With the myriad of different fillers currently available in the world of cosmetic enhancement, it’s normal to feel a little overwhelmed and confused about which one “works” the best. The fact is that differentiating between the various fillers isn’t necessarily an intuitive procedure, and different cosmetic surgeons have different ideas about which fillers are the best for certain uses. Trying to determine which filler is the “best” or most effective without considering where it’s to be applied is time better spent on researching the views of industry experts, who realize that each filler has its own benefits and drawbacks depending on the type of wrinkle it’s filling and the skin composition of each individual client.

So rather than trying to find “the one” filler that perfectly erases all wrinkles, let’s step back and take a quick look at all the major fillers on today’s market, their benefits, and which layers of the face each type works on.

Skilled plastic surgeons look at the face as a three-dimensional structure composed of several layers. The base layer is the bone structure of the skull, cheek, and jaws that supports all the layers covering them, from the muscles (which contribute to movement) to the soft tissues (which increase volume) and ending with the protective layer of the skin.

Each filler’s unique chemical properties work to create certain effects in one or more of these layers. The fillers available today generally use either “natural” substances like collagen and hyaluronic acid (Juvederm and Restylane) or the biosynthetic chemicals polylactic acid (Sculptra) or calcium hydroxyapatite (Radiesse) to produce results. The specific brand of each filler, the concentration of its active ingredient, and whether or not it also contains an anesthetic in its formula are further subcategories of these three main types.

Benefits of Different Fillers

While collagen is derived primarily from bovine tissue, hyaluronic acid (or HA) can be taken from patches of your own skin, which makes it highly compatible with your body chemistry and less likely to produce an allergic reaction. For those reasons, HA is a popular choice for newbie patients. In addition, it is the only kind of filler that can be reversed with an enzyme called hyaluronidase, which melts it almost immediately and voids any unexpected filler accidents. So there’s no need to worry about getting stuck with those overly full “duck lips” that can result when too much filler is injected.

The biosynthetic hydroxyapatite Radiesse is popular due to its high level of biocompatibility, low side effects, and predictable longevity of between 12 and 18 months. The polylactic acid Sculptra is also very safe and compatible with most patients’ skin tissue, its effects easily lasting two years or longer.

Heavy or Light Fillers

Many plastic surgeons separate fillers into two general categories – those that have “heavy” or volumizing effects and those that work on a “light” or superficial basis.

Radiesse is commonly used for its impressive lifting and volumizing effects when injected deeply into the cheek bone area, the middle of the face, or the hollows of the temples, and its longevity in these areas is quite similar. Sculptra works as a gradual collagen stimulator that, through a series of applications, repairs and volumizes structures just beneath the skin for a subtle, natural enhancement.

Some varieties of HA fillers – like Perlane and Juvederm Ultra Plus, and Juvederm Voluma XC – are also used to shape and contour “heavy” areas. Marionette wrinkles (which run vertically beneath the corners of the mouth) are often treated with these heavier HA fillers, since the tissue here is fuller and muscle movement is very active. Because these wrinkles often spread over to the inner cheeks and up to the edges of a patient’s mouth, very natural-looking results may be achieved by carefully blending HA fillers in these areas, as opposed to just “filling in” creases.

For “lighter” or more superficial tissue, the HA fillers Restylane and Juvederm are very popular among cosmetic surgeons. They can be applied to nearly any thin-tissue area that needs more volume or contouring, including folds around the nose, lips, cheeks, eyelids, eyebrows, and forehead. In these spots, the filler is applied in a manner similar to makeup or a highlighter, naturally volumizing and contouring them. Because the thickness of the skin and depth of the wrinkles in these delicate areas varies from patient to patient, a quality surgeon must determine which filler to use and how much is injected on a case-by-case basis.

What to Expect With Any Filling Procedure

Regardless of which particular filler your plastic surgeon determines is the best for you, they should fill you in completely on how they plan to perform the procedure ahead of time. During the operation, they should work slowly and steadily, allowing you to look at what’s been done and affirm whether the result is to your satisfaction. Ideally, they will also attempt to numb or work very gently on any hypersensitive spots, and will have a dependable arsenal of techniques at his/her disposal to make the procedure as comfortable as possible.

Plastic Surgery Institute Miami‘s team of cosmetic surgeons all carry board certifications from the American Board of Plastic Surgery. Dr. Jason Altman, MD is skilled in all types of cosmetic procedures, focusing on breast augmentation, liposuction, and rhinoplasty. Dr. Marcelo Ghersi, MD has many years of experience performing all types of reconstructive surgery, including rhinoplasties and repairing clefts and craniofacial defects. Following extensive training at Baylor College of Medicine and an eight-year tenure as Associate Professor of Plastic Surgery at the University of Miami, Dr. John Oeltjen, MD specializes in all forms of cosmetic and reconstructive surgery of the face, chest, and trunk.