What is the best dermal filler?

Structural Fat Grafting: permanently restoring youthful facial contours.  A number of 'soft tissue fillers' are available for temporarily improving facial areas that have lost volume or have developed deep lines and creases. Probably the most popular fillers currently are hyaluronic acid products like Restylane, Perlane or Juvederm which can be used to plump up thin lips and to fill out nasolabial folds (lines that run from beside the nostrils to the area beside the corners of the mouth) and marionette lines (lines that run from the corners of the mouth towards the jawline). The improvement generally lasts four to six months.

Some synthetic materials are available which can be used in an attempt to produce a permanent soft tissue augmentation. Unfortunately, the body treats such materials as foreign objects, and as a result the placement of synthetic materials may lead to inflammation, infection, migration and granuloma formation. In general, synthetic materials are less likely to produce a result that looks and feels natural.

For patients seeking permanent enhancement of soft tissue volume, the ideal material to use would obviously be something that is naturally-occurring and not rejected by the body or treated by the immune system as a foreign material. Whether the goal is to restore volume to an area such as the lips or the cheeks, or to fill in a crease or depression such as the nasolabial folds or marionette lines, the ideal material is quite clearly the material that one wishes was there in greater abundance in the first place: YOUR OWN FAT.

A relatively new technique has been developed called structural fat grafting, in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.

This is a procedure that requires specialized training and specialized surgical instruments, as well as patience and attention to detail on the part of the surgeon. When performed properly, permanent improvements in facial plastic surgery are possible. If enough fat resorption occurs following a fat grafting procedure such that the desired result is not achieved, a second 'touch-up' procedure can easily be performed to augment the result obtained from the first injection.

The best dermal filler is the one which gives you the results that you are looking for.

In determining the best filler to use, several things must be taken into account:

• Location: Not all dermal fillers can be used in all locations on the face. All fillers have some FDA indication. While off-label uses can be performed, some fillers are even restricted by the manufacturer for use in some areas.

• Longevity: Not all fillers last the same amount of time. In addition, not all fillers last the same amount of time in all areas. I have found that in high motion areas such as the lips, fillers tend to last less time than they do in other areas.

• Patient goals: For my patients who have not had facial fillers before, I suggest a hyaluronic acid filler. These are good for most areas of the face and the best part is that they can be removed with an injectible substance called hyaluronidase. In this way, even if the patient cannot tolerate the injected material for one reason or another, I can easily remove it and the patient does not have to live with the material until it dissipates.

The best dermal filler varies on the area to be treated and the aesthetic objectives of the patients. Restylane remains the gold standard.  Restylane can be combined with Prevelle for an excellent result.

Depending on the area, Juvederm, Artefill, Radiesse, and Perlane are also good dermal fillers that we use.