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What Filler should I use?

 Boy, how the world of “fillers” has changed since I started doing plastic surgery in the late 80’s. Originally we had bovine (cow) collagen and that was it. Patients had to be skin tested weeks prior and the bovine collagen did not hang around very long. It worked and made explaining the options easy, but greatly limited the quality and longevity of the results. Now it seems a new variation of a filler comes out every 6 months.  Without providing a complete list, my office now has five separate Restylane products, five separate Juvederm products, Belotero, Sculptra, and Radiesse, not to mention fat injections. Remember this lists just some of the worldwide options of fillers.  We aren’t even discussing the neuromodulators like Botox cosmetic, Dysport, or Xeomin here.
    The point of the above list of over 14 separate filler options is to remind you to not try to figure out what is the best filler for you. Try not to let the latest article in “O” magazine, Allure, or Glamour tell you what is best. Rely on your doctor’s expertise to choose the best filler for you. Many of the fillers fall into general categories. Some are less dense and great for fine surface lines. Some fillers are a bit more dense and terrific for lip volume and might last a bit longer. Others might be denser still, last even longer, but be more ideal for deep filling for the cheeks or chin, but not good at all for finer lines. To “heavy” a filler too superficial will be lumpier or stiffer than you my like. The different companies trademark/copy write their product, but it may be interchangeable with another companies product. Some of the differences are nominal and just marketing and slight variations on the same theme. While some of us have extensive experience with most of the available fillers some offices might opt to have a more limited set of options. This does not mean that office isn’t great at fillers for they may choose to get fewer options in bulk to offer a better price to the patients they serve. Also, one upside for some practices is limiting their options make them very familiar with what they do inject so they know how it works in their hands and are very comfortable with it.
    There is a great deal of science that goes into the elasticity, density, water absorption, and breakdown of a given filler and it makes no sense for you to try to figure all that out. My advice to my patients is to let me decide what filler to use to accomplish the ideal goals for the problems you are trying to fix. Yes, some products cost more than others so it’s good to let the staff and doctor know if you have a specific budget for that may help guide us to one filler or another. Just as I sit and write this blog I have injected six different types of injectibles this morning. Obviously, different patients had different issues to address, requiring slightly different products for different problems. I urge you not to try to master the science and variations of this growing list of fillers, let your surgeon your guide.
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