In the beauty industry, it’s rare to see a product that has existed for almost two decades suddenly spike in popularity, especially within a new demographic from its originally-intended audience. Dermal fillers have been around for 16 years, but they’ve had quite a renaissance in the last five. This is due largely in-part to women like Kylie Jenner who are more open about their use of filler to accentuate their features; Jenner even even created a multi-million dollar cosmetics empire around the buzz of her lip fillers. Recently, in her Paper Magazine cover story, Kylie admitted that her face has transformed, but not due to any facelifts or cut-crease shadow applications. Her explanation was simple: "It's fillers. I'm not denying that."
But what really are fillers, and what are the apprehensions around using them, aside from the evaporating social stigmas?
What Are the Different Types of Filler?
Firstly, there are a lot of options when it comes to types of filler. There are two principle manufacturers of injectable filler: the publicly-traded company Allergan, and Galderma, a wholly-owned subsidiary of Nestlé (yes, like the chocolate). Allergan is also the manufacturer of the widely-known and trademarked botulinum toxin wrinkle preventer, Botox, along with several models of the most-commonly used silicone breast implants. It’s safe to say that Allergan dominates much of the cosmetic enhancement market.
On June 5, 2006, Allergan announced the FDA’s approval of a family of hyaluronic acid (HA) dermal fillers for long-lasting correction of facial wrinkles and folds called Juvdérm. Juvéderm is a natural, biodegradable product, as is Galderma’s product, Restylane, and its family of competitive HA dermal fillers.
Today, both the Juvéderm and Restylane families of dermal fillers each have five different, but comparable products to address various facial concerns, like smoothing wrinkles and adding volume to sunken or depressed areas. Fillers also have different molecule designations, like high G prime. High G prime indicates a greater general density, or a thicker filler, which is more-likely used in areas to build more structure, like the cheekbones and mandible.
How Are Fillers Used?
Each product can be injected via a needle or a blunt-tip cannula. During the cannula technique, an initial injection site is created by a needle and then a tiny tube is inserted into the face to distribute the product (it's less scary than it sounds, since you're not watching this happen on your face), largely reducing bruising and swelling. It’s up to the discretion of the injector which technique is best for which filler and in what area, but we strongly recommend you go to someone who is trained in both methods. Additionally, both HA filler families dissolve naturally and gradually over time, generally between 8 to 24 months depending on the individual and the product used.
Which Filler Is Right For You?
Navigating which fillers to choose (and which technique) for different regions can be difficult, and using the right product is essential to achieving the most desired results. For definitive answers, we turned to two experts from both coasts: NYC-based cosmetic dermatologist Dr. Marnie Nussbaum, and Beverly Hills facial plastic surgeon Dr. Jonathan Cabin. If you’re considering dermal filler, or if you’ve had it before and want to know more, here’s our definitive guide to facial fillers to use according to each injection site.
Juvéderm & Restalyane
Juvéderm Voluma XC, Juvéderm Ultra XC, Juvéderm Volbella XC, Juvéderm Vollure XC, Juvéderm XC
Restalyane, Restalyane Defyne, Restalyane Refyne, Restalyane Lyft, Restalyane Sylk
The Injection Sites:
Dr. Nussbaum: “The cheekbones generally need more of a lift than the lower face. Therefore, we would use a filler with a high G Prime and particle size, such as Juvéderm Voluma XC, Restylane Lyft, or even Juvéderm Ultra XC if the skin is thin.”
Dr. Cabin: “Juvéderm Voluma XC via blunt-tip cannula. It’s a thick filler, so it adds structure and support. It is also the longest lasting HA filler (up to 2 years), so it is the best financial investment for this region.”
Dr. Nussbaum: “The chin usually needs projection from underneath, for which Juvéderm Ultra XC or Restylane Lyft may be used.”
Dr. Cabin: “Juvéderm Voluma XC via needle. Like [the] cheeks, it’s thick, which is great for structure, and again, it is the longest lasting HA filler.”
Dr. Nussbaum: “Nasolabial folds usually need a finer particle-size and have an easier flow. Therefore, Restylane, Juvéderm XC, or Juvéderm Vollure XC may be utilized, depending upon the patients’ needs.”
Dr. Cabin: “Juvéderm Vollure XC. A lot of times the nasolabial folds actually refer to two things: The 'shadowing' next to the nostril (called 'deep pyriform space' or 'ristow’s space') created by loss of soft tissue and bony volume in this area, and the deep crease or superficial wrinkle that extends from this area down to the corner of the mouth. Assuming you have to address both of these areas, I consider Juvéderm Vollure XC a 'hybrid' filler that can do both deep and superficial work. It also lasts 18 months, which is a nice bonus.”
Dr. Nussbaum: “Depending upon the desired aesthetic result, Juvéderm Volbella XC may be used, or Restylane Refyne, or Juvéderm Ultra XC.”
Dr. Cabin: “If I have to choose one, Juvéderm Volbella XC via needle. Most of my patients want a natural, hydrated, augmented lip, and are rarely in the market for the Kardashian/Jenner effect. In these cases, I go with Juvéderm Volbella XC for two reasons: It comes in a 0.6cc syringe (instead of the typical 1cc syringes most other fillers come in), and patients generally don’t need more than this in their lips. It is soft and natural looking and, most importantly, feeling. So, in kissing your partner, it is least likely to feel any different than a normal lip.
If someone really wants big lips, has super de-volumized lips, or needs me to build a lot of shape and structure, I opt for Juvéderm Ultra XC via needle. It is thicker than Juvéderm Volbella XC, and it loves water, so the lips can hold better shape and get super juicy.”
Dr. Nussbaum: “The jawline needs definition. Therefore, Juvéderm Ultra XC, Juvéderm Voluma XC, or Restylane Defyne may be used.”
Dr. Cabin: “For posterior jawline (toward the angle of the jaw) I would use Juvéderm Voluma XC with cannula or a needle. Posterior jawline, just like filling the chin and cheeks, is building onto bone.
For anterior jawline filler (toward the chin, also called the “post-jowl sulcus”) I would use Juvéderm Vollure XC with a cannula. Anterior jawline, which is just behind the chin, is very susceptible to smile-related movement. For this reason, I like to fill here at multiple depths to ensure it looks perfectly natural with movement. That’s why Juvdéderm Vollure XC, a great 'hybrid' filler, is perfect for this.”
Dr. Nussbaum: “Tear troughs need a filler that will not draw in a ton of water, while also avoiding the Tyndall effect (the bluish tint under the skin). Therefore, Resytlane is ideal for this area.”
Dr. Cabin: “Restylane with cannula. Under-eye filler is the most challenging in my hands, and the most overused in our industry. The most important consideration with under-eye filler is that a filler takes in as little water as possible (or, in technical terms, is relatively 'hydrophobic'). Otherwise you’ll trade under-eye hollows with bags made mostly of water. Restylane is relatively hydrophobic, and tends to look the most natural under the eyes in my hands.”
"The thing about filler is to use the correct filler for the right patient in the right amount,” Dr. Nussbaum emphasizes. Like many beauty trends, both experts agree that with filler, less is definitely more.