This is a common question and the answer is simple, but with a few important caveats to consider.
- Silicone is used as an off label permanent soft tissue filler, as it is not FDA approved for such use. It was once commonly used, but due to problems it became less common. The problem was found to be a manufacturing issue as impurities were found that resulted in granuloma formation (inflammatory lumps) in the skin. This problem has since been resolved. This filler can be used to fill in fine lines on the face, to add some volume to the cheeks and lips or to help contour the jawline. It is very helpful in raising depressed scars and correcting facial atrophy due to HIV or some medical conditions. This treatment can be very rewarding, but there are several caveats.
- One must plan for the future. If you fill today, how will it look in 10 years when one may want a facelift or another procedure. This must be well thought out.
- A bad result is a permanent bad result as there is no simple way to get this product out of the skin. Of every filler, one must choose their surgeon wisely as there is no quick fix when things go wrong!
- Bellafill is a soft tissue filler that contains polymethylmethacrylate. What is that you ask? Those are Plexiglass beads. This filler can be used to fill in deep lines, such as the smile lines and acne scars. While it can be used in the lips, this should be done with caution. Reactions do occur to this product and can be helped using corticosteroid injections. Like silicone, a bad result is a permanent bad result as removing this product is not easy! One must plan for the future as is the case with silicone. It is rarely used due to these issues.
- Sculptra is not technically a filler, but is a biostimulator–it causes the body to make collagen. This is a good thing! This product is used to add volume to the cheeks and temples. It is not used to fill in fine lines. Results take about 6 weeks to start to appreciate and vary from person to person. More than one treatment session is often necessary, but results may last 2-3 years. Results are not reversible.
- Radiesse is a filler made of calcium hydroxyapatite. It is commonly used to add volume to the cheeks, temples, smile lines, hands, and marionette lines. This product stimulates collagen production, which makes the results last longer. This product should not be used in the lips or in areas with thin or mobile skin. Although results may last 12-18 months, the gel carrier that suspends the calcium hydroxyapatite goes away in 6 months. For that reason, touch-ups are often needed at that time. The results cannot be reversed, although are not permanent. Therefore, if one is unhappy with the results, they must wait for the result to go away on its own.
- Juvederm Voluma and Restylane Lyft are hyaluronic acid fillers that are commonly used to add volume to the mid cheek and temples and hands. It is not used for fine lines. Results can last anywhere from 6 months to 2 years. These products are safe, affordable for most, and is immediately reversible if necessary.
In summary, we have a few important considerations:
- Permanent fillers: Are great because they last forever, but can be awful in the case of a bad result. One must consider future needs and how the fillers will be affected by natural aging or future procedures, so one must plan ahead.
- Bio-stimulators are not really fillers, but have the body make their own collagen. Radiesse acts as both a filler and a bio-stimulator. Results last longer, but cannot be reversed if one is unhappy with their result.
- Hyaluronic acid fillers are not very expensive and results are often excellent. In the event of a result that one is not happy with, it can be reversed instantly by injecting an enzyme that dissolves the filler.
- Choose your surgeon carefully, especially with products that are permanent and even those that cannot be reversed.