Permanent vs. Hyaluronic Acid Fillers

There has been an explosion in the field of dermal fillers” over the last 10 years. Up to the last decade, there had been mere flirtations with the idea of injecting substances into the face to improve appearance. The first attempt was with liquid silicone in the 1970’s and 80’s. This was an absolute disaster. It caused tremendous scarring, and was far too unpredictable to use in a safe fashion. Next, the concept of injectable collagen was introduced. The original prototypes for this had very poor results, and ultimately, it was abandoned.

In the late 1990’s, a number of pharmaceutical companies began to heavily research the field of dermal fillers. This lead to the development of injectable hyaluronic acid. Hyaluronic acid is a substance found naturally in skin and connective tissue. It is safe to both produce and to inject. This was the true breakthrough in injectable dermal fillers. Now, you had a substance that was safe to inject that produced consistent results!

Today, there are a number of knockoffs, but the two primary hyaluronic acid fillers are Restylane, Juvederm, Versa, and Belotero. Restylane is made by Galderma Aesthetics, Juvederm is made by Allergan, Versa is made by Prollenium, and Belotero is made by Merz Aesthetics. Let’s look at the benefits of each

• Restylane-L
  
  1. The most common dermal filler injected in the world. It has the longest and safest track record of any dermal filler on earth.
  2. Each syringe comes with 1cc of hyaluronic acid gel.
  3. Results are absolutely immediate.
  4. There is no recovery period.
  5. Depending on who does the injection, bruising is minimal. Typically, my injections cause little to no bruising.
  6. Results last 7-11 months, on average
  7. Over time, there is a cumulative effect in my opinion.

• Juvederm XC Ultra
  
  1. Currently, it is the most common filler injected in the United States.
  2. Each syringe comes with 1cc of hyaluronic acid gel, but is the same cost as Restylane
  3. Results are absolutely immediate.
  4. There is no recovery period.
  5. Depending on who does the injection, bruising is minimal. Typically, my injections cause little to no bruising.
  6. Results last 7-11 months, on average.
  7. Over time, there is a cumulative effect in my opinion.

• Revanesse Versa
  
  1. Currently, it is the fastest growing filler platform in the United States.
  2. Each syringe comes with 1.2cc of hyaluronic acid gel, but is the same cost as Restylane
  3. Results are absolutely immediate.
  4. There is no recovery period.
  5. Depending on who does the injection, bruising is minimal. Typically, my injections cause little to no bruising.
  6. Results last 7-11 months, on average.
  7. Over time, there is a cumulative effect in my opinion.

• Belotero Balance
  
  1. Second fastest growing hyaluronic acid on the market.
  2. Each syringe contains 1cc of hyaluronic acid.
  3. Results are absolutely immediate
  4. No recovery period
  5. This filler erases fine lines and wrinkles only. No significant subcutaneous volume, but fine lines and wrinkles disappear.
  6. This is the filler we use when people want their lip lines gone, but they don’t want to change their lips!

Restylane, Juvederm, and Versa are not a permanent filler. Neither is Radiesse, or Belotero. This may seem like a bad thing, but believe me, it is not. Consider for a moment what happens over time if you inject something permanent into an aging face. It will look great for anywhere from 2-5 years. However, as you age, all of the skin around the permanent filler will lengthen, while the permanent filler remains static. THIS WILL LOOK HORRIBLE. Don’t believe me?

Picture #1 is Joan in her late 50’s. At this point, she had a fantastic surgical facelift, as well as upper and lower blepharoplasty. She looks terrific. In picture #2, she has had a redo facelift with outstanding results. She looks young, vibrant, and overall very natural. As well, she has retained her facial animation. She looks great!! This is what I would consider an appropriate result following facelift surgery. Her neck contour is excellent. She has nice vibrancy to her skin, and her face shows charactery and beauty.

Now look at picture #3. Her face has lost significant amounts of its normal contour. Her cheekbones (zygomas) have become so prominent with a permanent filler that it makes her cheeks look sunken. Why did this happen? Because she got a permanent filler, and her skin elongated around it as she continued her normal aging process.

Now for the final picture, #4. The damage is irrevocable. Here, you see the angled depression in both cheeks now throws a HUGE shadow!! Her face has no wrinkles, but it also has no normalcy of structure either. She looks wrinkle-free artificial instead of youthful and natural. Once you get a permanent filler, if you have a problem, your have only two options after it starts to look bad:

• Get more of the same filler. This will offset the problem temporarily, but ultimately, you end up looking worse than you did to begin with. Essentially, you end up fighting the fire while feeding the flame.

• Get a salvage facelift. Not all plastic surgeons will undertake these. I have done a number of them, but the complication rate is exceedingly high, and the patient has to understand this. Not only do you have to do the salvage facelift, you have to remove all of this concrete filler from the face.

So what's the take home message?

• Temporary dermal fillers (Restylane, Juvederm, Radiesse, Belotero) are fantastic adjuncts for facial rejuvenation.
• Temporary dermal fillers do not accelerate the aging process.
• Temporary dermal fillers are safe in the short term and long term.
• Permanent dermal fillers will look good for 2-5 years.
• After 2-5 years, permanent fillers may WORSEN the look of aging. The face will age, while the filler will not.