Fillers: an introduction

Unfortunately, part of aging can include the loss of tissues of the skin and underneath the skin. When prevention with sunscreen was not enough one option for treating this type of aging includes fillers. The market for fillers has exploded in the last decade with new classes of fillers, each of which have strengths and weaknesses. Here are some thoughts on fillers:

1. Get fillers from a reputable dermatologist or plastic surgeon. Even a good filler in the wrong hands can cause problems including infection, lumps (called granulomas by dermatologists), and, of course, bad appearance. It is an unfortunate and not uncommon problem to see patients who had filler injections performed by poorly trained doctors with bad reactions like infection and granulomas. Some of the infections are easily treated by short courses of antibiotics but other infections with bacteria related to tuberculosis require years of treatment and/or surgical excision.

2. Different fillers are useful for different things (and have different risks). The materials commonly used to fill range from hyaluronic acid (a substance the body makes itself) to hydroxyapatite (one of the components of bone) to poly-L-lactic acid (basically liquid stitches like we would use as physicians). There are many other types of fillers, and there are things like silicone I do not think should ever be injected into skin for health reasons.

3. In skilled hands there are many possibilities with each of the fillers, and there is no single "best filler" for everything. In discussion with your dermatologist you can make a plan that fits your needs. In a nutshell, some of the hyaluronic acid fillers last not quite as long as the poly-L-lactic acid filler or the hydroxyapatite filler, but the body may be less likely to have a reaction to it. Also, there is an antidote—albeit an imperfect one—to hyaluronic acid fillers in case you do not like the results.



To summarize, if you think you are interested in a filler, talk to a dermatologist or plastic surgeon. Some doctors are more comfortable using some fillers over others. Steer clear of any doctor that offers you a "permanent" filler, or whose training is in question. In the right hands and for the right patient, however, fillers can enhance beauty and take away years of age.