Correct choose of filler is essential in providing a satisfying result for a patient. Unfortunately, it is not always an easy task given that the skin ages by losing fatty tissue (hence volume) which causes sagginess, and by the loss of elastin and collagen in the dermal layers leading to finer lines and “crepe-paper” like skin. It is usually a combination of fillers that will give the best effect, but given that time and money are always limiting factors how does a patient know which one to choose?

Well, the answer to this is that they choose the right doctor who can accurately describe the expected result of using particular filler in that patient’s skin. This of course, comes with training and experience. But to give the potential patient some insight, here are the types of fillers and their advantages and disadvantages.

Temporary Fillers

Temporary fillers generally last from 4 to 6 months, although the occasional patient has lasted up to 12 months. They are made in different viscosities and can be used in all layers of the skin.  The result is filling from fine lines to producing bulk to an area. The main types used in Australia are based upon  natural substances in skin called collagen and hyaluronic acid.  I personally find that collagen provides a very soft appearance, making it a great filler for finer lines such as peri-oral and crows. It is perfect in lips for those with petite facial features.  The hyaluronic acids are generally firmer and more jelly-like in nature.  They suit heavier lines, fuller facial features and give a plumper lip effect due to their ability to attract water. They are the primary filler for the lips area in my practice and can produce some very beautiful results. The advantage of these fillers is that they are generally less expensive, can be repeated regularly and if the individual results are not pleasing they will wear off and an alternative treatment can be found.

Semi-permanent Fillers

These fillers are relatively new in Australia but have been used overseas for nearly a decade.  The most reliable and safest I have found to be one that consists of calcium ions in a water based gel.  This gel dissolves over time to be replaced by a persons own collagen.  They last from 12 to 24 months and are designed to restore bulk.  Consequently they do not treat fine lines and are not used in lips. Favoured areas are cheeks, naso-labial lines and marionettes.  They are even able to restructure noses and chins. They are becoming rapidly more popular in my practice with the effects being quite dramatic and the fact that they can be done at the time of consultation with minimal discomfort. The downside is that if you are unhappy with the effect it will be there for nearly 12 months before an alternative treatment can be performed. They are comparatively about the same price as temporary fillers when taking into account that at least 3 temporary filler treatments would be needed over the same time span. This makes them ideal for those who are needle haters. Unfortunately, they can’t be used in lips. Instead, they are placed around the lip to provide more bulk where the gums have receeded causing the lips to concertina inwards.

Long Term fillers

The primary long term filler is fat.  This a natural alternative for filling where fat is removed from the patient’s own body and re-inserted into the desired areas. This removes the risk of filler allergy.  The result is a youthful, more rounded effect. It can also be combined with thread lifting to reduce sagging cheeks and jowls. Another advantage is that fat can be stored for future use. At least 2 treatments are needed and occasionally a third 6 months later. The results can last 3 to 5 years, and a lifetime for some lucky individuals.  This is my favourite filler for rebuilding an area.  It is also cost effective as the cost is per treatment not number of syringes used.

Permanent fillers

Permanent fillers are controversial. Some believe that as the face changes the effect may alter with time resulting in an unsatisfactory result outcome that can not be corrected. Personally, I fear that permanent fillers may result in permanent problems, and consequently I do not use them.  There are however, many doctors who find success with permanent fillers.  One warning, if you seek permanent filling then once in, if it fails to meet your expectations, other fillers should not be placed over the top.