Types of Permanent Fillers

	Softening of nasolabial folds with hyaluronic acid.

Permanent fillers can give results ranging from semipermanent to permanent. Some of the newer permanent fillers are liquid blends of natural materials and tiny particles of vinyl or polymer. Other permanent fillers are solid or mesh-like implants, inserted through tiny incisions.

Hybrids

One of the newer filler products, known as a hybrid filler, is considered permanent. Marketed under the brand name Artefil ™ , it is a blend of microscopic plastic beads and human collagen. The body absorbs the collagen in a few months, but the permanent tiny beads stimulate the production of the body's own collagen. The new colla-

gen encapsulates the beads, material are used to fill nasolabial folds and to augment lips. making the filler permanent.

The result: skin volume is boosted. The hybrid filler may be used for wrinkles, deep nasolabial folds, frown lines, and acne scars. Although used by some physicians, Artefil has not yet received official FDA app ro val.

	Samples of synthetic fillers. These strips of Advanta implant

Synthetic Implants

These solid, permanent implants are made from a medical-grade polymer similar to Gore-Tex ™ , the rubber used to make boots and raincoats.The polymer is firm but flexible. The implants come in various forms and shapes, including sheets, mesh-like strips, oval pieces, and round, tubular threads. Synthetic implants are often used for filling nasolabial folds.

Silicone

One well-known though controversial permanent filler treatment is silicone. Liquid silicone has been offered for years in microdroplet injection form by some physicians who believe that, used appropriately, it is safe and effective. However, debate over the safety of silicone continues in the medical community. Many doctors avoid silicone because of its history of causing problems in some patients, including migration or shifting of the silicone, infection, and hardening.

Are You a Candidate for Fillers?

Because there are so many ways to fill different types of wrinkles and reshape facial contours, you and your physician will want to review the options together and select the treatments that will work best for you. It is a very customized process, and often a combination of different types of fillers will produce the best results.

If you have a history of allergy to meat or other bovine products, or severe allergies in general, you may not be a good candidate for bovine collagen. About three in one hundred people test positive for bovine allergy.

Your Filler Procedure

For virtually all the injectable fillers, no advance preparation is needed. The exception is a simple skin test to rule out the possibility of an allergic reaction to bovine collagen. After a tiny amount of the solution is injected in a location elsewhere on your body, such as the arm, you'll need to watch the area closely for four to six weeks for signs of an allergic response, such as severe itching, swelling, or redness. Most reactions occur within three days, but the four-to-six-week window is necessary because a reaction could occur anytime during this period.To be certain, most doctors recommend a second allergy test two weeks after the first one.

Of course, if your doctor is using the newer hyaluronic acid, Restylane, allergic reaction will not be an issue. More and more doctors are using this acid as a soft tissue filler to reduce wrinkles.

Filler Injections

Once you and your doctor have decided where you would like to have fillers injected, the areas are cleaned with alcohol. Most fillers require an anesthetic, often a nerve block anesthetic. A nerve block is a deeper, more targeted injection of anesthetic into tissue containing sensory nerves in areas around the lips.

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