Dermal fillers can be composed of a variety of substances, some naturally occurring and some synthetic. One of the most common compounds used in dermal fillers is hyaluronic acid (HA). HA is a naturally occurring substance found in our skin, and it plays a major role in keeping skin hydrated and volumized. HA fillers, depending on their specific chemical makeup, can last from six months to much longer before being gradually absorbed by the body.
One of the main benefits of HA fillers, aside from their natural appearance when injected, is that they can be dissolved by a special solution in case of an adverse event, or if the person dislikes the appearance. Also, most HA fillers are premixed with lidocaine, a numbing agent, to maximize comfort during treatment.
Other available dermal fillers include those made from calcium hydroxylapatite, poly-L-lactic acid, polymethyl methacrylate, and autologous fat (fat that is transplanted from another part of your body). Calcium hydroxylapatite is a mineral-like compound naturally found in human bones. It has been used in dentistry and reconstructive plastic surgery for years with a long track record of safety. Poly-L-lactic acid is a synthetic filler that helps to stimulate collagen production. This filler is different from other fillers because its results are gradual; volumization occurs over several months as it stimulates the body to produce collagen. Polymethyl methacrylate is a semi-permanent filler. While it is more durable compared to other more readily biodegradable fillers, it has potential complications such as forming lumps or being visible under the skin.
Each of these substances has its own pros and cons, as well as a unique density, longevity, and texture, which means a particular material may be more or less suited to a specific area of the face or desired result. Choosing the right type of dermal filler requires the guidance of an experienced, board-certified dermatologist or cosmetic surgeon with a thorough understanding of facial anatomy, and familiarity with the variety of available fillers and their respective injection techniques. A medical professional will thoroughly evaluate any specific areas of concern, understand what you hope to get out of the procedure, and review what to expect before, during, and after the treatment to ensure the best cosmetic outcome.
What types of dermal fillers are available?
There are several different types of dermal fillers. The most common types are:
Calcium hydroxylapatite
Calcium hydroxylapatite is found naturally in human bones and is a mineral-like compound. It’s often used to:
Moderate-to-severe creases such as nasolabial folds, marionette lines and frown lines
Enhance fullness of the cheeks and other facial contours
Improve volume in areas of facial wasting such as can occur in HIV-positive people taking certain medications
Calcium hydroxylapatite is biosynthetically produced, which means that no animals or animal products are used. This lowers your risk of an allergic reaction and no skin testing is required. This type of dermal filler is known to produce a very natural result, doesn’t migrate and side effects are rare. This dermal filler was first used in dentistry and reconstructive surgery and has a long safety record.
Hyaluronic acid
Hyaluronic acid injections can be used to improve the skin’s contour and reduce depressions in the skin due to scars, injury or lines.
Polyalkylimide
After the injection, a thin layer of collagen slowly forms around it over the course of about a month. The gel is eventually completely surrounded. A single procedure can inject large volumes. This product, which is thought to be quite stable over time, can even be removed if necessary.
Polylactic acid
Polylactic acid is a synthetic dermal filler that is injected into your face, causing your body’s own production of collagen. This type of dermal filler is known as a stimulator. This non-toxic, biodegradable substance has been used for more than 40 years as suture material.
You will likely need about three monthly treatments to achieve your desired results. With each treatment, there is re-stimulation of your own collagen. Then it can take four to six weeks to see the full effect. While this type of dermal filler is considered semi-permanent, you may still need occasional touch-ups.
Polymethyl-methacrylate microspheres (PMMA)
PMMA is considered a semi-permanent filler and is most often used to treat medium-to-deep wrinkles, folds and furrows, particularly nasolabial folds. It can also be used to fill out pitted scars and to augment thin lips.
One of the downsides of PMMA is that a number of cosmetic injections are needed to create volume and it can take up to three months to realize the full effects. It may also be visible under the skin. To avoid any unwanted results, it’s key that your plastic surgeon is familiar with the proper technique, which involves injection at the dermal subcutaneous junction using threading or tunneling methods.
