woman getting a facial filler injection

In the world of aesthetic medicine, facial fillers play a crucial role in enhancing and rejuvenating various facial features. However, different types of fillers work and act differently, each with its unique benefits and side effects. Choosing the right facial filler for each individual’s specific needs is essential for achieving the best results.

From hyaluronic acid fillers, which provide natural-looking results, to collagen stimulators that promote long-lasting effects, the range of facial fillers available offers diverse solutions for different aesthetic goals. In this article, we’ll delve deeper into the types of facial fillers and explain what sets them apart.

What Are Facial Fillers?

Facial fillers are non-surgical cosmetic treatments used to enhance and rejuvenate facial features. These injectable substances are typically composed of biocompatible materials, such as hyaluronic acid or calcium hydroxylapatite, that add volume, smooth wrinkles, and restore youthful contours. The procedure is commonly used to address various concerns, including nasolabial folds, marionette lines, and facial wrinkles, providing natural-looking results with minimal downtime. Since different types of facial fillers are available, each with unique characteristics, you can choose the most suitable option based on your patient’s specific needs and desired outcomes.

While the effects of fillers are temporary, they are still long-lasting, ranging from a couple of months to a couple of years, depending on the type of filler, the patient’s metabolism, lifestyle factors, and the exact area where they are used. It offers patients a way to achieve a refreshed and revitalized appearance without invasive surgery.

Types of Facial Fillers

As mentioned earlier, there are several types of fillers for the face. To be exact, there are five:

  • Hyaluronic acid (HA);
  • Calcium hydroxylapatite (CaHA);
  • Poly-l-lactic acid (PLLA);
  • Polymethyl-methacrylate microspheres (PMMA);
  • Polyalkylimide.

Before going into the details of each filler type, it’s essential to understand that each one has unique properties and benefits. Some may be more suitable for specific concerns or areas of the face, and knowing their differences can help you make informed decisions as a medical professional. Let us examine each type closely to fully comprehend its applications and distinctive characteristics.

Hyaluronic Acid (HA)

FDA-approved brands: Juvederm, Restylane, BELOTERO® BALANCE, Prevelle Silk, Captique, Hylaform Plus, and Perlane.

HA fillers are the most popular and widely used type of all of them, with Juvederm and Restylane being the most popular facial filler brands. They are derived from two main sources: animal sources and non-animal sources. Animal-derived HA is obtained from rooster combs and is used by only a handful of companies nowadays. At the same time, non-animal-derived HA has become an industry standard and is produced using a biofermentation process with gram-positive bacteria. Biofermentation has become popular since HA obtained from bacterial fermentation severely reduces the chance of an allergic reaction.

HA is a natural substance found in the human body, which makes HA fillers fully bio-compatible, meaning they’re well-tolerated by the human body and less likely to cause an adverse reaction. Once injected, HA fillers are gradually broken down by the body’s natural enzymes and processes, making them fully biodegradable, but at the same time, temporary. However, in cases where the patient is unsatisfied or for any other reason, the filler can be broken down with a hyaluronidase injection, accelerating its dissolution in the body.

It works by replenishing our body’s ever-diminishing supply of HA and attracting and retaining water molecules, which add volume and hydration to the treated areas. This process plumps up the skin, smooths wrinkles, and restores youthful contours. Additionally, HA stimulates collagen production, contributing to long-term skin rejuvenation. Depending on various factors, including the face filler brands you use, the treated area, and lifestyle factors, they can last anywhere from several months to two years.

HA fillers offer one distinct benefit compared to other fillers. They’re fully biocompatible and reversible. Biocompatibility reduces the risk of allergic reactions and makes them compatible with a broader range of patients. Additionally, their fully biodegradable nature ensures that they naturally dissolve over time, allowing for easier adjustments or reversals if necessary. These qualities make HA fillers a versatile and safe option for achieving natural-looking results in facial rejuvenation.

HA fillers have potential side effects like any medical procedure. These may include redness, swelling, bruising, or tenderness at the injection site. In rare cases, patients may experience allergic reactions or granulomas. Most other types of facial fillers have the same or similar side effects.

Calcium hydroxylapatite (CaHA)

FDA-approved brands: Radiesse

This type of facial filler is composed of calcium hydroxylapatite microspheres, which are tiny spheres made from calcium and phosphate. These microspheres are then suspended in an aqueous carboxymethylcellulose gel carrier for easy injection into the skin. The CaHA microspheres are created through a biosynthetic process that mimics the structure of natural calcium hydroxylapatite found in bones. These synthetic microspheres are biocompatible and biodegradable, allowing them to be safely used as a dermal filler.

Due to their biocompatibility, CaHA fillers have a low risk of causing allergic reactions or adverse side effects in most patients. Additionally, the filler’s biodegradable nature allows it to gradually break down, leaving no residue in the body. However, unlike HA, the process is longer, giving it substantial longevity compared to HA-type face fillers.

Once injected, CaHA fillers add immediate volume to the treated areas. The gel-like solution binds with the surrounding tissues, providing structural support and stimulating collagen production. These tiny microspheres act as a scaffold, further enhancing the filler’s volumizing effects and promoting long-term collagen production. This dual action helps improve skin elasticity and smooth out wrinkles and fine lines, leading to a more youthful appearance over a prolonged period. Compared to some other fillers, CaHA fillers can offer longer-lasting results, typically lasting between 1 and 2 years. The gradual biodegradation of CaHA particles allows the effects to be sustained over an extended period.

CaHA offers exclusive benefits that set it apart from other types of facial injections. First and foremost, it stands out for its ability to stay in place without migration, ensuring precision and long-lasting results. Moreover, CaHA’s remarkable capability for immediate volume restoration makes it particularly suitable for areas that require significant volume restoration. Additionally, what makes it truly exceptional is its three-dimensional approach, which enables a more natural and comprehensive facial rejuvenation that targets both soft and hard tissue at the same time.

While CaHA fillers are generally safe, some common side effects may include mild bruising, itching, discoloration, swelling, and redness at the injection site. These effects are typically temporary and subside within a few days.

Poly-l-lactic acid (PLLA)

FDA-approved brands: Sculptra

Among the different fillers for faces, this the best-known semi-permanent filler admired for its ability to address facial fat loss associated with anti-retroviral therapy-induced lipoatrophy in HIV patients. Sculptra is made from a biodegradable polymer, poly-L-lactic acid, from which it got its name.

When PLLA is injected into the subcutaneous tissue or deep dermis, an immediate but temporary augmentation occurs due to tissue edema and fluid from the product reconstitution. However, the real impact comes from the process that follows. The PLLA particles induce an inflammatory response through phagocytosis by tissue macrophages, leading to the breakdown of PLLA into lactic acid monomers. These monomers are metabolized, stimulating the production of new collagen fibers in the skin. This collagen growth provides gradual volume restoration and skin tightening over time, making PLLA a valuable choice for those seeking long-lasting results. The duration of PLLA fillers typically ranges from 12 to 24 months.

The most significant benefit of this type of face injection is that it has been FDA-approved for use on immunocompetent people, but be sure to check their medication before the procedure to avoid any unwanted side effects. It can furthermore improve various facial concerns through multiple sessions. PLLA fillers offer significant improvements for facial concerns, such as correcting nasolabial fold deficiencies, and facial wrinkles, and enhancing the cheeks, providing a natural and revitalized appearance. These benefits are achieved through a series of injections at recommended intervals.

While on the subject of side effects, the PLLA fillers come with common injection site reactions, including redness, swelling, bruising, and tenderness. However, these effects are usually mild and temporary and subside within a week. While rare, PLLA can trigger an allergic reaction and the formation of granulomas.

Polymethyl-methacrylate microspheres (PMMA)

FDA-approved brands: Bellafill

PMMA is a semi-permanent filler consisting of tiny, biocompatible microspheres suspended in a collagen-based gel. What makes it unique is that, unlike other semi-permanent fillers, this type of face filler isn’t fully biodegradable and leaves tiny microspheres inside the skin. The microspheres are composed of polymethyl-methacrylate, a synthetic polymer widely used in medical implants and other applications.

When injected, the collagen-based gel provides immediate volume enhancement, filling in wrinkles and folds to create a smoother appearance. Over time, the body gradually absorbs the gel, while the PMMA microspheres remain in place. The microspheres stimulate the body’s natural collagen production, leading to further volume restoration and continued skin texture and elasticity improvement.

Compared to other fillers like hyaluronic acid (HA) or calcium hydroxylapatite (CaHA), PMMA fillers are considered semi-permanent. Once the collagen gel is absorbed, the PMMA microspheres act as a framework, providing long-lasting support and volume to the treated areas. They often last for 2 to 5 years before the treatment needs to be repeated.

One of the distinct benefits of PMMA face filler types is their longevity. Due to the gradual stimulation of collagen production, the results can last for several years, making them an excellent choice for patients seeking long-term facial rejuvenation. The main disadvantage of this longevity is that microspheres can only be removed surgically if necessary.

However, we mustn’t dismiss the possibility of adverse reactions, as there is always the possibility of side effects. Fortunately, most side effects are mild and temporary, including acute injection site reactions like bruising, swelling, pain, redness, and tenderness. Additionally, rash formation, granulomas, and lumps are possible, though these occurrences are rare.

Polyalkylimide

FDA-approved brands: None

Unlike other semi-permanent types of facial fillers, polyalkylimide fillers are unique as they are the only permanent injectable fillers. They contain no biological tissue and are members of the acryl-derivative family, alkyl-imides, which do not have any free monomers. While there are no FDA-approved brands of this type on the market, Aquamid is well-known and used across the globe.

When injected into the skin, the polyalkylimide acts as a volumizer, providing immediate augmentation to the treated areas. It helps to restore lost facial volume, smooth out wrinkles, and reduce the appearance of other fine lines and folds, such as nasolabial folds, glabella lines, and chin folds.

Polyalkylimide fillers offer one crucial, distinct benefit compared to other facial filler types. They are a true permanent filler, meaning that they do not get fully absorbed by the body over time like most other fillers. Additionally, their volumizing effect is long-lasting, providing extended results that do not require frequent touch-ups.

Nothing comes without a price, and the same is true with polyalkylimide fillers. Common side effects are infection, inflammation, asymmetry, filler migration, the formation of granulomas, and fat necrosis. While rare, these adverse effects can happen, leading us to their biggest problem: They can only be removed by draining the area or by surgical removal of the implant.

What Are The Safest Facial Fillers?

While all the different fillers for the face are safe and offer different benefits, longevity is often a priority for patients. However, for medical professionals, the primary concern is the safety of the filler used. Although the majority of fillers have comparably mild side effects, it is crucial to be able to remove the filler safely in the event of a severe side effect. From this aspect, HA fillers stand out as the safest option as they can be entirely and quickly removed without surgery, making them the preferred choice in the medical community.

Conclusion

In the vast landscape of facial filler types, a multitude of options awaits, each with its distinct benefits catering to various aesthetic concerns. From the natural-looking results and biocompatibility of hyaluronic acid fillers to the longevity and permanent approach of polyalkylimide fillers, there is a solution for every individual’s unique needs.

However, navigating this landscape can be confusing for most people, and that’s where medical professionals play a crucial role. By carefully assessing patients’ goals and conditions, you’ll guide them toward the most suitable filler, ensuring satisfying and rejuvenating outcomes. With the proper medical guidance, patients can confidently embark on their journey toward a refreshed and revitalized appearance, feeling more confident and comfortable in their skin, and Medica Depot will be there to help you find whatever your patients require.

FAQ

What type of facial fillers are best?

Hyaluronic acid fillers are one of the best types of facial fillers due to their natural-looking results, biocompatibility, and ability to be easily adjusted or reversed if needed.

What is the most popular facial filler?

Restylane is still the most popular facial filler. It has been manufactured for over 25 years and is the first hyaluronic acid filler to be FDA-approved in the USA.

Which facial fillers last the longest?

Radiesse, Juvederm Voluma, and Sculptra offer long-lasting benefits if we focus on hyaluronic acid fillers. However, overall, Bellafill dermal filler surpasses them all, providing results lasting from 2 to 5 years with minimal touch-ups.

Sources:

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  3. Emerging permanent filler technologies: focus on Aquamid; Paul S Yamauchi; Oct 2014
  4. Calcium Hydroxylapatite; Jani Van Loghem, (MD), Yana Alexandrovna Yutskovskaya (MD and WM). Philip Werschler (MD); Jan 2015
  5. Poly-L-Lactic Acid; Christine K. Sickles, Ali Nassereddin, and Gary P. Gross; Jun 2022
  6. ArteFill® Permanent Injectable for Soft Tissue Augmentation: II. Indications and Applications; Gottfried Lemperle, Neil S. Sadick, Terry R. Knapp, and Stefan M. Lemperle; Sep 2009
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  8. Evaluation of injectable CaHA for the treatment of mid-face volume loss; Kenneth Beer, Monica Yohn, and Joel L Cohen; Apr 2008
  9. Long-term outcomes of surgically removed migrated polyalkylimide (bio-alcamid) filler to the periorbital area; Ziyad A. AlHarbi, Hind M. Alkatan, and Adel H. Alsuhaibania; Jul 2019
  10. Complications after treatment with polyalkylimide; Leonie W Schelke, Helga J van den Elzen, Marijke Canninga, and Martino H A Neumann; Oct 2009
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