Should Dermal Fillers be Permanent?

by Alexandra Kilpatrick

HSP dermal fillers

They may not be as familiar or popular as Botox, but for those who want minimally invasive procedures, dermal fillers have a wide appeal.

Dermal fillers are injectable agents used cosmetically to fill in lines, add volume to the face, plump lips and address signs of aging.

Nearly 1.9 million hyaluronic acid dermal filler procedures were performed in the United States in 2013, according to the American Society of Aesthetic Plastic Surgery.

Dermal fillers were also the second most popular procedure performed on women after Botox in 2013, according to the American Academy of Facial Plastic and Reconstructive Surgery.

HA fillers are the most popular and have far surpassed bovine collagen as the most popular agent since the FDA approval of Restylane in 2004. Other FDA-approved HA fillers like Juvederm and Belotero are available in the United States.

Radiesse, a form of injectable calcium hydroxylapatite (CaH) was FDA approved for aesthetic use in 2006 and widely used in the United States to fill in nasolabial folds, also known as parentheses lines.

Both HA and CaH fillers contain molecules naturally found in humans. HA is an intracellular and extracellular substance found throughout our bodies, while CaH makes up 70 percent of our bone structure. Both fillers are naturally metabolized by the human body and tend to be tolerated well if used properly.

The FDA first approved the bovine collagen filler Zyderm I in 1981. However, reports of paraffin injections date back to the early 20th century. Silicone has been injected in the face and other body parts for decades.

The FDA released guidelines in 1991, banning the sale of injectable silicone for aesthetic purposes. The FDA recently approved monitored clinical studies to assess the safety of injectable silicone, but none of these studies have been completed yet.

“A common question I receive in my practice is, ‘Why can’t fillers be permanent?’” Stephen Prendiville, M.D., the only fellowship-trained facial plastic surgeon in Fort Myers certified by both the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology, said in a press release.

“This is a reasonable question since most fillers last between six months and a year and our natural desire is to have a more enduring product. The simple answer is that aging and its effects are dynamic. After our mid 40s, the fact is a changing canvas because of the sun, stress and our genetic code.”

The FDA approved the filler Artefill, which contained bovine and polymethylmethacrylate (PMMA) spheres, for aesthetic use in 2006. Since PMMA cannot be metabolized by the body, the filler is considered permanent.

“The deleterious effects of such compounds can present themselves many years later,” Prendiville said in the release. “I have seen patients with granulomas five years or more after having had PMMA injections. In my opinion, a happy patient at nine months with an absorbable product is far better off than a patient with ongoing problems at five years.

“I would encourage [users] to exercise caution when considering ‘permanent fillers’ for reasons of safety and based on the fact that there are so many great products that are well tolerated on the market. Without question, longer lasting and/or permanent fillers belong in the hands of an experienced facial plastic surgeon, plastic surgeon, dermatologist or occuloplastic surgeon.”

If you or someone you know would like to learn more about plastic surgery, please feel free to schedule a consultation or contact one of our representatives today!

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Should Dermal Fillers be Permanent?