Dermal fillers are gel-like substances injected into different areas of the face to smooth lines, wrinkles and deeper folds. Fillers are also used to restore volume to the face where tissue has degenerated with age or where lipoatrophy (fat loss caused by disease) has caused the cheeks to collapse. They can also be used to fill in pockmarks and acne scars and to contour or reshape facial features, adding volume to lips and cheeks. More permanent fillers can even be used to reshape the nose and jawline.

There are a multitude of different fillers on the market, ranging in longevity, composition and viscosity, making the choice for the consumer a complicated one. While your cosmetic doctor is best placed to advise you on the filler most suitable to your needs, educating yourself before your consultation will make you feel more comfortable and confidant when it comes to discussing your options. Dermal fillers can be used in conjunction with botulinum toxin injections for a cumulative and complementary result.

Following are descriptions of the most common fillers in use in Australia.

Aquamid

Aquamid is a long-lasting injectable filler used to restore or add volume to the skin. Many practitioners are using it to enhance features in a way which would have required surgical implants in the past.

Aquamid is used to fill in nasolabial folds, enhance cheekbones, lips, or the nose and to smooth out wrinkles or folds in the skin. The gel is composed of 97.5 percent water and 2.5 percent polyacrylamide, and once injected, it integrates completely with the body's tissue.

Aquamid is non-absorbable, biocompatible, non-toxic and does not migrate from the injection site, which means the results will last for years. Aquamid is extremely soft to the touch. It feels and looks like part of the body.

Collagen

Collagen fillers consist of sterile, purified reconstituted collagen fibril from cow skin and may be injected into the skin to fill out facial wrinkles and folds, skin depressions and some types of indentation resulting from scarring. It is ideal for lip enhancement, biocompatible and has an excellent 25-year safety record. Testing is required before a collagen treatment to ensure allergic reactions do not occur.

Esthélis

Esthélis is a resorbable hyaluronic acid (HA) gel injectable filler. It is used to treat a variety of wrinkles including nasolabial folds, glabellar lines and crow's feet, and is also used to augment the lips, cheeks and chin. Because hyaluronic acid is a substance which occurs naturally in the body, Esthélis is bio-compatible, bio-degradable and has a proven safety record. The gel is a monophasic polydensified substance - exceptionally smooth and soft - making it particularly suited for treating fine lines and those with very fine skin, where more granular injectable gels can cause visible lumping. Greater volumes can be injected into the mid or deep dermis to restore volume to larger areas of the face. Treatments last up to nine months, depending on the patient.

Fat transfer

Fat is harvested from the patient's own body, usually from the thighs or buttocks, cleaned thoroughly and prepared for injection into the face. It is used to fill nasolabial folds, enhance lips and restore volume to the cheeks. The down time is longer than for other dermal filler treatments, with recovery lasting anywhere up to 10 days. Some of the injected fat is reabsorbed by the body over time and results last an average of three to five years depending on the patient.

Fortélis Extra

Fortélis Extra is pending Therapeutic Goods Administration approval for use in Australia. It is a resorbable implant developed from HA with a volume-enhancing effect specifically to treat folds and facial depressions, deep contours and hollows. It can also be used to increase lip volume and has amazing elasticity. Results last up to 12 months depending on the patient.

Juvéderm

Juvéderm is a resorbable HA gel filler available in two formulations - Juvéderm Ultra and Juvéderm Ultra Plus. Ultra is a more delicate formula, designed to correct fine wrinkles and for contouring, whereas Ultra Plus is more robust and is suitable for adding volume to larger areas such as the cheeks. Juvéderm fillers have a high concentration of cross-linked particles, which increases the longevity of the products and creates an exceptionally smooth consistency. This makes it easier for practitioners to inject and manipulate, which means more accuracy in placement and less pain for the patient during the procedure. Results last up to 12 months.

Perlane

Perlane is an injectable stabilised HA gel, composed of a relatively higher concentration of HA and intended for deeper injection to restore lost volume and for correcting facial wrinkles and folds. Results last for at least six months to a year depending on the patient.

Radiesse

Radiesse is a longer lasting injectable filler made from calcium hydroxylapatite microspheres suspended in a water-based gel. Radiesse has a two-fold effect: on injection it immediately restores volume and it prompts a process known as collagenesis, stimulating the growth of new collagen in targeted areas. Radiesse is not suitable for the lips. Results last anywhere from 12 to 18 months depending on the patient.

Restylane

Restylane is an injectable stabilised HA gel filler. Its medium-sized particles combine with the body's own HA to enhance the volume of targeted tissue and smooth lines. Biodegradable and biocompatible, Restylane is used to treat glabellar lines (vertical forehead creases between the eyebrows), the nasolabial folds (the folds which run vertically from the sides of the nose to the outside edges of the lips) and smokers' lines. It can also enhance volume in the lips and the cheeks, as well as to smooth lines on the forehead and neck. Results last for at least six months and sometimes longer depending on the patient.

Restylane Lipp

Restylane Lipp is an injectable stabilised HA gel filler designed especially for lip augmentation.

Restylane SubQ

Restylane SubQ is a stabilised hyaluronic acid (HA) gel filler designed for injection deeper under the skin to restore volume to large areas of the face.

Restylane Touch

Restylane Touch is similar to Restylane but the size of its HA particles is smaller, making it well suited to treating superficial lines and wrinkles.

Restylane Vital

Restylane Vital is designed for injection into the face, hands and décolletage to restore moisture and volume to sun-damaged skin. As well as increasing hydration levels, manufacturers claim it stimulates the production of collagen and elastin in the areas treated, helping to minimise the appearance of crêpey skin.

Sculptra

Sculptra is a long-lasting filler made of poly-L-lactic acid. It works by stimulating the body's own production of collagen and its results are gradual - as opposed to the more immediate results of other fillers. Two or three treatments are required and the first results are usually observable after around six weeks. It is used to treat deep nasolabial folds, folds around the corners of the mouth (marionette lines), sunken cheeks, wrinkles and lines in the cheeks or chin and deep scars.