There are so many dermal fillers, and more are always being developed as the market expands and the technology improves. Keeping them straight can be difficult, because this isn’t like choosing between prescription and generic medication. Fillers have proprietary formulas and also actually differ in ways that influence how they move in your face and how long they last.
Hyaluronic acid (the big one)
Hyaluronic acid is a large sugar molecule found naturally in the human body (which also means it’s almost impossible to be allergic to). HA absorbs and retains moisture, which is why it’s a part of facial/skincare routines.
One of its advantages is that its dissolvable by injections of hyaluronidase, which is a synthetic version of the enzyme that your body naturally produces to break down the filler over time. Most people who get their filler dissolved have no problems, but there are some reports of it also breaking down the natural fat in their face, so it’s not completely risk-free to dissolve filler.
Major HA brands
Most filler brands you’ve probably heard of are HA fillers.
- Juvederm
- Restylane
- Revanesse
- Belotero
Of these four, Juvederm and Restylane are the two most common.
Juvederm vs. Restylane: The molecular showdown
Consistency-wise, Juvederm is more of a smooth gel; Restylane is more granular. That explains why Juvederm diffuses more while Restylane tends to stay in place. Juvederm is usually used in places with thinner skin and for fine lines.
Restylane is better for forming a shape under the skin, but the effect can be lumpy or unnatural looking if it’s not executed well.
However, both Juvederm and Restylane have many, many product lines based on the treatment area and goals of the injector, which range from the least volumizing fillers for diffuse treatment to the most volumizing to build shapes.
Longevity-wise, Juvederm has the slightly more complex HA configuration, meaning it often lasts a little longer than Restylane.
The other two HAs
Revanesse is a more recent addition to the marketplace (and is usually less expensive than the other two). It has cross linked molecules that are more consistently sized and stay closer together. It tends to last longer than both Juvederm and Restylane and cause less swelling.
I had Revanesse Versa injected in my lips. The texture felt very smooth while staying (mostly) in one place. It lasted about a year.
Belotero is another relatively recent addition whose molecular structure is better at filling out fine lines and can be injected closer to the surface of the skin than the other three without causing a blueish tint to the skin if an injector tries to inject a different HA filler too shallowly (called the Tyndell effect, yuck).
Non-HA fillers
Then we have the non-hyaluronic acid fillers. These are not dissolvable with injections. If you hate the way they look, you either have to wait for a potentially very long time for your body to dissolve them, or you have to get them physically (i.e. surgically, yikes) removed. The upside is they almost always last longer than HA fillers.
The big ones:
- Sculptra (made of poly-L-lactic acid, or PLLA) is a collagen “stimulator”, meaning it works by encouraging collagen formation. It’s a liquid, not a gel (meaning you can’t build volume with it), it’s biodegradable, and it’s absorbed by your body quickly. It works really well for reducing fine lines. You will usually need a few sessions a few weeks apart (usually 2-4 sessions about 4 weeks apart) before you begin to see results, which should be very natural looking and gradual when they happen.
- Radiesse (made of calcium hydroxylapatite) is a dermal filler, made of the same material as in your teeth/bones, suspended in gel. It provides volume and also encourages collagen formation, so that as the filler dissolves, some of the volume will be replaced by your own collagen formation. The effect lasts about 12 months, sometimes a little longer. It’s used for deep lines and wrinkles, especially around the mouth, but you can’t use it in the lips. It’s especially good for clients with thicker skin.
- Bellafill (made of polymethylmethacrylate, or PMMA) is a gel that contains microspheres and bovine collagen. The collagen provides some volume initially, and the spheres encourages your own collagen formation. Bellafill advertises that the results last for five years. It’s not biodegradable, meaning the spheres will stay in your skin indefinitely, and your body will build new collagen around them. It’s also the only filler officially approved to fill in pitted acne scarring.
I had Bellafill injected into my upper cheeks to fill out my nasolabial folds. I could see a subtle result right away, plus it continued to improve over the following couple of years.
Longevity
Here’s some rules of thumb about filler longevity, but note that your metabolism and re-absorption rate may be different from the average person’s.
- Non-HA fillers last longer than HA fillers (two to five years compared to six to eighteen months). But HA brands HA brands are always trying to come up with new formulations that will last longer.
- The deeper the injection and the greater the molecular weight, the longer a filler generally lasts.
Some people have claimed they still have hyaluronic acid filler (which should totally dissolve within a couple years at the longest) three, five, or ten years after getting filler. It’s rare, but be aware that there’s no guarantee that a certain length of time will definitely erase 100% of your filler.
Advice for finding an injector and getting filler
Know what you’re being injected with. Even if you completely trust your injector’s judgment at selecting the best filler for you, record what you got injected, when, and where. Plus, if you don’t end up liking the results of type of filler and you don’t think it was because of the injector’s (lack of) technique, you might have much better results with a different type of filler.
If you want to do research ahead of time, a lot of the times the injector won’t commit to a recommendation until they see you in person, but you can ask ahead of time for what brands they use, and you can research each option they might recommend on your own so that you’re well-informed at your appointment.
Go to someone whose judgment you can trust. You want someone who will turn away your money if you want something that’s unrealistic or unflattering for your features. Ask your friends for recommendations and read reviews of dermatologists and med spas thoroughly. You probably aren’t going to find the most skilled people on Groupon.
Fillers usually have lidocaine in them, and your injector might also numb the injection site beforehand, but injections will likely still hurt, at least a little. My lip injections were about a 3/10 on the pain scale, while my cheeks were maybe a 1/10. Brace yourself, breathe through it, and the process should be over within a couple minutes. Skilled injectors are surprisingly quick at what they do.
