Many fillers are currently available and more are on the horizon. The original fillers were Zyderm and Zyplast, collagen products derived from cowhide. Collagen typically lasts for 3 months. Because the protein in cow collagen is slightly different from human collagen, some may be allergic so testing is required prior to treatment. Recently, Cosmoderm and Cosmoplast were released. They are both human collagen and therefore do not require skin testing.
In 2003, Restylane, a hyaluronic acid derived from bacteria, became available in the United States. With a duration of about twice that of collagen, this product has soared in popularity and is now the most common filler used. Its use has expanded beyond the original FDA approved use (treating the nasolabial folds) to lip augmentation, tear troughs, the brow and the pre-jowl areas. Because hyaluronic acid is identical across species, testing is not necessary. Perlane, a sister product to Restylane, was FDA approved in May of this year. Its larger particle size allows for more robust augmentations.
In 2006, the FDA approved three other fillers which we currently use: Juvederm, Radiesse and Sculptra. Juvederm is another hyaluronic acid product derived from bacteria, much like Restylane. Its duration is similar to Restylane. Radiesse is a suspension of bone mineral. Radiesse may last a year or more. Sculptra is polylactic acid, a biodegradable polymer that stimulates the production of collagen. The filling effect of this product is not immediate, but it may last up to two years.
All fillers are administered in the office either with topical anesthesia or with an injectable anesthesia.