Filler agents are used to replace lost volume that occurs with skin aging, and more importantly skin photoaging, or long-term sun damage.
As opposed to botulinum toxin or Botox® which is used to treat dynamic or movement lines of the upper face, fillers are more commonly used to treat the lower face and add volume to plump up skin. This replaces lost volume and can improve the appearance of fine lines and wrinkles.
The most common fillers use materials that are present in the body already.
The most widely used material is hyaluronic acid, or HA. Hyaluronic acid is a complex sugar that is a normal component of our skin, and is especially abundant in babies’ skin and healing wounds. It’s a great matrix for cells to move and heal and promote growth. That’s why it is though that these fillers promote the body to stimulate skin and collagen growth. HA also binds 1,000 times its weight in water. Common brand names of hyaluronic acid fillers are Juvederm® and Restylane®, and their many sub-types.
Depending upon the size of the HA molecules and the extent of cross-linking (bonds between molecules), the HA filler will have more or less pliability or stiffness. This is the reason there are many types of HA filler under each brand name. Some are used to provide more bulk volume, some are for treating fine lines, and some are in-between.
Another physiologic filler is Radiesse®, which is a biocompatible filler composed of calcium hydroxyapatite, the mineral component of bone. The filler is soft and injectable, and is commonly used to add volume to hands. It can last somewhat longer than some other fillers, and also stimulates the body to produce extracellular matrix or new skin.
Sculptra® is a biodegradable and biocompatible filler composed of poly-L-lactic acid, the same material used in absorbable sutures. Scupltra® is used to provide volume to the face and gradually encourages a tissue response that produces new skin and collagen. Sculptra® is often administered in a few sessions to achieve the optimal addition of volume. It can last 2 years and provides volume or fullness that has been lost due to photodamage and aging, where loss of fat tissue occurs in faces over time given a gaunt or sunken appearance.