Injectable fillers have become an integral part of nonsurgical enhancement of the face and body. A wide variety of fillers are currently available in the United States, and even more are available worldwide. In the last few years, there has been an explosion in the use of injectable fillers. Due to the specific nature of each filler material, each one has different applications, advantages, and disadvantages. In this chapter, we will be discussing all of the available fillers and the various techniques we employ during treatment of the face and body.

MATERIALS AND MECHANISMS OF ACTION

The mechanism of action that all injectable fillers share is the augmentation of an existing area to a desired target volume. There are permanent and semipermanent fillers. In the nonpermanent group are short-acting, intermediate, and long-acting fillers, depending on the length of duration of the product.

The collagen-based fillers include bovine collagen (Zyplast, Zyderm) and recombinant human collagen (Cosmoplast, Cosmoderm), which are in the short-acting category. The older bovine collagen fillers require a skin test prior to use, whereas the newer human collagen fillers do not. Collagen-based fillers are injected into the dermis, in the superficial and deep planes, depending on which one is being used. These fillers are manufactured with lidocaine, making the injections easier to tolerate. Collagen-based fillers can be used anywhere on the face but are most commonly used in the perioral area, especially the nasolabial folds and lips. Collagen-based fillers are injected through a 30-gauge needle.