It happens everyday.  Patients ask how long they can count on their dermal filler lasting.  The problem is, is that there is no quick and easy answer.  There are a number of variables that factor into filler longevity, with the ultimate unknown being that there is no way that a physician can determine how one’s body is going to degrade a particular filler.

In the US, the majority of patients are injected with Hyaluronic Acid (HA) fillers.  The commonly known HA fillers are:  Juvederm Ultra, Juvederm Ultra Plus, Restylane, Perlane, Voluma, and Belotero.  The differences between the HA fillers are their manufacturing process, and the concentration of the HA in the filler.  The harder the HA is for the body to break down, the longer it will last.  A larger particle of HA has less surface area then multiple smaller particles taking up the same space.  Less surface area means there is less area for the cells to “chew up” the HA.  In general, larger particles will last a little longer than smaller particles.  Another factor in HA fillers is how tightly the particles are bound together.  Cross-linking, adding bonds between molecules of HA, has been shown to significantly add longevity.  All HA fillers are a combination of cross-linked and non cross-linked HA.  Too much cross-linking leads to a filler that is very hard to inject, and has led to more complications (in a filler that is no longer on the market).  Non cross-linked fillers last only 3-4 months and are hardly used anymore.  One last variable in HA fillers is their ability to attract water, their hydrophylic properties.  The more they attract water, the longer the HA filler gives a correction.

The fillers that are collagen stimulators, tend to lead to longer longevity.  Fillers in this group are:  Radiesse, Sculptra, and Bellafill.  While studies have shown a very mild collagen response to the HA fillers, the visible volume correction with the HA fillers is the gel, not the collagen.  With the collagen stimulators, the body responds to what is injected by creating an inflammatory response and lays down collagen.  Until the particle is degraded by the body, collagen will continue to be produced.  Radiesse is made of calcium hydroxylapatite, and is the shortest duration in this group.  Artefill should be considered a permanent filler, because its component, Poly Methyl Methacrylate (PMMA), does not get broken down by the body.  Sculptra has consistently given about 2-3 years duration in studies and in the authors experience.

The location in the face a filler is injected is one of the most important factors to determine longevity. Areas where there is more movement, there is faster breakdown.  In order of increasing duration in the face, the order is (in the author’s experience):

  1. Lips
  2. Marionette
  3. Nasolabial Folds
  4. Tear Troughs
  5. Cheeks
  6. Temples

(Forehead, nose, earlobes are variable)

A couple more very important variables that should be mentioned.  The more filler that is injected, the longer it will last.  This applies to all the fillers.  Also, filler doesn’t stop working all of a sudden.  It takes months of gradual loss to notice a difference in volume.  In fact, even when the patient believes there is no longer results, biopsies have proven that there is still filler present.

After all the above explanation, the author’s experience with the commonly used fillers is:

  1. Lips:  HA fillers give about 4 months, longer with recurrently injected lips.
  2. Tear troughs:  HA’s – about 9-12 months, Sculptra and Bellafill – years.  Juvederm could last years and should never be injected in tear troughs.
  3. Nasolabial:  similar to tear troughs
  4. Temples:  HA’s – 12-18 months, Sculptra and Bellafill – years
  5. Cheeks:  HA’s – 18 months, perhaps 2 years with Voluma; Sculptra and Bellafill – years

Remember that individual results are unpredictable.  These are generalizations and offer no guarantee as to how long a patient’s results will last.  There are many variables that factor into longevity that are listed above, not to mention how each individual responds, degrades, a certain filler.

Blog: http://stevenfweinermd.wordpress.com/

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