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December 2016

3 most important questions to ask about fillers

02 Dec 2016

WITH so many filler brands in the market, it can be really confusing to patients as which product to choose, and which brand to select. Being SAVVY about what is to be injected into your face is important!

After all it will stay in your face for years to come. 

In M&W we do not use non-biodegradable fillers as we do not wish any long term complications to arise in any of our patients in the future.

To make it EASIER for you to understand, we have isolated 3 most important things that you need to know about fillers:

1)  What kind of fillers are there?

There are three kinds of fillers in the market.  One is HA (hyaluronic acid) fillers and the second is non-HA fillers (which means other fillers that are not hyaluronic acid).

The strongest advantage of HA fillers is that they can be “dissolved” by a product called ‘hylase’. (hyaluronidase)  What that means is that HA fillers have a ‘rewind button” – if you don’t like what you see, you can reverse it right away.  Hylase is a very safe product to be used to dissolve fillers as it only works on fillers but not on the HA in your skin.  There are incidences of allergy to hylase but it is rarely seen.

What that also means is that non-HA fillers do not have a ‘rewind’ button.  Be sure that your doctor is skilled enough to achieve the results you need.

Lastly the third kind of fillers are, strictly speaking not “fillers”, as they are COLLAGEN STIMULANTS.  These material when administered stimulate the formation of collagen, so they have a mild filling effect AND also in addition, skin tightening, lifting and hence rejuvenation effects.  (i.e. Sculptra)

Ellanse is a unique filler as it has both filling and collagen stimulating effect. 

2) What kind (property) of filler gel do I need?  

What a lot of patients do not know is that not all fillers are the same in properties.  Some are very WATERY (i.e. Restylane vital light)  in nature, and this filler are excellent products to be used as skin booster as they can be injected superficially and improve the hydration of the skin.  Even amongst the ‘watery fillers’, some last longer than others.  The non cross linked fillers like in some Korean skin booster fillers only lasts 3 months whereas restyle vital light (which has cross linked hyaluronic acid) lasts up to 9 months.  The pricing also defers, so be sure you know what you are getting.

Others are STIFF HARD GELS (i.e. Restylane Perlane, Restylane SubQ, Belotero Intense, Teosyal Ultradeep), very much like a stiff hard hair gel (to help you visualise and imagine).  These gels are suitable to sculpt areas like the nose and the chin, as their firmness allow the look and feel to be closer to that of bone.  (can you imagine a soft wide nose bridge ?  It is very possible to create such a bridge by choosing the wrong, or right, kind of fillers)

Lastly there are SMOOTH SOFT GELS (i.e. Emerval Volume (from Restylane), Juvederm series (ultra, voluma) Belotero volume) .  Imagine a smooth agar agar, firm and mouldable.  These gels are suitable to sculpt and enhance smooth contoured cheeks, forehead and temples, or even hollows under the cheeks at the jaws.  Just think of areas you want a smooth and not lump appearance.  (and hence stiff hard gels may not be suitable in these areas)

3) How long does it last?

For HA filler – essentially all HA fillers consists of HA chains, it is what CONNECTS the chains and how many such connections (i.e. cross-linkage), that determines the duration of HA filler. The higher degree of cross linkage the longer the duration, but also the stronger tendency to create bumps.  By far Juvederm Voluma in our limited clinic experience of 10 years, have proven to be the longest lasting HA filler.

Here’s what we have observed clinically for the different brands:

(HA brands)

Juvederm products – very long lasting, up to 2 years plus for voluma

Restylane– although it gives a stiff sharp look for the nose and chin, the definiton fades off in 3-6 months.  For the longest lasting products range, we estimate it to up to 18 months at best.  They have provided the longest skinbooster range though.

Belotero, Teosyal – similar to Restylane in duration. For under eye fillers where we need a smoother more watery product, we prefer Belotero balance over Restylane vital light because we observe a longer duration of up to 9-12 months.

(Non-HA brands)

Sculptra – lasting up to 2 years. But it is less a filler more a collagen stimulant

Ellanse – the longest lasting range up to 4 years!