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    Different Fillers, Different Missions

    The use of injectable fillers into the face has become accepted practice by cosmetic dermatologists, cosmetic plastic surgeons, and facial cosmetic surgeons.

    The names of the products are well-emblazoned in the vocabulary of most Americans. Recently, there has been an addition of some newer products to the list of FDA-approved fillers. Radiesse dermal filler is a unique product; it contains tiny calcium microspheres that are suspended in a gel. When the combination is injected just underneath the skin surface, it stimulates the body to produce its own natural collagen and it is the building of that additional collagen which helps plump and fill the depressions particularly around the mouth and chin.

    Another product that has received attention recently is Sculptra. This is a synthetic material that originally was used to treat the aggressive facial fat loss in HIV patients. It showed its stuff and has been approved for use to fill the face for cosmetic purposes. It is particularly helpful for those patients who are seeing a shrinkage of the tissue of the cheeks and particularly those who have lost large amounts of weight. It can also be used to plump up the tissue over the cheekbones simulating larger cheekbones. It has worked nicely in the nasolabial crease, the parenthesis-like depressions that demarcate the upper lip from the cheek. It has had a ten-year run in Europe and the doctors there are still very happy with the results.

    Juvederm and Restylane are well known and have proven their value. These are both made from hyaluronic acid, a naturally occurring sugar-like substance. It typically lasts four to six months. A thicker version of Restylane is known as Perlane – often a favorite for plumping the lips.

    Evolence is a collagen product which has shown some promise and is just now reaching the market place. Speaking of collagen, the forerunner of all today’s fillers was bovine collagen made from cow skin. It has been supplanted by the other products because it required testing to make sure that one was not allergic to this other-species product. But collagen had a long and successful track record and opened the door to the newer products.

    I would suspect, since science never sleeps, there will be newer, more long-lasting products coming through the pipeline. Pardon the pun, but this stuff is here to stay.

    - Robert Kotler, MD, FACS

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