How does Dr. Ridenour decide which filler to use?
Many patients are confused by the choice of a filling agent. This confusion arises because of the variety of products available and because of conflicting information received from marketing sources. Our choice of a filling agent is based on both science and art, taking into account several key considerations. Filling agents have differing properties that allow a knowledgeable physician to choose a "best product" or a "best overall product" for an individual patient's needs.
Key physical properties in choosing a dermal filler:
1. Extrusion force determines how easily a product is injected. Products with low extrusion force allow more precise delivery of the product and allow the use of smaller needles, thereby reducing trauma to the patient (e.g. bruising).
2. G-prime (g') refers to the "hardness" of a product. In general products with more hardness allow greater displacement or lifting of soft tissue. These can be very valuable when trying to shape the cheek or jawline for instance. Particle size and consistency influence many factors, including the "feel" of a product, how closely the product can be placed to the surface of the skin and in some cases how long the product lasts in the body.
3. Cohesiveness of a product determines how well that product "stays together" under the stress of injection. Products with greater cohesiveness tend to lift lines and folds better and may stay in position better than products of a less cohesive nature.
4. Water binding capacity is an important consideration in some fillers, particularly in products made of hyaluronic acid. These sugar molecules bind water to give the skin a natural plush appearance, but too much water binding can cause a swollen, edematous look.
5. Refractive qualities (light scattering) of some products are a consideration when using fillers in fine lines close to the surface of the skin. Some products are more prone to a bluish discoloration when placed at a certain depth, which is undesirable (Tyndall scattering)
Some of FDA-approved Filling Agents used at Ridenour Plastic Surgery
Juvederm Voluma® is the number one filler product world-wide. It is best suited for lifting of the cheek and mid-face area and is approved for 2 years duration by the FDA.
Juvederm Ultra® and Juvederm Ultra Plus® are hyaluronic acid products with exceptional smoothness and cohesiveness, making them our number one choice for filling fine lines and creases around the mouth.
Restylane® is a versatile filling agent made of hyaluronic acid. It can be used for a variety of applications and is a frequent choice of ours for treating the under eye hollows.
Perlane® is a similar product to Restylane® with a larger particle size that is best suited for the cheeks and nasolabial creases.
Radiesse® is made of calcium hydroxyapatite, a natural mixture of calcium, phosphorus and water found in teeth and bones. Radiesse is a firm product, making it an ideal filler for cheek and chin augmentation. A limitation of Radiesse is that it cannot be dissolved with an enzyme like the hyaluronic acids.
Sculptra® is a unique filler made of a biocompatible and biodegradable material known as poly-L-lactic acid. Sculptra induces your body to make it's own collagen. A series of 3 or 4 injections about one month apart allows for a gradual increase in facial volume and tone. Sculptra is ideally suited for patients with very significant fat loss and facial atrophy that desire a gradual correction over 3 to 4 months.
Artefill® is a long acting filler made of polymethylmethacrylate (PMMA). Distinct from other fillers on the market, the PMMA microspheres in Artefill do not degrade over time, resulting in a long-lasting correction. Concerns over the long-term safety of Artefill have diminished with 5-year safety data showing a similar safety profile to that of currently available short-term fillers. The main limitation of Artefill is that it cannot be dissolved and it should be considered a permanent product.