Facial Fillers for Wrinkles

Overview

Facial fillers are manufactured products or materials from your body which are injected to temporarily erase wrinkles. At Mayo Clinic, treatments are performed exclusively by physicians or mid-level providers such as physician's assistants. Mayo Clinic providers strive to give you the most natural look and result with wrinkle fillers. They choose the best skin filler or combination of fillers to meet your needs. Your provider will discuss the options with you. Mayo Clinic offers competitively priced treatments.

Facial Filler Options

Collagen Injection
Collagen is a fibrous protein found in skin, bones and connective tissues. Collagen helps give skin its texture and elasticity. Aging, sun damage and smoking break down collagen and contribute to the development of wrinkles.

The collagen that is injected can come from several sources, including cow (bovine) skin, pig (porcine) skin, your own skin, or skin from a deceased donor. Collagen is injected into the skin to treat certain acne and other scars on the face, and to fill furrows on the forehead, cheeks and lips. It can stay in the skin for up to six months or, in rare cases, as long as a year. Collagen is ultimately absorbed by the skin and its effects disappear. Collagen must be reinjected every three to six months to sustain the appearance of fullness. To get the longest-lasting results, the surgeon may slightly overfill with each injection.

Purified bovine collagen, derived from cow skin, is the most common skin filler and has been used to treat skin defects since the early 1970s. It is approved by the Food and Drug Administration. Before receiving an injection of bovine or porcine collagen, patients will undergo skin testing to determine the potential for an allergic reaction. Collagen also can be derived from the patient's skin, grown in a laboratory, or obtained from deceased donors. No allergy testing is required when laboratory-produced collagen is used.

Collagen injection is relatively safe. Because skin is more sensitive than fat, more pain is associated with collagen injections than with Botox™, which is injected under the skin and into the muscle. About 3 percent of patient have an allergic reaction to collagen injections.

Hyaluronic acid
Hyaluronic acid products manufactured or derived from rooster combs are injected to decrease fine lines, creases and depressions and to restore skin volume and fullness. Hyaluronic acid injections may be combined with Botox™ or other injection treatments.

One product, Restylane™, has been used by cosmetic surgeons since 1996. It is a non-animal-based product, which eliminates the risk of allergic reaction, and is effectively used to diminish moderate-to-severe facial wrinkles, such as the nasolabial folds between the nose and the corner of the mouth. Prior to receiving a Restylane™ injection, you will be instructed not to use aspirin, nonsteroidal and anti-inflammatory medications, herbal supplements or high doses of vitamin E for three weeks. These products may increase bleeding or bruising at the injection site.

A topical anesthetic is applied prior to injecting the skin. Results of the treatment usually last at least six months.

Juvéderm™ has a higher concentration of hyaluronic acid than Restylane™. It is used to diminish moderate-to-severe facial wrinkles, including nasolabial folds, wrinkles on the lower and upper face, small wrinkles directly above the lips, and to create fuller lips.

To minimize bleeding or bruising at the injection site, patients should not use nonsteroidal and anti-inflammatory medications, aspirin, herbal supplements or high doses of vitamin E three weeks prior to a Juvéderm™ injection.

Juvéderm™ use does not cause an allergic reaction, because it is a non-animal-based product. An anesthetic cream is applied to numb the skin prior to the injection. Results of treatment usually last six months to one year.

Hydroxyapetite
Radiesse™ is considered a semipermanent filler for deeper skin wrinkles and creases. It is not intended for high movement areas such as the lips. It also can be used to contour the jawline or correct facial asymmetry or facial dips. Radiesse™ injections may last one to three years. When used for contouring, injections last up to one year.

Fat transplantation
Fat may be harvested from certain areas of your body, often the lower abdomen, through liposuction and then placed in a syringe and injected through small incisions into the cheek, tear trough, temple or forehead. Like bovine collagen, the effects are unpredictable and may be temporary. Your surgeon may choose to over-inject fat to extend the results of the procedure. The care taken when fat is harvested, filtered, prepared and injected is crucial and helps yield more lasting results.

To get the desired results will likely require more than one session of fat transplant injections, as well as overfilling the site to compensate for the body's reabsorption of the fat. Bruising usually diminishes within three weeks.

Risks

Risks associated with treating facial wrinkles include, but are not limited to:

• Allergic reaction at the injection site or throughout the body. Signs of a systemwide reaction include rash, hives, swelling or flulike symptoms.
• Infection
• Irregularities in surfaces, contours and firmness can be associated with skin augmentation procedures.