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There are a variety of substances that can be injected to hollow or creased areas to raise them up to a more youthful appearance. Your own fat is one of the best sources for this filler, and is discussed in detail under "Fat Transfer." The following is a discussion of artificial (synthetic) fillers.

Synthetic dermal fillers

Static: Collagen (Cosmoderm, Cosmoplast), Juvederm, Restylane, Cymetra, Alloderm, Hyalaform, Artefill, etc.)

These substances are called static, because they act as a filler, but do not stimulate tissue growth within or under the skint. Typically, they are thick, gelatinous materials, injected under the skin to lift a crease or wrinkle back to its original position, or to enlarge (augment) lips. In general they are all equally effective, although there are some differences as noted below. New products are being developed all the time, with claims of having a longer-lasting effect. The most common ones in use today are collagen and hyaluronic acid (Juvederm®, Restylane®). Collagen lasts about 3 months. The hyaluronics, the results are longer lasting: 6-9 months or more. Most of these products result in only temporary effect, because the body reabsorbs the injected material.

Dynamic: Radiesse, Sculptra, Artecoll

The key to long-lasting results seems to be in the ability of the material or procedure to stimulate growth of the body's own collagen. These fillers are considered dynamic, because instead of merely filling a space, they actually stimulate your body to build new substances (usually collagen), which typically last longer than artificial fillers. Radiesse is a synthetic tissue filler which is remarkably effective in softening or erasing folds or wrinkles. Because of its tendency to form nodules in the lips, we no longer use this material for lip augmentation. It has no known allergic reactions and does not require a skin test. It was initially advertised as lasting 3-5 years, but experience has shown a more realistic 12 to 18 months. Artecoll was just recently approved, and consists of tiny microspheres suspended in collagen. It is thought to last for many years, and may even be permanent is some people. Sculptra is a synthetic substance that comes as a powder, and is dissolved in saline before being injected. It is usually given in a series of 2 to 3 treatments, a few months apart. The results are not immediate, but may take several months to become apparent. The effect seems to last several years.

 A series of treatments is recommended for best results.

Procedure

Each of these materials is injected with a needle using a special technique to the area being treated. The results are immediate (except for Sculptra). The type of injection, use of local anesthesia, size of needle, post-procedure care and duration of effect depends on the material chosen. See the table below for comparison.

Comparison Table