Injectable Fillers Overview
Reviewed by Scott R. Miller, MD, FACS
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When it comes to injectable fillers, what's in a brand name? If you've just begun looking into facial treatment, the options may seem overwhelming and confusing. There are many brand names with several ingredients, which have different, but perhaps overlapping, uses.
This article will help clarify which ingredients are in which brand names for injectable fillers. You'll learn about their primary uses, as well as other uses for which some practices may be using injectables.
Ingredients and Brand Names
You may not have heard of the ingredient calcium hydroxylapatite, but perhaps have heard of its brand name, Radiesse. You may have heard of the term "fat fillers," but do not realize that fat filler ingredients may be human-based or bovine-based (derived from cows). Ingredients play an important role in the function of an injectable or filler. Following is a discussion of ingredients and brand names.
Botulinum Toxin-Based Injectable (Botox)
Although Botox is not a filler, it is an injectable that releases contractions causing wrinkles by temporarily paralyzing the muscle causing the contraction. This improves wrinkles of the forehead and around the eyes for up to six months. Botox is considered safe and effective. Each syringe contains 100 units of synthetic sterilized Clostridium botulinum type, a neurotoxin complex without preservatives.
Botox is FDA-approved for certain cosmetic purposes and used off-label for others. A related product is Myobloc, a brand name for Botulinum toxin type B. Myobloc is FDA-approved for medical purposes and is used off-label for cosmetic treatment.
Human-Based Collagen Fillers
Human-based collagen is used under brand names such as CosmoDerm, CosmoPlast, Cymetra, Autologen, and Fascian to build volume in facial areas including the lip area (such as for lip augmentation), above and below the eyes, crow's feet, the nasolabial fold area (the grooves from your nose to your mouth), and frown lines.
Human-based collagen fillers are biocompatible and produce results that may last for four or more months. But as collagen treatments continue over time, more and more of the collagen remains, and results may last longer, in some cases forever. It is important to note that the treatment area is typically overfilled initially, because up to 40% of the collagen dissipates within a short time.
Bovine-Based Collagen Fillers
The brand names of bovine-based collagen fillers include Zyderm and Zyplast. This form of collagen is derived from cows and may be used to add volume to facial areas such as the lip area, above and below the eye, crow's feet, the nasolabial fold area, and frown lines. Because some people are allergic to bovine-based collagen, your doctor will perform an allergy test.
Results may last for four or more months, but as with human-based collagen, if you continue to have treatments over time, some of the collagen will remain, and results may last a lifetime. Also, ArteFill (described below) uses a bovine collagen product to suspend polymethylmethacrylate (PMMA, a type of plastic) microspheres that lodge into the treatment area after the collagen dissipates, with the goal of providing a more permanent benefit. Since up to 40% of bovine-based collagen soon dissipates, the treatment area is typically overfilled at first.
Both human-based and bovine-based collagen are FDA-approved for cosmetic uses.
In a fat transfer procedure, your doctor may extract fat cells from a discreet area of your body, prepare the cells, and then transfer them through an injection to the lip area, above or below the eyes, crow's feet, nasolabial fold areas, and/or frown lines.
Surgeons use various techniques to prepare the fat cells, and the technique used may impact the longevity of the results. Fat transfer results can be unpredictable, but in many cases last longer than those achieved through the use of traditional fillers.
Fat fillers do not require FDA approval for cosmetic use.
Skin Cell-Based Injectable Fillers
Skin cell-based injectable fillers use your own skin cells to rejuvenate your facial appearance. The only product of this type currently on the market is Laviv. The Laviv procedure involves the removal of a sample of your fibroblast skin cells (usually from behind your ear). The extracted cells are sent to a lab, where they are reproduced and placed in a solution for injection into your face. Laviv injections are administered in three sessions, typically three to six weeks apart, and results last up to six months.
Laviv is approved by the FDA for the treatment of nasolabial folds.
Also known as vampire facelift, Dracula therapy or Selphyl injections, vampire injections involve the injection of a substance derived from your own blood thus the ghoulish name. Your blood is first removed from your arm and processed using technology known as the Selphyl system to produce platelet-rich plasma (PRP). This PRP is then injected back into your face, where it is believed to stimulate collagen production. Vampire injections are used to treat lines, wrinkles and hollow areas of the face.
The Selphyl system is FDA approved for the preparation of PRP for use in orthopedic surgery.
Calcium Hydroxylapatite (Radiesse)
Under the brand name Radiesse, each syringe contains CaHA particles that are suspended in a water-based solution (available in 0.3, 0.8, or 1.5 cc) to reduce the appearance of wrinkles and skin folds around the mouth and nose as well as fill certain scars. The filler is biocompatible, non-toxic, and non-allergenic; results last for up to six months or more.
Radiesse is FDA-approved for medical purposes and is used off-label for cosmetic treatment. It is not recommended around the lips because of its larger particle size.
Hyaluronic Acid-Based Fillers (Restylane, Juvederm,
Hylaform, Perlane, and Dermalive)
Brand names containing hyaluronic acid include Restylane, Perlane, Juvederm, Belotero and Hylaform. Hyaluronic acid is a naturally occurring polysaccharide (carbohydrate) that exists in human tissue. Hyaluronic acid-based fillers treat nasolabial folds, frown lines, crow's feet, and lips.
Hyaluronic acid fillers are said to offer longer lasting results than collagen-based fillers. Restylane and Juvederm are FDA-approved for certain cosmetic purposes and used off-label for others.
Synthetic Poly-L-Lactic Acid (Sculptra)
Synthetic poly-L-lactic acid, also known under the brand name of Sculptra, is a synthetic but biocompatible material derived from natural sources. Sculptra treats skin folds, indented chin, hollowed cheeks, and sunken eyes. Results last up to two years. People usually require multiple initial treatments to obtain a fully satisfactory outcome and then receive maintenance treatments in order to continue to see results.
Synthetic Polymethylmethacrylate Microspheres (PMMA)
in Bovine-Based Collagen (ArteFill)
Under the brand name ArteFill, synthetic PMMA microspheres suspended in bovine-based collagen can improve skin folds such as nasolabial folds. Results are immediate and continue to build over the course of time, lasting for up to five years. ArteFill was FDA-approved (October 2006) for treatment of nasolabial folds or smile lines.
In many medical treatment areas, including cosmetic injectables and fillers, you will often hear the term "off-label." When the FDA approves a substance for medical or cosmetic purposes, it is for a very specific use. That FDA-specific use is printed on the label. But the FDA also allows physicians to use their own judgment. Physicians are allowed to prescribe fillers for newly discovered uses that were not originally included in the FDA-approval specification (although certain controlled drugs such as opiates are excluded from off-label use).
For example, Botox is FDA-approved for cosmetic use for lines between the eyes, but is commonly prescribed off-label for other areas of the face. Sculptra is FDA-approved for certain non-cosmetic uses, but is commonly prescribed for a number of cosmetic uses.
During the course of your cosmetic treatments, you may be prescribed a filler for a use that is not printed on the label. Cosmetic fillers are commonly used off-label, as many new applications are constantly being found. Doctors may also use a combination of fillers customized to fit the facial conditions of each patient.
The fact that physicians can prescribe treatments off-label is a good reason to choose a qualified, trained, and experienced dermatologist or a board-certified plastic surgeon who has extensive expertise in the specific treatment you are receiving.
Chart of Fillers
Here is a quick reference guide to the most common injectable filler ingredients, the brand names of products that contain them, and important facts about each.
45155 Research Place
Ashburn, VA 20147
Bitar Cosmetic Surgery Institute
3023 Hamaker Court
Fairfax, VA 22031
Bitar Cosmetic Surgery Institute
8650 Sudley Road
Manassas, VA 20110