fillers as it cannot be guaranteed that unwanted effects will not appear over longer periods of 20 to 30 years.

For example, many years ago Teflon was used a safe filler in injections. However, it was banned later due to formation of granuloma and other undesirable effects.

Currently, hyaluronic acid is used as the most common and safest type of filler in the US and Europe. It naturally occurs in human tissues and will be decomposed within a few months from injection by hyaluronidase. To improve its durability, some manufacturers add some chemical bonds between the molecules of hyaluronic acid to lengthen its decomposition by enzymes in the body. Hyaluronic acid is injected at different concentrations into different parts of the face. For example, higher concentrations are used for the cheeks while lower concentrations are applied to the lips or used for fillers injected under the eyes. If used improperly, high concentrations may cause unevenness at injection points. High concentrations have longer effects, while lower concentrations are absorbed more quickly and their effects remain for a shorter period of time.

This may lead some people to ask for higher concentrations of hyaluronic acid to be injected into their lips or under their eyes. An advantage of hyaluronic acid is that it can be decomposed by the enzymes existing in the body. The enzymes can be injected to accelerate the removal of unwanted results.

Calcium hydroxylapatite and polylactic acid are two other forms of fillers. They are semi-permanent fillers that remain in the body for a longer time. The two fillers are the most commonly used semi-permanent fillers in the US and Europe. It should be noted, however, that semi-permanent fillers in general are less common than temporary ones. A difference from hyaluronic acid is that these semi-permanent fillers are injected deep into the face and are not appropriate for injections under eyes or into lips.

Collagen is another appropriate form of temporary fillers. Initial types, taken from animals, resulted in topical allergies. The problem was later solved to a large extent by new manufacturing techniques. Collagen is currently used for lips and areas around the eyes for its low concentration. However, it is not widely used, given the advantages of hyaluronic acid.

Body fat is another ingredient used in fillers. In this technique, fat is taken from different areas of the body using cannulae. It is then injected into the face. Fat injection is discussed in another part of our website.

Here are some common brands of fillers:

Juvederm, Restylane, Stylage, perlane, Radiance, Sculptra, CosmoDerm, Cosmoplast, Varioderm, Zyderm, Belotero