Types of Dermal Fillers (Collagen, Restylane, Sculptra & Radiesse)
Sagging skin, wrinkles and fine lines create the most obvious and visible signs of facial aging, and the more of these that a person has, the older their face will look. Typically, lines first appear where the skin has a natural tendency to fold or crease as a result of a person’s most dominant facial expressions.
These are known as “expression lines” and are most likely to occur in the outer corners of the eyes where they form laughter or periorbital lines, along the sides of the mouth where they form smile lines, and along the central region of the forehead where they form worry lines.
With advancing age, the natural lines of the face eventually become deeper and more pronounced causing nearby skin to develop fine lines and wrinkles.
It is these latter markings that we associate with aging, and what most anti-aging skin care and beauty products try to prevent or reverse.
Injectable Dermal Fillers
Whilst anti-aging creams, serums and lotions can, in some cases, be very effective at slowing down or preventing the appearance of wrinkles, they tend to be relatively ineffective once a wrinkle has already formed, especially if that wrinkle is deep and well established.
Fortunately, advancements in plastic surgery have resulted in new treatments that provide a much more powerful weapon to fight the signs of aging with.
One of the most popular of these treatments involves the use of a dermal filler compound, or skin filler/wrinkle filler as they are sometimes called, which is injected underneath the skin to plump it up and raise any depressions which it may have.
Dermal fillers may also be used on the hands in conjunction with laser skin resurfacing, so that the age of the face appears to match the age of the hands.
Dermal fillers are, however, far from perfect. For one, they only provide a short-term fix, so in order to maintain the results that come from their use, repeated treatments are necessary.
In addition, dermal fillers are not very effective when applied to skin which is very loose or has significant amounts of sagging. In such cases, a surgical facelift still remains the only viable option for treating such problem areas.
There are also risks involved with dermal fillers, which, in some cases, can produce very undesirable side effects. For example, incorrectly injecting a filler into the skin may damage a blood vessel and cause bleeding that results in a bruised appearance of the skin.
Furthermore, if a dermal filler is injected too close to the surface of the skin, it may block blood vessels and cause the skin in that area to die off which will then leave a person with significant and permanent facial scarring.
However, the risk of suffering from an adverse reaction is extremely low providing you go to a well-trained and experienced medical professional.
So you shouldn’t necessarily be put off by these risks if you are considering having dermal filler injections, but you should at least be aware that such things can happen.
Currently, there are many different types of injectable dermal fillers on the domestic market, and each have advantages and disadvantages.
Below, you will find listed some of the most common dermal fillers that are in use today:
Collagen injections involve injecting collagen under the surface of your skin to improve its texture, resilience and shape.
One of the main advantages of using collagen as a dermal filler, is that it has been around for quite a long time and so a lot is known about its safety and the type of results that it can produce.
Collagen injections are also very inexpensive and simple to administer, as they don’t usually require anesthesia unless you are treating the lips.
The collagen that is injected into the skin is a natural protein that can come from either human or cow tissue, and so the Food and Drug Administration (FDA) considers the procedure to be safe.
One thing that you should be aware of, however, is the possibility of suffering from an allergic reaction to the collagen.
For this reason, it is important to have a skin test done before you proceed with the full treatment. If you do react badly to the collagen, then you may be offered an alternative type of dermal filler.
Ideally, two skin tests should be done in a one month period, with each two weeks apart. The chance of having an allergic reaction though, is relatively low, as only about 2% of people will experience such reactions.
Collagen injections can be used for many things. The most popular uses include filling in wrinkles and scars to make them less noticeable or less visible.
Some people also use collagen injections to plump up their lips to make them look more luscious and youthful looking.
Any benefits that you get from having collagen injections will, however, be temporary, because the injected collagen eventually dissipates into the body.
How quickly this occurs can vary depending on the individual, although in general, collagen injections will last anywhere from 90 days up to 8 months. So in order to maintain your results, you will need frequent repeat treatments.
On average, most people find that their results last for 2-3 months.
Is it Painful?
Sticking a needle into your face is not exactly the most pleasant experience that you could go through, but saying that, most people eventually get used to it after repeated treatments.
Collagen injections do sting, but the pain only lasts for a very short time. If you are squeamish of needles, then you will probably find it a bit more uncomfortable.
To help you get through the pain, it is a good idea to focus on the thought of how good your skin is going to look for the next few months, and to see the pain as the price you must pay for a younger looking and more attractive face.
After Treatment Skin Care
After being treated with collagen you may find that your skin looks overfilled. This is normal, as around half of the injected collagen will be absorbed into the skin overnight leaving the other half to act as a filler.
During the first week after your treatment, the remaining collagen will slowly settle into the correct regions of the skin so your results will gradually improve as this occurs.
After you have had your collagen injections, you probably won’t want to schedule any dates or appointments for one or two days because your face may become red and inflamed after the procedure. For some people, this inflammation can last up to a week.
To help speed up the recovery process, you can try using ice wrapped around a towel or cloth for the first 24 hours to calm your skin down.
It is recommended not to use any products on your skin during this period, because the small injection holes could let bacteria enter the skin and cause an infection.
For this reason, it is very important that you keep your face clean for the first three days after treatment and that you avoid touching your face with your hands.
Once the collagen has finally settled under your skin, the surface of your skin should appear very smooth but could feel bumpy underneath. This is perfectly normally and will not affect your external appearance.
How much collagen injections cost can vary depending on where you go. It is possible, for example, to get collagen dermal filler injections done very cheaply. But the level of hygiene with such practitioners is generally quite low which greatly increases the risk of infection.
The amount of collagen that you require will also determine how much your dermal filler treatment will cost. Collagen is measured in cubic centimeters, so the more you require, the more you will pay.
This is why most doctors will not give you a set cost ahead of time, because it is impossible to accurately determine how much collagen you require until after the procedure.
To give you a rough idea though, collagen injections can range from $300 to $400 per syringe. Most patients will require four to six treatments a year if they wish to maintain their results.
One of the most popular alternatives to collagen injections are Restylane injections, which are an FDA approved treatment that can be used to improve the appearance of facial folds and facial wrinkles.
Restylane is made from biodegradable, non animal and stabilized hyaluronic acid, something which is naturally found in the skin and what gives it volume and fullness.
As you age, the levels of hyaluronic acid in the skin slowly begin to decline, and so with each passing decade, the visible signs of aging become more and more apparent.
The reason why Restylane injections can be such a beneficial skin treatment is because they help to replenish your levels of hyaluronic acid.
Since hyaluronic acid attracts moisture and expands, when it is injected into the skin it results in a plumping effect that raises fine lines, wrinkles and folds from underneath thereby lessening their visibility.
Hyaluronic acid injections have many advantages over collagen injections, one of which, is that they tend to produce much longer lasting results.
Typically, Restylane injections will last for between 6 to 12 months, so you won’t need to have as many treatments each year to maintain your results.
The results themselves also tend to look very natural as hyaluronic acid plumps up your skin from the inside, so you will usually get much better results from this type of treatment than you would from Botox or some face lifts.
This makes Restylane injections especially good for plumping up the lips, filling out marionette lines, plumping up the nasolabial folds and improving the shape and contour of the jowls.
Another major advantage of Restylane injections is that they are made from a non-animal source.
This means that they have none of the complications typically associated with collagen injections, such as allergic reactions, and so skin tests are not required before treatment.
Side effects, however, may occur after your treatment and can include headaches, nausea and muscle weakness in a minority of patients.
Finally, patients who have been treated with Restylane injections report less bruising, swelling, pain and tenderness compared to those who get collagen dermal filler injections.
Is it Painful?
Although a typical treatment session usually only takes about 30 minutes, Restylane injections tend to be much more painful than collagen injections and frequently require anesthesia which bumps up the price per treatment.
You may therefore, want to try having collagen injections first and see how you get on with them. If you are unhappy with the results that you get, you can always try hyaluronic acid injections next time.
After Treatment Skin Care
After your treatment session, your face may feel swollen for up to three days and can also be red and painful at the injection sites. But after a week, your skin will have settled down and will look normal.
During this time, especially for the first few days, you want to ensure that your skin is kept clean and that your injection wounds are disinfected to minimize the risk of an infection occurring.
To cope with the redness, you may want to try applying oils to your face that have natural anti-inflammatory properties, such as emu oil for example.
Long term, your main concern should be in trying to keep your hyaluronic acid levels as high as possible.
Hyaluronic acid is naturally broken down in the skin by an enzyme called hyaluronidase, so if you can inhibit this enzyme from degrading your hyaluronic acid, then you can make the results of your Restylane treatment last much longer.
One way that you can do this is by using face creams that contain Phytessence Wakame extract, as this extract, which is taken from a Japanese seaweed, inhibits the action of hyaluronidase meaning that the levels of hyaluronic acid in your skin will remain higher for longer.
This extract may also be listed as: Undaria Pinnatifida, Wakame Kelp, Japanese brown sea kelp extract, Fucodian or Fucoxanthin.
In addition, you may also find it beneficial to take hyaluronic acid supplements internally. Dosage should be 200 mg for one or two months, and then 100 mg per day thereafter.
Due to the fact that Restylane injections usually require a local anesthesia, cost per treatment will be slightly more expensive than having collagen injections.
The amount you pay will be determined by how large of an area on the face that needs to be treated, although you can expect to pay somewhere in the region of $350 to $800 per syringe. Most patients will require two treatments per year to maintain their results.
Poly-L-lactic, more commonly known as Sculptra or New-fill, uses microspheres, a synthetic polymer, as a dermal filler. As with collagen and Restylane injections, this treatment is also FDA approved and so is considered to be safe to use for cosmetic purposes.
Sculptra, however, works slightly differently to the previously discussed dermal filler treatments, as the microspheres that it contains result in an irritation of the skin which subsequently increases fibroblastic activity (i.e. cells responsible for synthesizing collagen) thereby resulting in a natural increase in collagen levels and thickness in the treated areas.
In other words, Sculptra causes the skin to make more collagen by itself. So in this sense, Sculptra is not actually a filler on its own, by rather acts like a stimulant so that the skin fills in itself.
By far the biggest benefit of poly-l-lactic acid treatments is how long the results last for.
A single treatment, for example, can continue to provide results for up to two years. This can be very attractive to people who don’t have time to go for a booster shot every few months.
The polymer present in Sculptra has been used for medical purposes for many decades, and so is considered to be very safe.
This is always a concern with new treatments, as it is not until something has been used for a long time, and by many people, can you truly make a determination as to how safe it really is.
Also, because the polymer is synthetic, the chance of you suffering an adverse reaction is extremely low, and so you won’t need to undergo a skin test before your treatment.
Some people, however, are allergic to lidocaine, which can be added to the Sculptra suspension. So if you are allergic to lidocaine, you should mention this to your dermatologist, cosmetic doctor or plastic surgeon.
As was previously mentioned, Sculptra stimulates the body to make its own collagen, and so it is one of the few treatments that actually reverses the aging process in the skin.
These effects are, however, only temporary, as eventually the microspheres will break down and be absorbed into the body.
It is also worth mentioning that you won’t be able to use Sculptra everywhere on the face, so you will be limited as to where Sculptra can act to reverse aging.
Some of the places that Sculptra is not designed to be used are around the eyes, around the mouth or in the lips. Sculptra works best for treating nasolabial folds, marionette lines, cheeks, the chin and scars.
Is it Painful?
Sculptra injections are usually administered under local anesthesia, but sometimes a topical numbing cream may be used instead.
You will be able to feel the needle going into your skin, and possibly also a slight burning sensation, but because your skin has been numbed you shouldn’t feel any real pain.
If anesthesia is not used, then the pain is similar to what you would experience when having Botox injections.
After Treatment Skin Care
Immediately after your treatment, you may notice similar symptoms to what you would get with other types of dermal fillers. As a result, your face may be red, sore, swell and bruise in the areas you have been treated.
These symptoms will normally go away within a week, but in some people they can take up to two weeks to go away.
Around 10% of patients, however, experience lumping or track marks under the skin, which can take several months to disappear. Although, most of the time, they will naturally go away within a few weeks.
Your main concern after being treated with Sculptra, is ensuring that you properly massage your face as you have been instructed.
This is necessary in order for the treatment to be spread evenly and settle properly underneath the skin, as there is a risk of small bumps or lumps developing if you don’t massage your face enough.
The results you get from Sculptra will take longer to appear than with collagen or restylane injections, so you won’t be able to judge your final result until about 2-3 months after your initial treatment.
You may, however, start to see some improvement after the first month.
As with all dermal fillers, the cost of your treatment will depend on the size of the treated area and how much Sculptra is used to treat it. Typically, prices per syringe can cost anywhere from $500 to $1000.
The first time you have Sculptra injections, you will likely require a further 2-4 treatments spread out 1-2 months apart for the initial treatment.
After that, your results may last up to two years, but most people will go in for a yearly booster to maintain their initial results.
Radiesse, formerly known as Radiance, is a calcium hydroxyapatite based treatment which uses bone shaped microspheres that are suspended in a watery carboxymethylcellulose gel.
It has been used for several decades in dental and orthopedic fields, and is considered to be safe for use as a dermal filler by the FDA.
Radiesse dermal fillers work similar to Sculptra in the sense that they stimulates production of collagen within the skin, although they differ from Sculptra fillers as they can also be moulded or shaped to provide improved definition or contour to the face.
As with Sculptra, Radiesse is a very long-lasting treatment that can continue to show results for 1-2 years.
It is particularly useful for lifting deep depression in the skin such as in the nasolabial folds or in the frown lines of the forehead as well as for lifting scars such as those caused by acne.
Furthermore, because it can be moulded into shape, Radiesse can also be used to provide the jaw line, chin and even nose with an improved contour.
However, if Radiesse is injected too close to the skin’s surface, it can make the skin look white. It also has a tendency to clump together when injected into the lips which can then give the lips an unnatural looking appearance.
The calcium hydroxyapatite microspheres used in Radiesse treatments are non-allergenic, and so the risk of suffering from an adverse reaction is extremely low.
As a result, you usually won’t need to get a skin test done before you have your treatment.
Calcium hydroxyapatite is also a natural mineral component found in bone, so when the Radiesse microspheres eventually break down, they can be absorbed by the body without any adverse effects occurring.
Is it Painful?
Radiesse is injected underneath the dermal and subcutaneous layers of skin with a very fine needle as shown in the video below:
The skin is treated with a topical anesthetic which should numb most of the pain, although you will still feel the needle going into your skin and possibly also a slight burning sensation.
If you have had dermal filler injections done before, then you shouldn’t find this too uncomfortable.
Sometimes a topical numbing cream is used instead of a topical anesthetic. This can reduce the cost of the treatment somewhat, but may increase the amount of pain that you experience.
After Treatment Skin Care
The side effects from Radiesse injections are similar to other dermal fillers, so you can expect swelling, bruising and tenderness of the skin in treated areas for the first few days.
This will settle down within a week, but until it does, you should avoid exposure to strong direct sunlight as this could aggravate your skin and cause it to become more inflamed.
Just like after having any dermal filler injection, you should ensure that your skin is kept clean, because until your injection wounds heal, the natural barrier that the skin normally provides against germs and bacteria will be broken which increases the risk of your face becoming infected.
Immediately following your treatment, you may notice some improvement to the appearance of your skin. But the main results will only be noticeable after the first month.
This is because you need to wait for the calcium hydroxyapatite microspheres to stimulate the rebuilding and thickening of your collagen, which is similar to how you have to wait for the results from Sculptra to show.
Radiesse is one of the most expensive dermal filler injections that you can have. Fortunately, the results are also very long-lasting, and so the $800 to $1200 price tag per syringe won’t be wasted money.
How much your treatment costs, will of course, depend on the size of the area that needs to be treated and how much Radiesse is required.
But the good thing about Radiesse treatments is that you only pay for what you use because your surgeon or dermatologist won’t need to inject more than is required.
This is something that happens with collagen and Restylane injections because some of what is injected is immediately absorbed by the body.
As a result, extra filler has to be injected to compensate for the amount that the body absorbs, but this means that you end up paying for something which you don’t actually use or benefit from.
In addition to sagging skin, fine lines and wrinkles, a loss of facial volume is another very visible consequence of aging.
Typically, this appears as a depressed or hollow look under your eyes or on your cheeks and occurs as a result of the underlying fat and muscle having atrophied over the years.
Whilst dermal fillers can in some cases be used to restore lost facial volume, when dealing with a significant loss of volume, they tend to be far less effective. In such cases, a much better option is to use a facial implant instead.
Facial implants can include implantable substances, injectable substances or fat transferred from other regions of your body to areas in which volume is to be restored.
Unlike dermal fillers, facial implants will not degrade over time which means that once they have been inserted underneath the skin, they will stay there permanently and you won’t require any more visits to your surgeon.
The two most common areas of the face that implants are used are the chin and the cheeks.
If you have a chin implant, most cosmetic surgeons will make a small incision under the chin and put the implant in through that incision. Some surgeons, however, may choose to make the incision inside the lower lip and insert it that way.
The advantage of having your implant inserted through an internal incision is that there will be less noticeable scarring than had the incision been made on surface of the skin.
Although, it should be noted that this is not always possible, as it largely depends on the type of chin implant that you require and the shape of your face. So this is something that your surgeon will discuss with you.
Most people who have chin implants do so to correct a receded chin or jaw line which they have had since birth.
Cheek implants can be inserted via an external incision under the lashes of the lower eyelid or an internal incision inside the mouth. They are designed to increase volume in the cheeks and make them appear more prominent or regular on the face.
Generally, most patients prefer to have an internal incision made via the mouth, as not only does it leave less visible scarring, but the procedure itself posses less of a risk as the surgeon will not be operating around the delicate eye region when inserting the implant into the cheek.
Face Implants for Body Modification
Some people, as shown in the pictures below, have face implants to drastically change the appearance of their face for artistic reasons.
This is known as body modification, but not all surgeons are willing to carry out such a procedure. So if this is something that interests you, then you may have to hunt around a bit for a willing surgeon.
Facial implantables differ slightly to face implants in the sense that they are softer. This makes them more suitable for delicate regions of the face, such as for filling out thin lips and folds in the cheeks.
Because implantables are soft, they generally require a smaller incision to insert and some can even be attached to a thread and pulled in to place.
Obviously, a smaller incision will result in a smaller scar which makes implantables ideal for discretely improving or enhancing the contour of the face.
However, unlike face implants, not all facial implantables are permanent. Some, such as Gore-Tex, are permanent, whilst others, such as AlloDerm, are not permanent.
Generally, you will find that the softer the implantable is, the more likely it is to not be permanent.
Due to the soft nature of AlloDerm, this implantable tends to be most commonly used for lip implants.
AlloDerm can help to restore lost volume in the lips, thereby giving your lips a thicker and fuller appearance. It can also be used to smooth out wrinkles and lift depressions in the lips.
AlloDerm is made from the tissue of human cadavers, and is treated to ensure that it does not evoke an allergic reaction in the recipient. However, because it is organic in origin, it will eventually break down.
AlloDerm lip implants can last anywhere from several months to two years, although most people start to notice results fading in six to nine months which is roughly what you would get with a dermal filler.
Gore-Tex is a synthetic implantable which means that once it has been inserted it will not break down over time.
Gore-Tex is most commonly found in a thread or sheet form, and tends to be used on the outskirts of the lips to create a more defined outer edge.
Plastic surgery medical insurance
Whilst it is true that face implants and face implantables are commonly used for cosmetic purposes, they are also often used for reconstructive purposes.
For example, if a person’s face becomes disfigured as a result of an accident, and that disfigurement interferes with their ability to see, breath or eat properly, then implants may be used to restore normal functioning of the face.
When implants are used for medical rather than cosmetic purposes, many insurers will cover the cost of the surgery. They won’t, however, pay for your surgery if you are only doing it to change the way you look without there being anything medically wrong with you.