Fillers: What are they?
Fillers are injectable substances (in the subcutaneous tissue or in the deep dermis) widely used in aesthetic medicine to counteract imperfections of various origins (acne scars, lesions associated with surgical trauma, wrinkles and other signs of skin aging, etc.), or to give volume and filling to "empty" areas of the face or body (such as, for example, thin lips), or to reshape certain areas of the face and body (cheeks, cheekbones, buttocks, etc.).
To achieve the aforementioned objectives, there are several types of fillers that can be used. However, basically, we can distinguish two different types of fillers:
- Resorbable or biological fillers .
- Semi-permanent or partially synthetic fillers .
- Permanent or completely synthetic fillers, otherwise called non-absorbable fillers .
Absorbable fillers
Absorbable fillers, biological or superficial, if you prefer - also defined as surface fillers - are so called because they are completely reabsorbed by the skin (as they are progressively metabolized).
Indicatively, the duration of their effect varies from 3 to 10 months, but it is heavily influenced by factors that are strictly individual and related to the individual's lifestyle (stress, smoking, nutrition, etc.).
Superficial fillers are particularly suitable for filling and filling wrinkles around the eyes / mouth, thus rejuvenating the aesthetics of the face. The use of this type of substance has several advantages, in fact the absorbable fillers:
- They do not require a recovery time: after filler injections, normal daily activities can be resumed.
- They are well tolerated by the skin (especially those with hyaluronic acid);
- They ensure an effect that is as natural as possible.
On the other hand, injections of biological fillers - similar to many other cosmetic treatments - can cause some undesirable effects, albeit minor, such as:
- Redness located in the treated area;
- Edema;
- Appearance of small hematomas and ecchymoses.
Types of Absorbable Fillers
Among the main types of biological fillers currently used by aesthetic medicine, we recall:
- Bovine collagen (eg Zyderm, Zyplast).
- Autologous collagen (eg Cosmoderm, Cosmoplast).
- Hyaluronic acid (eg Restylane, Perlane, Perfectha). The latest generation of hyaluronic acid fillers have a slower absorption, which allows you to prolong the desired soft-lifting effect for up to a year or more.
- Agarose gel : natural polymer of algal derivation (from algae).
- Endoplast 50 .
- L-polylactic acid (eg. Sculptra): stimulates the synthesis of neocollagen resulting in a lifting effect. Therefore, the filling effect is not immediate as for the other types of fillers. It is indicated for the treatment of fine wrinkles, small furrows or natural folds of the skin. Furthermore, the polylactic acid filler is also used to increase the volume of cheekbones or chin.
Semi-permanent fillers
The semi-permanent fillers belong to the so-called depth filler group. These substances can be injected both into the subcutaneous tissue and into the deep dermis.
They are particularly indicated to increase the volume of lips, chin, cheekbones and to mask deep cutaneous depressions typical of aging.
Types of Semi-permanent Fillers
The main semi-permanent fillers still used are:
- Calcium hydroxyapatite (eg Radiesse): it is a type of filler capable of performing an exceptional rejuvenating effect.
- Hyaluronic acid associated with an acrylic hydrogel (eg Dermalive).
- Polymethylmethacrylate microspheres in collagen : filler used above all for lip filling (ex. Artecoll).
Permanent fillers
Permanent, synthetic or non-reabsorbable fillers are particular substances that the body cannot in any way metabolize, unlike what happens with biological fillers and semi-permanent fillers. Together with the latter, the permanent fillers belong to the group of depth fillers.
Given the body's inability to metabolize them, permanent fillers remain in the subcutaneous tissue - or in the dermis, depending on the case - definitively. They are indicated to correct depressions and furrows in the skin that are much deeper than simple expression lines
They have the advantage of being able to be removed in case of unpleasant aesthetic effect. On the other hand - in addition to cryptic side effects - there is an increased risk of allergic reactions to the prosthesis, as well as the risk that it may break or migrate to other sites with the risk of going to compress the nerve endings. In addition, their safety in use is somewhat questionable in the long term and can cause serious side effects, such as infections, abscesses, fibrosis and filler granulomas, loss of sensitivity and difficulty in moving the treated area.
Types of Permanent Fillers
The permanent fillers derive from polymers with alkyl-amidic bonds and polyacrylamide. Therefore, among the main substances used, we find:
- Polyacrylamide gel (eg Aquamid).
- Silicone in prosthesis / injectable.
Lipofilling
A separate discussion can be made for lipofilling. A particular technique of cosmetic surgery that allows to rejuvenate, fill or remodel different areas of the face and body.
Lipofilling consists of the injection of autologous fat - taken from the patient himself - instead of the common fillers described above. For this reason the adipose filler can be considered a natural filler (but not reabsorbable, since it is reabsorbed minimally just after the operation and then remains in the area where it was inoculated).
The technique that allows the injection of this natural filler - known, in fact, as lipofilling or lipostructuring - involves the taking of a known quantity of fat cells (of fat) from a specific area of the subject's body, their purification and, subsequently, their injection in areas where there are imperfections to be corrected (such as wrinkles) and emptying points to be filled or remodeled (such as, for example, lips that are too thin, cheeks emptied, cheekbones, etc.).
For more information, read the in-depth article: Lipofilling.
