Guide to Filling Wrinkles

Learn about all the different kinds of wrinkle fillers.

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Because Restylane is a gel, it cannot be mixed with local anesthetics. Without lidocaine, the injections hurt and so some sort of anesthetic is usually used. Outside the United States, different types of Restylane are available. One, an experimental hyaluronic acid mixed with the anesthetic lidocaine, is currently in development. Early reports indicate that injection of this material hurts less than other hyaluronic acids. Restylane is most commonly injected into the fine wrinkles around the mouth and face. It is less effective for the deeper wrinkles and folds. It can also fill depressions of the face and nose.

Other brands of hyaluronic acid are also available. Hyalaform is made from roosters’ combs, as opposed to the test-tube production of Restylane. Plastic surgeons say that Hyalaform may disappear sooner than Restylane—perhaps after just three months. Restylane packs four times as much hyaluronic acid into its product as its competitors, which may explain its better clinical results. There may be a higher allergic reaction rate with Hyalaform than Restylane.

Puragen
This is a souped-up hyaluronic acid. The Mentor Corporation has altered the molecule to make it more stable. That means it takes longer to fade away. Puragen Plus also has the anesthetic lidocaine added to the gel, making injections less painful. Puragen is already approved in Europe and will most likely be approved in the United States.

Radiesse
When a product changes its name, it reminds me of a Dragnet episode: ‘‘The names have been changed to protect the innocent.’’ This injectable product, formerly called Radiance, is now called Radiesse (apparently, the original name was too close to other medical products). Radiesse is made of calcium hydroxylapatite, the building block of bone and teeth. Other chemicals in the mix have long been allowed as the carriers for injectable medications. Radiesse is completely synthetic; no animal products are used in its production. That gives assurance that infectious diseases cannot be contracted through its use. The nontoxic chemical degrades over time, broken down into calcium and phosphate, normally present in the body. Collagen (or scar) surrounds the degraded Radiesse particles, allowing the filler to last a long time.

Radiesse is not used for fine wrinkles but for deeper depressions, such as the nasolabial folds. Approved by the FDA for tissue filling in 2006, its list of uses has been steadily growing. Not only has it been used to fill the marionette lines between the corner of the mouth and chin, but it has also corrected sunken cheeks, filled dimples, and rejuvenated the depression between the jowl and the chin. Radiesse is also being used as a nonsurgical implant to make the chin and cheek bones larger.