Correct choice of filler is essential in providing a satisfying result for patients. Unfortunately, it is not always an easy task given that the skin ages by losing fatty tissue (hence volume) which causes sagginess, and by the loss of elastin and collagen in the dermal layers leading to finer lines and “crepe-paper” like skin. It is usually a combination of fillers that will give the best effect but, given that time and money are always limiting factors, how does a patient know which one to choose?
Well, the answer to this is that they choose the right doctor who can accurately describe the expected result of using a particular filler in that patient’s skin. This, of course, comes with training and experience. But to give the potential patient some insight, here are the types of fillers used with their advantages and disadvantages.
Temporary fillers generally last from 3 to 6 months, although the occasional patient has treatments lasting up to 12 months. They are made in different viscosities and can be used in all layers of the skin. The main types used in Australia are based upon sugar chain substances found in all skin types and are water loving. For this reason the more hydrated a patient skin the better the product works. They are the primary filler for the lip area and can produce some very beautiful results. The advantage of these fillers is that they are generally less expensive, can be repeated regularly and if the individual’s results are not pleasing they will wear off and an alternative treatment can be found.
Long-term fillers are designed to restore bulk to an area. They come in a variety of types from sugar chain molecules, to collagen stimulators and even calcium ions enclosed in gel where the gel dissolves over time to be replaced by a person’s own collagen. They last from 9 to 12 months initially and up to 24 months with ongoing use. They are designed to restore bulk. Consequently they do not treat fine lines and are not used in lips. Favoured areas are cheeks, naso-labial lines and marionettes. They are even able to restructure noses and chins. They are becoming rapidly more popular in my practice because the effects can be quite dramatic, together with the fact that they can be done at the time of consultation with minimal discomfort. The downside is that if you are unhappy with the effect it will be there for nearly 12 months before an alternative treatment can be performed. They are comparatively better value than temporary fillers when taking into account that at least 3 temporary filler treatments would be needed over the same time span. This makes them ideal for those who are needle haters. Unfortunately, they can’t be used in lips but instead can be placed around the lip to provide more bulk where the gums have receded, causing lips to concertina inwards.
Another long-term filler is fat. This is a natural alternative for filling where fat is removed from the patient’s own body and re-inserted into the desired areas. This removes the risk of filler allergy. The result is a rounder, more youthful contour to the area. It can also be combined with thread lifting to reduce sagging cheeks and jowls. Another advantage is that fat can be stored for future use. At least 2 treatments are needed and occasionally a third 6 months later. The results can last 3 to 5 years, and a lifetime for some lucky individuals.
Permanent fillers are controversial. Some believe that as the face changes the effect may alter with time resulting in an unsatisfactory outcome that cannot be corrected. Personally, I fear that permanent fillers may result in permanent problems, and consequently I do not use them. There are however, many doctors who find success with permanent fillers. One warning, if you seek permanent filling then once in, if it fails to meet your expectations, other fillers should not be placed over the top. Permanent fillers do not dissolve and thus if a problem occurs it might need to be cut out which leaves scarring.
Generally, the longer lasting the product the more risk the body will react to it. For this purpose, I recommend that patients select long-term products that last up to 18 months on average and are made from natural substances found in the body. After all, safety should always be a patient’s primary concern.