What are the most common types of fillers and how do I know which one to get?
To start, “it helps to think of the face in 3 dimensions and multilayered,” says Shafer. “There’s the structural support (such as the cheekbones), the muscle layer (contributing to animation), the soft tissue layer (fat and tissue contributing to volume) and the skin (draped over all the underlying layers).” Each injectable has different physiochemical properties and works to achieve specific goals in certain anatomical areas; “there isn’t one magic filler,” says Shafer, who explains that they’re subdivided into hyaluronic acid (Belotero, Juvederm, Voluma, Restylane), calcium hydroxyapatite (Radiesse) and poly L-lactic acid (Sculptra). “Further, each brand also has subcategories based on the concentration of the product and whether it’s mixed with an anesthetic.” According to Shafer, hyaluronic acid (HA) fillers, which are made out of a molecule naturally found in our skin (read: high compatibility with little to no reaction), are ideal for first-time patients and can be injected almost anywhere you can think to add volume or shape—nasiolabial lines, cheeks, lips, eyelids, eyebrows, forehead lines, and nose. “Their greatest advantage is that they’re the only filler category that’s reversible by an enzyme, hyaluronidase, which can ‘melt’ it almost instantly—this has been revolutionary in treating patients with filler mishaps,” he says. Radiesse, in the calcium hydroxyapatite category, has “excellent lifting capacity when injected deep into the bone and it has FDA approval for rejuvenation of the hand,” says Shafer, and Sculptra, in the poly L-lactic acid category, is a collagen stimulator that works gradually over the course of a series of treatments and works to repair the underlying skin structure overtime for a natural-looking correction.
Lorenc divides fillers into two broad categories—heavy/volumizing or light/superficial. “Radiesse is my go-to volumizing filler for the malar area [ed. note: cheek bones], the mid-face or the temporal hollow because the longevity is predictable,” he says, adding that other choices for these areas are the “heavy hyaluronic acid fillers such as Juvederm Voluma XC, and for deep deposition, Perlane-L from the Restylane family of HA products.” The lips, lip lines, and nasolabial folds require lighter, more superficial filler injections; Lorenc tends to treat these areas with Restylane and Juvederm hyaluronic fillers and Belotero.