Dr. Shervin NaderiFacial Plastic Surgeon specializing in Rhinoplasty & Anti-aging as well as Facial Balancing Botox & Filler Injections

Discussion of Cosmetic Fillers by Dr. Shervin Naderi, Virginia Facial Plastic Surgeon

23 Nov 2007 · 3 min

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2:58

Dr. Shervin Naderi (Virginia facial plastic surgeon) explains categories of cosmetic injectable fillers: collagens, hyaluronic acids, and a mixed group of other fillers. He describes collagen (from cow, pig, or human) as fine-structured, useful for very fine lines and small scars, relatively painless (contains lidocaine), but short-lived (~2–3 months); human collagen requires no skin testing. Hyaluronic acids (examples: Restylane, Juvederm, Purlane, Hyloform, Captique) are the most commonly used "workhorse" fillers and last roughly 4–8 months depending on product. Other fillers include Radiesse (hydroxyapatite/bone cement; lasts ~1 year; avoid fine lines and lips due to nodule risk) and Artifil (PMMA microspheres in collagen matrix; described as the only FDA-approved permanent filler in the U.S.; typically requires 2–3 injections; avoid for fine lines and lips).

Questions this video answers

Cow, pig, and human.

No — human collagen does not require skin testing.

About two to three months at most.

Restylane, Juvederm, Purlane, Hyloform, Captique.

Approximately four to six to eight months, depending on the product.

Chapters

The next common group of injectables are the fillers. And the fillers fall in several main categories. The oldest types of fillers that we have that are still available today are the collagens. The next group are the hyaluronic acids. And the third group, I like to include other fillers and materials that really don't fit into the first two group that I mentioned. Collagen is a natural substance. It comes either from cow or pigs or from human sources. And depending on which source you choose, the cost varies and also the need for skin testing varies. Human collagen does not require any skin testing before injection. The injections are relatively painless compared to the other injectables because there's a little bit of lidocaine within each syringe. The downside of collagen is that it only lasts about two to three months at most. The upside is that it's one of the finest as far as molecular structure, so you can place it into very fine lines effectively. Especially little marks such as chickenpox or acne scars can be treated very nicely with collagen. The second and the most popular group are the hyaluronic acids. Restylane, Juvederm, Purlane, Hyloform, captique. All of these fall in this group. It's also a natural effect substance within skin, and the duration lasts somewhere between four to six to eight months, depending on the product. Finally, the last group is a hodgepodge of different fillers. Radiesse, which initially came out under the name Radiens and then changed to the word Radiesse, is Hydroxyapatite, which is bone cement. It's a fine substance. However, it cannot be placed into fine lines and it should be avoided into the lips because it has a high chance of causing nodules. Radius advantage is that it lasts about a year or slightly longer. The next filler, which recently became FDA approved and is the only FDA approved filler of a permanent nature in the United States, is Artifil. Artifil is a mixture of polymethyl methacrylate, or minuscule glass feet swimming in a matrix of collagen. It takes typically two to three injections. The costs are a little bit higher, but since it's perfect and long term, it does become cost effective. Again, it should be avoided into fine lines and not placed into the lips. There are other forms of injectables, but really the workhorse of injections are the hyaluronic acids, with Restylane and Juvederm being the most popular.