revolutionized the injectables market when it was FDA approved in 2004. Since
then, the options of hyaluronic acid fillers have grown substantially, and also
some have left the market. Restylane had the market cornered until the
introduction of Juvederm
in 2006. In the year 2007,
Perlane was finally approved,
which is essentially the same as Restylane, although it’s higher density makes
it more appropriate for deeper wrinkles and creases, as well as restoring volume
to the mid-face and cheeks.
Filler Juvederm Filler
Images courtesy of Allergan, Inc.
Acid is capable of holding 1,000 times its weight in water, naturally occurring
hyaluronic acid is responsible for binding moisture in the skin. It does
this by filling in the space between collagen and elastin fibers in the skin –
which hence will hold in moisture and maintain skin’s volume.
Naturally occurring hyaluronic acid in
the skin decreases over time due to aging, sun exposure and other environmental
factors. When hyaluronic acid is injected under the epidermis, it temporarily
replenishes the skin’s volume by replacing deteriorated support layers of the
The longevity of a hyaluronic acid filler
is determined by the amount of cross-linking of the gel molecules. The more
solidly (or cross-linked) a hyaluronic acid product is the longer it will last.
The absolute amount of hyaluronic acid in a syringe does not translate into more
of the product remaining in an injected area. Only the actual cross-linked
amount of hyaluronic acid in the syringe will actually remain in the body. The
non-cross-linked product will be dissolved in a few days.
Concentration: The higher the hyaluronic acid concentration, the larger the needle and
greater the force required to inject.
Particle size: Larger particles can last longer. Larger particles can create a firmer result
so are usually reserved for deeper dermal use. Smaller particles are reserved
for more superficial indications, and may dissipate earlier.
The fillers that are available to us
today have the ability to plump up fine lines and wrinkles on the spot with immediate improvement. Some can also offer us longer
staying power as well.
As many patients or
consumers are realizing,
many times the areas of concern are better addressed by volume restoration
versus pulling the skin and muscles tighter as in a face lift. Volume loss
under the eye area (tear trough) is a common concern for both men
and women, and injection with a hyaluronic acid filler seems to correct the
problem better than actually surgery sometimes.
can restore volume loss
under the eyes. Although, this area remains an area with controversy with
whether or not a filler should be applied there, this simple and almost painless
procedure can make a huge difference. The tear trough or hollowing under the
eyes, sometimes extending onto the cheek, is created by fat loss
or sagging of the surrounding tissue.
This hollow alone can create a
shadowing effect that leads to dark circles under the eyes. The dark
circles can also be caused by many superficial vessels in this area. The
dark circles are best improved when caused by shadowing but can also alleviate
those cause by superficial vessels. The "Tyndall Effect" comes
about when hyaluronic acids (such as
are placed too superficially - or close to the skin surface. The deeper
these fillers are placed the less likely for the Tyndal Effect (bluish tint) to
As with all
fillers today, many are concerned about what is going to happen to my face if I
stop getting the injections. Most plastic surgeons and dermatologists agree that
there is some evidence that the hyaluronic acid fillers and also other types can
actually increase your own collagen to some degree, which may give
a longer duration of wrinkle softening.
If a lump
should occur with any of the hyaluronic acid fillers, such as Restylane, Perlane,
Juvederm, etc. an injection of Hyaluronidsase or commonly called
(off label use of Hyaluronidsase) can dissolve lumps or granulomas that might
This treatment although it is used off label and not FDA approved for
this application, is very well documented and widely used when needed.
Varying hydration levels of the
hyaluronic acid fillers have an impact on their performance overall. Where
Hylaform Plus and
Captique have concentrations, of 5.5 mg hyaluronic acid,
Restylane has 20 mg of hyaluronic acid, and
Juvéderm has 24 mg of hyaluronic
acid cross-linked per ml of water. The newly named "Hydrelle" or (Elevess)
contains the highest amount of hyaluronic acid - at 28 mg.
It is these properties make them extremely
hydrophilic, which results in more swelling upon injection of the product, as
tissue fluids get absorbed by the higher concentration product.
How long does
Depending on where these fillers are
injected, the longevity of the filler can range from 3 - 9 months.
How is it injected:
These fillers are injected after
you receive a topical or local anesthetic to minimize any discomfort you might
have. Either a topical anesthetic cream may be applied or a local anesthetic
agent may be injected to numb the region. If you decide to get a dental/nerve
block (local anesthetic), there is more swelling after the procedure; however
this will wear off within two hours.
during injection:Nerve blocks deaden the area and prevent
the pain associated with this procedure.