Dermal Fillers Cheat Sheet

Dermal Filler Technology

The market is currently brimming with a wide variety of dermal filler types and brands. In contrast to botulinum toxin, dermal fillers are used to reduce the appearance of lines and wrinkles that are present at rest and to fill depressed scars and lip lines. Throughout the years, substances such as paraffin, silicone, and collagen, have been utilized as dermal fillers to treat soft-tissue imperfections. However, the use of these substances has since been terminated due to the high occurrence of adverse reactions and serious complications, including swelling, lymphadenopathy, granuloma formation, and ulceration.

Today, the following dermal filler technology is used:

•  NASHA Technology: NASHA is Galderma’s non-animal stabilized hyaluronic acid. It is used in Restylane        Refyne and Restylane Defyne.

•  Vycross Technology: Vycross is Allergan’s innovative combination of low and high molecular weight hyaluronic acid. It is used in Juvederm Voluma, Volbella, and Volift.

•  Hylacross Technology: Hylacross is found in Allergan’s earlier dermal filler range, and it utilizes crosslinking of high molecular weight hyaluronic acid.

•  Cohesive Polydensified Matrix Technology: This is a 2-step cross-linking process that creates a cohesive gel with zones of various densities. It is used in the Belotero dermal filler range.

What Is Hyaluronic Acid and Why Is It Popular In Dermal Fillers

The most popular dermal fillers are those made using Hyaluronic acid (HA). HA is a type of sugar molecule that is naturally found in the skin and connective tissues of the body. This naturally occurring polysaccharide works by cushioning and lubricating the skin, eyes, nerves, hair, and joints. In the cosmetic and medical industries, HA has a wide range of uses from correcting wrinkles to treating osteoarthritis. The most sought-after property of HA is its ability to bind significant amounts of water.

Sources of Hyaluronic Acid

Initially, HA was extracted from animal material. However, as the number of applications of HA increased, the demand for HA also increased, and this method of HA extraction was no longer feasible. Today, scientists are able to isolate HA from Streptococcus equi bacteria, specifically groups A and C. The work of F. Kendal in 1937 had great scientific and practical importance, as it is how the majority of HA isolation and extraction has taken place over the past 8 decades. In addition, HA production by cultivation of Streptococcus equi bacteria was described in a significant number of patents for clinical applications filed between 1985 and 2002.

Functions of Hyaluronic Acid

•  HA molecules hydrate the skin and create volume by binding to water.

•  HA lubricates the joints.

•  HA acts as a scaffold by binding other matrix molecules.

•  HA regulates several aspects of tissue repair, including enhancing immune response and epithelial  regeneration.

Particle Size and Concentration

The unique structural characteristics of HA has made it an ideal ingredient in various biomedical and cosmetic applications. The chemical and molecular composition of HA is the same throughout all living organisms, so HA is very unlikely to cause an allergic reaction in patients. HA with a smaller particle size is suitable for treating fine lines and wrinkles, while HA with a bigger particle size creates more volume and has a lifting effect.

Recommended Brands for Different Facial Folds

•  Nasolabial Folds: Prominent nasolabial folds are often treated with Restylane, Perlane, BELOTERO® BALANCE, and Juvederm Ultra using a linear pulling or pushing threading technique.

•  Marionette or Melomental Lines: Lines of the oral commissures can be treated with Belotero Plus Intense, Restylane, Perlane, and JUVÉDERM® ULTRA 4 using a linear pulling approach.

•  Crow’s Feet or Periocular Lines: Low viscosity fillers are suitable for these facial lines. Periocular lines can be treated with Juvederm, Radiesse, Restylane, Sculptra, and Belotero using a serial puncture technique.

Best-Selling Dermal Fillers

Juvederm

Juvederm is an FDA-approved dermal filler that contains cross-linked hyaluronic acid as an active ingredient. It is clinically proven to be safe and effective in improving glabellar lines, nasolabial folds, and lines and wrinkles in the forehead. Post-injection reactions include swelling, bruising, localized pain, redness, and lump formation. The benefits of this filler last approximately 3 to 6 months, and it costs around $550 to $1,200 in the United States.

Restylane

Restylane is an FDA-approved dermal filler containing non-animal derived hyaluronic acid (NASHA). It is mainly used for treating mild to moderate wrinkles, and the effects last for about 9 to 12 months. Common side effects include swelling, redness, bruising, transient pain, and lump formation. The cost for each injection ranges from $300 to $800.

Belotero

Belotero is a soft-tissue filler approved by the FDA for correcting moderate to severe wrinkles. The HA formulation in this filler is created using a two-step cross-linking process, resulting in a cohesive polydensified matrix gel. Post-injection reactions such as swelling, redness, bruising, and pain may occur. The effects of the filler will last around 3 to 6 months, and it costs about $100 to $400.

Sculptra

Sculptra is an FDA approved soft-tissue filler for treating HIV-associated lipodystrophy (fat loss). It contains PLLA microspheres that are around 40–63μm in size. The most common adverse reaction from this filler is injection site nodules. Redness, swelling, and bruising may also occur. When done correctly, the effects may last up to two years. Overall cost can range from $700 to $1,200.

Radiesse

Radiesse is a semi-permanent dermal filler that is FDA approved for fold and wrinkle correction, volume restoration, and cheek augmentation. It is also approved for improving the appearance of veins and tendons in the back of the hands. Patients may experience minimal side effects, such as redness, swelling, bruising, itching, and transient pain. The beneficial effects of this treatment may last up to 18 months, and the overall cost averages from $600 to $800.

Perlane

Perlane is a minimally invasive dermal filler that contains a thicker HA gel solution for treating deeper wrinkles and augmenting volume. Each vial costs around $500 to $900, and the effects last between 9 and 12 months. Patients may experience mild and transient side effects, such as swelling, redness, bruising, tenderness, and localized pain.