Filler injections are popular these days for their promise to make people look younger without plastic surgery.
With a simple needle injection, this non-invasive procedure can help minimize or eliminate mild to moderate wrinkles – with virtually no down-time. And some medical doctors claim that injections in the cheeks and temples can make a patient look 10 years younger.
But with so many fillers on the market these days, how should you go about choosing the right filler for you?
This article takes a look at several fillers that are currently being used, including what they do, how much they cost, how long they last and potential side effects and risks.
We’ve interviewed two top experts in their field: Justin West, a board-certified plastic surgeon and Medical Director of Finesse Plastic Surgery in Southern California; and Yuly Gorodisky, owner of the West Coast Plastic Surgery Center who is board-certified by the American Osteopathic Board of Surgery.
Let’s start by briefly discussing collagen injections, which were popular about a decade ago, but have since become a thing of the past. Later on we’ll explore popular fillers being used today.
Collagen Injections – A Thing of the Past
Collagen injections were popular about 10 years ago as one of the very first ways to smooth out wrinkles and enhance facial features, according to Dr. Gorodisky.
Around that time, a new filler was introduced in a gel form using a product called hyaluronic acid, which is found in the skin and other parts of the body.
“The longer lasting results, ease of use, and safety made this type of injection the filler of choice and put most collagen producers out of business,” Dr. Gorodisky said. “Today collagen is almost never used in the aesthetic industry.”
Dr. West agreed that collagen injections have come in and out of favor over the past decade. Around the time he was finishing his plastic surgery training in 2010, most of his mentors had stopped using collagen in favor of hyaluronic acid – HA – based products.
“One of the big issues was convenience,” Dr. West said. “Prior to using a collagen product, a skin test is required to demonstrate that the patient isn’t allergic. With the HAs, there is no testing required, so patients can get treated at their first visit instead of waiting one to four weeks to find out whether they are a safe candidate for collagen.”
Now that we’ve discussed how collagen injections have largely been replaced with other fillers, let’s talk about what today’s fillers are made of.
Materials Contained in Filler Injections
According to the Food and Drug Administration, most fillers have a temporary effect because they contain materials that are absorbed by the body over time.
The FDA noted the following absorbable materials used in fillers include:
Collagen: a type of protein that is a major part of skin and other tissues in the body. Sources of purified collagen used in soft tissue fillers can be from cow (bovine) or human cells. The effects of collagen fillers generally last for 3 to 4 months. They are the shortest lasting of injectable filler materials.
Hyaluronic Acid: a type of sugar (polysaccharide) that is present in body tissues, such as in skin and cartilage. It is able to combine with water and swell when in gel form, causing a smoothing and filling effect. Sources of hyaluronic acid used in dermal fillers can be from bacteria or rooster combs (avian). In some cases, hyaluronic acid used in dermal fillers is chemically modified to make it last longer in the body. The effects of this material last approximately 6 to 12 months.
Calcium hydroxylapatite: a type of mineral that is commonly found in human teeth and bones. For wrinkle filling in the face or for the hand, calcium hydroxylapatite particles are suspended in a gel-like solution and then injected into the wrinkle in the face or under the skin in the back of the hand. The effects of this material last approximately 18 months.
Poly-L-lactic acid (PLLA): a biodegradable, biocompatible man-made polymer. PLLA is a long-lasting filler material that is given in a series of injections over a period of several months. The effects of PLLA generally become increasingly apparent over time (over a period of several weeks) and its effects may last up to 2 years.
The FDA has approved only one product made from a material that remains in the body and is not absorbed:
Polymethylmethacrylate beads (PMMA microspheres): a non-biodegradable, biocompatible, man-made polymer. This material is used in other medical devices, such as bone cement and intraocular lenses. PMMA beads are tiny, round, smooth particles that are not absorbed by the body. When used as a soft tissue filler, PMMA beads are suspended in a gel-like solution that contains cow (bovine) collagen and injected into the face.
Now that we’ve taken a look at the materials contained in fillers, let’s talk about the fillers that are currently on the market and what they do.
How Current Filler Injections Can Off-Set the Appearance of Aging
One of the most defining features of aging is a loss of volume in the face.
“People don't usually think of fat as a good thing, but the fact is that a key difference between a young face and older face is fat,” Dr. West said. “As we age, the fat pockets that help define our faces wastes away. Fillers help to replace that volume.”
Wrinkles are another defining feature of an aging face.
“We see wrinkles beginning in the 30s and 40s as a result of loss of facial volume and a general degrading of skin quality,” Dr. West said.
Fillers generally add volume to the areas of injection, Dr. Gorodisky said. Some are designed to:
- Fill wrinkles
- Enhance bone structure
- Lift sagging skin
- Plump and smooth out hollow or thin features of the face
“As we age, our face goes through changes that include the loss of fat, bone mass, increased laxity of the skin and thinning of the skin which makes wrinkles and folds more apparent,” Dr. Gorodisky said. “The areas around the eyes get hollow, the cheeks get flatter, and the lips get thinner.”
There are different fillers that can help with these changes, he said.
“Some fillers are made for deeper injection to restore bone structure, some are injected to enhance the softness of the tissues, and some are placed very close to the skin to help smooth out fine lines,” Dr. Gorodisky explained.
One of the main features of an aging face is loss of volume – and that’s why fillers are so incredibly popular, Dr. West added.
“Patients walk in the office with wrinkles and contour issues that make them self-conscious – 15 minutes later they leave looking younger and feeling better about themselves,” Dr. West said. “In the right hands fillers are incredibly effective, which is why filler procedures are one of the top aesthetic procedures performed in the United States each year.”
Now, let’s discuss filler brands that are currently being sold in today’s anti-aging market.
Filler Injection Brands, Cost, Uses and How Long They Last
In Dr. Gorodisky’s practice, many fillers are available, and the filler of choice depends on the patient’s concern.
The following are fillers he injects and what they address:
- Deeper wrinkles: Juvederm Ultra, Ultra Plus, Vollure, Restylane and Radiesse
- Cheek volume: Voluma, Radiesse and Restylane Lyft
- Fine lines: Vollbella, Belotero and Restylane Silk
“Newer fillers, such as Restylane Refyne and Defyne, are also used around the mouth and lip areas,” Dr. Gorodisky said. Additionally, “Sculptra is a volumizer and can be used in the temples, cheeks, and anywhere the patient needs to increase softness and volumize the tissues.”
The longevity of the fillers can range from 3 to 6 months, or even 18 to 24 months depending on the type.
“Most last about 9 to 12 months and usually require touch-up treatments every 6 to 9 months to maintain the results,” Dr. Gorodisky said. “The cost ranges from $450 to $800 per syringe or vial of filler, and most patients who get more than one vial will get some savings on additional syringes.”
Dr. West’s practice also offers a wide range of fillers, including Juvederm injections, which range from $500 to 700 per syringe.
“Juvederm Ultra is a nice product to use in the lips both to add volume and improve definition,” Dr. West said. “Juvederm Ultra Plus is great for the nasolabial folds and marionette lines, which are the wrinkles people get in their 40s and 50s from the side of the nose down past the corners of the mouth.”
Two other fillers he uses to add volume to deeper areas in the face are Radiesse and Voluma. These fillers range from $600 to 800 per syringe.
“We use these to plump up the cheeks and to add volume back to patients who have developed hollow temples,” Dr. West said. “These are two of my favorite areas to inject because restoring volume there can make a patient look 10 years younger in less than 10 minutes.”
On the opposite end of the spectrum is Belotero, which Dr. West uses to minimize very fine lines around the eyes commonly referred to as crow’s feet.
“This filler costs between $500 and $650 per syringe and is often used together with Botox to bring life back to tired looking eyes,” Dr. West said.
Dr. West and Dr. Gorodisky receive requests for certain fillers over others, depending on the concern of the patient. The next section covers their most popular fillers and why.
Most Popular Filler Injections Used by Plastic Surgeons
In Dr. Gorodisky’s practice, the most popular fillers are:
- Juvederm to fill the wrinkles around the mouth and for enhancement of the lips.
- Voluma for lifting aging cheeks and creating a more youthful appearance of the face.
- Restylane to fill in the hollow groves under the eyelids.
- Sculptra for softening a gaunt facial appearance that happens as people age.
Dr. West said he personally doesn’t have many patients who request a particular filler by name.
“That only seems to happen right after a big advertising campaign by one of the manufacturers,” Dr. West noted.
“What we do see is trends based on age,” Dr. West said. “Our younger patients are more likely to come in asking about lip fillers and they will often bring pictures of someone famous whose lips they want.”
Middle-aged patients are usually concerned about their nasolabial folds, which are the lines from the side of nose to the corner of the mouth.
“With our older patients, the focus is volume loss,” Dr. West said. “They show us photos from when they were in their 20s to 30s, and say they want that youthful face back.”
In these cases, Dr. West will place the younger picture alongside a current photo to show the patient exactly there they have lost their fat volume.
“By adding a few syringes of Radiesse or Voluma to the cheeks and temple region, we can immediately set the clock back 5 to 10 years for many of our patients,” Dr. West said.
But before you purchase any filler, it’s important to be aware of the side effects, which we cover in the next section.
Side Effects and Risks of Filler Injections
In Dr. West’s office, the most common reactions are bruising and swelling.
“The vast majority of people look just fine immediately after getting fillers and could go right back to work after a treatment,” Dr. West said. “For patients who take blood thinners such as aspirin, it is possible to get minor bruising that lasts a week or two.”
Dr. Gorodisky agrees that the most common side effect of the treatment with fillers is bruising.
“Some patients bruise more than others, but this is always a temporary side effect,” Dr. Gorodisky said. “Some patients get some swelling in the area of injection, but it does not last too long in most patients.”
Another possible side effect may be lumps that are usually caused by filler clumping together due to excessive muscle contraction in the area, Dr. Gorodisky noted.
“More risky side effects, which are extremely rare, are due to infection in the area of injection and compression or occlusion of blood vessels due to injection of the filler into an artery,” Dr. Gorodisky explained. “This is usually avoided by careful technique, making sure the area is very clean, and there are no skin infections near the site of injection.”
While it’s important to be mindful of the potential riks of injectable fillers, it’s also crucial to know what to avoid, which we talk about in the next section.
Filler Injections – What to Avoid
1. Avoid Too Much Filler
The main thing to avoid is doing too much of any filler, according to Dr. West.
“It's better to make small changes over several office visits than to make a dramatic change in one session,” Dr. West advised.
“I always suggest patients try a syringe or two, then walk around and see how they feel about the changes for a week or two. If they like what they see, then that's all they need,” Dr. West noted. “If they like the improvement, but feel that they could use some more, it's easy to come back.”
Dr. Gorodisky agreed: “It is easy to add more filler, but it is more difficult to remove it, if too much has been used. Results will usually be seen after a few days, due to swelling that is seen right after the injection.”
2. Avoid Fillers Without FDA Approval
It’s also important to avoid using fillers that are not approved by the Food and Drug Administration, Dr. Gorodisky emphasized.
“Some illegitimate providers may inject non-medical grade products or fillers that are not indicated for the purpose they are used and can severely disfigure the patient and cause permanent damage,” Dr. Gorodisky warned.
3. Avoid Re-Used Syringes
Additionally, check which filler is being used and make sure you are getting a brand new syringe.
“A syringe should never be shared or used on more than one person,” Dr. Gorodisky said.
He added that patients should seek an injector with experience, and one who is comfortable treating the area that you are concerned with.
“Make sure the injector is prepared in an event of a complication with the knowledge and supplies to treat an occluded blood vessel or infection,” Dr. Gorodisky said.
4. Avoid Inexperienced Injectors
Dr. West recommends finding an injector with a great reputation for soft hands and a great aesthetic eye.
“You want someone who can minimize any discomfort and deliver natural results,” Dr. West said. “For your first treatment, ask about getting fillers in your cheeks. This simple treatment takes the years off faster than anything else I do.”
5. Avoid the Money Factor
While the money factor is important when you’re thinking about paying for injections, the cost should not be the most important aspect, Dr. West said.
“I wouldn't focus on bang for your buck when it comes to noninvasive or surgical procedures,” Dr. West said. “This is your face we are talking about. You only get one and you can't really hide it from the world if something goes wrong.”
The Bottom Line
In the aesthetic world, whether it is noninvasive procedures like fillers or surgical procedures like facelifts, the most important thing for patients is to be realistic about goals and expectations, Dr. West emphasized.
“In plastic surgery we use syringes and sutures, not magic wands,” Dr. West said. “While we have the ability to improve wrinkles and replace lost volume, we have limitations. We can't make a 60-year-old face look 20 again.”
A consultation with a plastic surgeon is necessary to make sure the fillers will meet the expectations of the prospective patient, Dr. Gorodisky advised.
“Some patients may not see the results they want because they may be a better candidate for a more invasive surgical treatment,” Dr. Gorodisky noted. “Also, risks and downtime – bruising and swelling – need to be considered when scheduling a filler treatment before an important event or a social function.”
Fillers are one of the best and easiest procedures available to make patients look younger and more rested, according to Dr. West.
“This is the ideal first step for people who have never had a cosmetic procedure, but are starting to see the effects of aging when they look in the mirror or see photos of themselves and wonder where their youth went,” Dr. West said.
When patients are getting fillers, they should first understand the goals of treatment and develop a plan for future treatments, Dr. Gorodisky advised.
“Expectations must be realistic: if it took 40 to 50 years to develop the signs of aging, it is unlikely they will be reversed with only one or two injections,” Dr. Gorodisky said. “It also may take multiple treatments to get the result that is most optimal.”
Since most fillers are not permanent, additional treatments will be needed to maintain the desired results, Dr. Gorodisky added.
“Since patients have different concerns and different amount of aging, the plan must be made for each individual to address their areas of concern.”
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