Facial Fillers

What Makes Facial Fillers Different?

The current market holds a wide variety of dermal facial fillers out there, and while many of the pharmaceutical companies want you to believe that one filler is better than all others, in reality, it doesn’t work that way. Dermal facial fillers that are currently available in the United States represent a group of FDA-approved minimally invasive plastic surgery treatments. Each separate facial filler has specific properties that makes them unique in how they rejuvenate and how they react to the tissue. In the end, there is “no best filler” for everyone, and one filler never fits every part of the human face. Furthermore, there a number of other types of cosmetic injectables such as BOTOX and Kybella that are not classified as “fillers”.

What is G’?

To understand the effects of different dermal facial fillers, we wanted to review what exactly fillers can and cannot do as a whole before getting into specifics on each separate injectable. There are a multitude of factors that contribute to dermal filler outcomes, but two of the crucial concepts involved are called “g- prime” (g’ for short) and “viscosity”.

Dermal Facial Fillers Differ in Viscosity

Imagine facial fillers on a seesaw, the more they lift, the less they fill and vice versa.

Put simply, the higher the level of g’ means that there is less spread of the filler, and that the filler grabs on to surrounding tissue. From an appearance standpoint, the higher g’ dermal facial fillers correspond to higher degree of tissue lift (Lift concept). The lower g’ dermal facial fillers tend to be softer, tend to spread out more, and tend to absorb water. They do not “grab on” in a sticky fashion to surrounding tissue. Rather, lower g’ fillers interface deeper with the tissue, and attract water from the surrounding deep tissue. From an appearance standpoint, these fillers will demonstrate minimal tissue lifting, but will offer superior fullness to the treated areas. These dermal facial fillers are less viscous, and because of this behavior they give our patients a higher degree of tissue fill (Fill Concept).

Looking at this from another perspective, picture a see-saw in your mind. A single dermal filler will provide either a lifting effect to the tissue with minimal fill, or a filling effect to the tissue with minimal lift. It cannot provide both. This is a basic framework for a very complex concept, but it does offer a general understanding of dermal filler behavior.

Facial Fillers either Spread or Lift

With this in mind, the “Flow Characteristics of Facial Fillers” graph can be interpreted a little clearer. Basically, different facial fillers will lift or fill differently, and by understanding how each filler works, we can consistently provide superior results in our dermal filler patients because we can tailor pick the appropriate facial filler for each type of face, and almost every type of presenting issue. For example, according to Dr. Sundaram’s data, Radiesse™ is the most elastic and viscous dermal filler. After injection, it predictably provides the greatest amount of lift to sagging tissue.

Comparison of Dermal Facial Fillers

Because of our understanding of this unique property of Radiesse®, we use it almost exclusively for lifting up sagging midfaces (cheeks), brows, and temples. Radiesse® is our most reliable facial filler for tissue lifting. If you are interested in learning more about cheek lifts with Radiesse, you may want to read our article on Dr. Durkin’s fanning technique for Radiesse injections in men and women. This specific filler, in our opinion, consistently provides the best aesthetic result for patients wanting to maintain a natural appearance while minimizing tissue descent. However, it is too viscous to use in the lips!! Because of this, we generally avoid use of Radiesse™ in the lips, and lower eyelids, as it can cause bumpiness under the skin, and a poor overall texture to the skin.

For lips, Juvederm Ultra Plus XC™ is king. It provides a small degree of lift, but offers incomparable tissue integration, and a high degree of water absorption.   We utilize Juvederm™ in lips more than any other filler because it consistently provides a superior result. Conversely, we rarely use it in the midface, as we do not want to create an over-volumized look or “chipmunk cheeks”.

Dermal Facial Fillers in Cheeks

Using the wrong facial filler can result in an over volumized appearance.

So what does all of this mean to the individual patient? It means that everytime we evaluate a patient for facial fillers, we have a comprehensive understanding of facial anatomy, as limited incision is our most common surgical procedure, and we have a comprehensive understanding of individual dermal filler behavior. Thus, we are able to choose the appropriate facial fillers for each region of each face, rather than making a choice based on a sales and marketing campaign.

Our goal with fillers is to provide the best possible result with minimal discomfort using the appropriate amount of product required, and the right product for the right effect. We take great pride in tailoring each and every dermal filler patient for maximal outcome by using fillers as individual tools in our aesthetic armamentarium. Restylane works in certain areas better than Juvederm™. Belotero™ works better for certain types of wrinkles than Radiesse.

The experience and knowledge that we bring to the evaluation of patients seeking dermal filler therapy is what separates us from our competitors. We want your best result using the best technique in combination with the best filler available for your specific anatomy. Our fundamental philosophy is to provide a natural appearance to your dermal filler therapy.

We are conservative with our dermal filler volumes, believing that a natural look is best. However we are very open to combining synergistic therapies with dermal fillers, such as Botox, Xeomin™, Broadband Light, laser skin resurfacing, Latisse™, SkinCeuticals™, and others. These fundamental concepts are what separates our practice from our competitors. We do not subscribe to a “one dermal filler is best” philosophy. We believe in using dermal facial fillers to their maximal effect based more on their clinical characteristics than on the volume injected. By combining different filler therapies, we can consistently produce a superior outcome while using conservative, appropriate volumes of each dermal filler.