Thursday, October 21, 2021

Types, Cost, Uses, Side Effects and More

  • Hyaluronic acid fillers can treat lines and wrinkles, and provide a plump, youthful appearance
  • Results are temporary, typically lasting up to 18 months depending on the treatment area
  • These fillers are considered safe with mild side effects
  • Total cost of treatments will be determined by the type of filler, your location, number of vials used and the fees of your provider

Dermal fillers are injectable treatments that can combat the signs of aging such as lines, wrinkles and furrows. Additionally, they can rejuvenate the face by augmenting the lips, cheeks, chin, and other areas. 

Hyaluronic acid is a popular choice among injectable fillers due to its versatility, effectiveness, and few associated side effects.

What Are Hyaluronic Acid Fillers?

Hyaluronic acid is a type of sugar that is found naturally within the body, including skin, connective tissue and joints. 

Among its many biological functions, it plays an important role in tissue hydration, joint lubrication, immune response and tissue repair. In the skin, it is a major component of the natural skin barrier.

Hyaluronic acid is used as a nonpermanent soft tissue filler. Its unique physical properties, such as its large water-binding capacity, along with its established track record of effectiveness and safety make it a popular choice as a dermal filler.

Due to its molecular structure, hyaluronic acid dissolves over time and is excreted through the body.

How do they work? 

This acid is a humectant, which means it can hold moisture: It can bind up to 1,000 times its volume in water. This makes it a compelling treatment as a dermal filler due to its ability to pull in and retain water, enhancing the volumizing effect while also adding hydration.

Hyaluronic acid fillers are injected into the skin through a needle or cannula to restore lost volume, smooth wrinkles and fine lines, and add volume and plumpness. Effects are visible immediately after the treatment.

Types of Hyaluronic Acid Fillers 

Although all hyaluronic acid dermal fillers are based on the same molecule, a number of physical and chemical properties can be altered by manufacturers to influence their products’ performance and outcomes.

Modifications include the particle size of the hyaluronic acid used, degree of crosslinking between molecules, the concentration of hyaluronic acid, and the consistency and viscosity of the gel. 

These variations account for differences in the effectiveness, longevity and appropriate injection sites of different dermal fillers.

Juvederm 

Juvederm is a family of hyaluronic acid-based dermal fillers that include the following products; all are FDA-approved for the following indications:

  • Juvederm Voluma XC: Adds volume to the cheek and midface area
  • Juvederm Ultra XC: For lip augmentation and smile line correction 
  • Juvederm Ultra Plus XC: For nasolabial folds (lines between the nose) and smile lines; lasts longer than Ultra XC
  • Juvederm Volbella XC: Lip augmentation and correction of perioral (around the mouth) lines
  • Juvederm Vollure XC: Treats lines and wrinkles around the nose and mouth including nasolabial folds and smile lines

The hyaluronic acid used in Voluma, Volbella and Vollure is highly concentrated, and crosslinked to provide long-lasting results.

All Juvederm XC products are premixed with a numbing agent (lidocaine) to reduce the discomfort from the injections.

Restylane

Restylane is a line of FDA-approved hyaluronic acid fillers that includes:

  • Restylane: Corrects moderate-to-severe wrinkles and lines such as nasolabial folds, and for lip augmentation; Restylane-L includes lidocaine
  • Restylane Lyft: Adds volume to the cheek and treats moderate-to-severe facial wrinkles and folds. Lyft is the first and only hyaluronic acid filler approved by the FDA for correcting volume deficiency in the back of the hands
  • Restylane Silk: For lip augmentation and correction of wrinkles around the mouth
  • Restylane Refyne and Restylane Defyne: Corrects laugh lines such as nasolabial folds and marionette lines (vertical lines from the corners of the lips to the chin). Refyne is for mild-to-moderate lines and furrows; Defyne for moderate-to-deep lines

Belotero

Belotero Balance is a hyaluronic acid filler that is manufactured to produce a soft and cohesive gel. It is best suited for the correction of fine lines and wrinkles around the mouth such as nasolabial folds, smile lines, vertical lip lines and chin wrinkles.

Other members of the Belotero family, such as Belotero Intense, effectively treat moderate-to-severe facial wrinkles and nasolabial folds. Belotero Volume has greater lifting capacity and volumizing effects to restore lost volume in the cheeks and temples.

Revanesse

Revanesse Versa (formerly Revanesse Ultra)  is a dermal filler that received FDA approval in 2017. This filler is approved for the treatment of moderate-to severe wrinkles and nasolabial folds.

Teosyal

Teosyal is a brand name of a range of hyaluronic acid dermal fillers that utilizes a technology called resilient hyaluronic acid (RHA). This serves to increase the gel’s ability to bounce back to its original shape after stretching.

Some products within this group (RHA 2, RHA 3, RHA 4) received FDA approval in 2017.

What Are Hyaluronic Acid Fillers Used For? 

Hyaluronic acid fillers are quite versatile and can be effectively used to achieve different goals in various areas of the face and body.

One well-known application is adding volume to the cheek and lips for greater fullness; fillers can also contour and define the jawline.

These fillers can fill in and smooth wrinkles and lines in the face, including frown lines, deep forehead lines, smile lines, crow’s feet around the eyes, nasolabial folds and in the chin area.

Some fillers can also address volume loss and wrinkles in the earlobes, and volume loss in the back of the hands. Lastly, they can fill in depressed scars and depressions in the skin under the eyes and in the cheeks.

How Long Do Hyaluronic Acid Fillers Last?

When used to correct lines, wrinkles and depressions in the face, hyaluronic acid fillers last between 12 and 18 months, on average. When large volumes are injected for cheek augmentation or jawline sculpting, results can last up to 24 months.

Conversely, lip augmentation using fillers lasts between six and nine months.

In order to maintain results with hyaluronic acid lip fillers, treatments need to be repeated at regular intervals. For example, if results are expected to last 18 months, you may wish to schedule a session after 16 to 17 months of the initial treatment.

Side Effects of Hyaluronic Acid Fillers

Hyaluronic acid fillers are quite safe when applied by an experienced medical professional. Most side effects are mild and resolve without treatment, and include the following:

  • Discomfort which can be reduced by using a filler with lidocaine or a topical anesthetic
  • Redness, swelling and bruising due to minor tissue trauma
  • Mild itching and/or rash

More serious side effects that may require medical attention are rare and include:

  • Infections from nonsterile injection technique
  • Nodules from local tissue reaction
  • Filler migration or poor aesthetics due to poor injection technique by an inexperienced provider
  • Injury to blood vessels if accidentally injected into a blood vessel; this can lead to tissue death (gangrene) or blindness if a clot forms and moves to the vessels that supply the eyes

How Much Do Hyaluronic Acid Fillers Cost? 

Hyaluronic acid fillers are typically available in 1 mL syringes and cost $600–$1,000 per syringe. The cost can go up in areas of the country with a higher cost of living.

The number of syringes you use plays a significant role in determining the final cost of treatment. For example, most people obtain good results with 1–2 vials of filler for nose or lip injections while cheek augmentation generally requires at least 2–4. 

As a result, you can expect to pay about $800 – $1,600 for lip injections and $1,600 – $2,000 for cheek augmentation. 

Repeat treatments generally require the same quantity or slightly less than the initial treatment. Some providers may offer discounts on repeat treatments or when you use more than one vial. They may also offer installment plans to help with the payments, as insurance generally does not cover filler treatments.

When determining the total cost, the type of filler and your provider’s fee must also be factored in.

Other Types of Fillers

Other types of dermal fillers are available and, depending on your particular needs and goals, may be more appropriate for you.

Calcium hydroxylapatite (CaHA)

Calcium hydroxylapatite (Radiesse) is a mineral-like, biocompatible dermal filler. It is used for the correction of moderate-to-severe facial wrinkles, to add volume to the cheeks and jawline, and to rejuvenate the back of the hands. 

Radiesse typically lasts between 12 and 18 months and may last longer in some cases.

Poly-L-Lactic acid (PLLA)

Poly-L-Lactic acid (Sculptra) is a dermal filler that can stimulate the body to produce new natural collagen in the treatment area. This can add to the filling effect and produce long-lasting results for up to 2 years.

Sculptra can treat nasolabial folds, marionette lines in addition to other facial wrinkles. Off-label, it is sometimes used for buttock augmentation and for treating depressed cellulite areas.

Polymethyl-methacrylate microspheres (PMMA)

Polymethyl-methacrylate microspheres (Bellafill) is composed of biocompatible microspheres that can stimulate the body’s collagen production. It can be used to correct smile lines and certain types of depressed acne scars.

PMMA is considered a semipermanent filler, as results can last up to 5 years.

Fat injections

Using liposuction, fat tissue can be harvested from the buttocks, thighs or abdomen and then injected into the treatment area. 

Although this can produce relatively long-lasting results, the procedure is more invasive than traditional fillers and the results are less predictable.

Takeaway

Hyaluronic acid dermal fillers are a safe and effective treatment for wrinkles and lines, and for adding volume to localized areas of the skin; results can be seen immediately after treatment. 

There is a wide range of different fillers that are designed to treat specific issues in various areas of the face and body. Your provider will determine which filler is appropriate for you based on your specific needs and goals.

Results are temporary but can often last for more than 1 year; repeat treatments are necessary to maintain these results. The total cost of treatment will depend on the number of syringes used, the size of the treatment area, your geographical location and your provider’s fees.

Sources

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  • U.S. Food & Drug. Premarket Approval (PMA). https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P160042 
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  • Bass LS, Smith S, Busso M, McClaren M. Calcium hydroxylapatite (Radiesse) for treatment of nasolabial folds: long-term safety and efficacy results. Aesthet Surg J. 2010 Mar;30(2):235-8. doi:10.1177/1090820X10366549
  • Brown SA, Rohrich RJ, Baumann L, Brandt FS, Fagien S, Glazer S, Kenkel JM, Lowe NJ, Monheit GD, Narins RS, Rendon MI, Werschler WP. Subject global evaluation and subject satisfaction using injectable poly-L-lactic acid versus human collagen for the correction of nasolabial fold wrinkles. Plast Reconstr Surg. 2011 Apr;127(4):1684-92. doi:10.1097/PRS.0b013e318208d371
  • COHEN, S.R., BERNER, C.F., BUSSO, M., CLOPTON, P., HAMILTON, D., ROMANO, J.J., RULLAN, P.P., THALER, .M.P., UBOGY, Z. and VECCHIONE, T.R. (2007), Five‐Year Safety and Efficacy of a Novel Polymethylmethacrylate Aesthetic Soft Tissue Filler for the Correction of Nasolabial Folds. Dermatologic Surgery, 33: S222-S230. doi:10.1111/j.1524-4725.2007.33365.x

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