Wrinkles caused by muscle activity can appear even at a young age and can be effectively treated with Botox (crow’s feet, frown lines, etc.). Wrinkles resulting from the loss of the skin’s natural elasticity are best corrected through lifting procedures (facelift, etc.). The loss of subcutaneous fat tissue can only be compensated by introducing autologous fat or synthetic fillers.
The first artificial filler was most likely paraffin, which was already used around 1900 to correct tissue defects. Due to severe complications, its use was soon discontinued. Around 1950, animal collagen and silicone oil were used. Collagen often caused allergic reactions (due to animal protein), while silicone oil led to intolerance reactions. Around 1990, the first hyaluronic acid preparations were introduced to the market. Hyaluronic acid is a sugar molecule naturally found in the human body and possesses several important properties. It binds water in the skin (up to 1000 times its own weight), forms a mechanically stable three-dimensional network between cells and collagen fibers, and stimulates the production of fibroblasts (connective tissue cells). Its ability to bind water gives hyaluronic acid its special flow properties (“viscoelasticity”), making it particularly suitable for injection purposes.
A functional classification of fillers can be made into the following categories:
- “Completely degradable” (resorbable), breakdown occurs within 4–6 months
- “Slowly degradable” (slowly resorbable), breakdown occurs within about one year
- “Non-degradable” (non-resorbable), not broken down by the body
- Combination products
Hyaluronic acid belongs to the resorbable fillers currently available under the following brand names: Hylaform, AcHyal, Belotero, Hyal2000, HylanSeS, Jolidermis, Juvéderm, Perlane, Puragen, Restylane, Revanesse, Rofilan Hylan Gel, and Teosyal. Resorbable fillers also include collagen-based products such as Resoplast, Zyderm, Zyplast, Fibrel, Permacol, Evolence, Cymetra, Dermalogen, CosmoDerm, Cosmoplast, Autologen, or Isologen.
Slowly resorbable fillers include New Fill and Radiesse.
Non-resorbable fillers include Amazinggel, Aquamid, Argiform, Evolution, Outline, Bio-Alcamid, Adato Sil-ol 5000, Bioplastique, Dermagen, Silicex, or Silicone 1000.
Combination fillers containing both resorbable and non-resorbable components include Artecoll/Artefill, Dermalive, or Dermadeep.
Permanent or slowly resorbable fillers carry a certain residual risk of intolerance reactions or nodule formation. For this reason, I only use hyaluronic acid-based fillers or perform autologous fat transplantation.
Fillers can be used in all facial areas; the most common applications are lip augmentation, correction of nasolabial folds, correction of dark circles under the eyes, and volumization of the cheekbone region.
When applied correctly, fillers are safe and have minimal side effects. After treatment, there is usually no significant pain or downtime. Moreover, the therapy provides visibly noticeable improvements with minimal time and manageable financial effort. With consistent use over the years, it may be worth considering the use of autologous fat as a filler. Although the initial cost is higher due to the surgical procedure, in the long term it is more cost-effective, as once the desired volume is achieved, no further injections are required.
