Dr. Nick Milojevic

Milo Clinic

One of the leading british aesthetic doctors


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Hyaluronic acid dermal fillers in anti aging medicine – facts, myths and innovations

In the ever growing and evolving, magical world of anti aging medicine, we can use hyaluronic acid dermal fillers as a multi talented tool, filling and wiping away eyebags, straightening noses, performing non surgical facelifts, erasing wrinkles, augmenting lips and rejuvenating the aging skin itself.

But how does the consumer (read patient), make a choice of which filler to choose. What is the best dermal filler? (This is a title of a “vintage blog” of mine which you can find in these blog pages) Which filler will give the best results? Which is the softest? Which the longest lasting filler? Which is the safest filler?

From the IMCAS conference in Paris (a wonderful yearly non surgical aesthetic medicine conference I am going to this weekend!) to the Anti Aging medicine conference in Monte Carlo, thousands of aesthetic doctors gather every year to hear about yet another batch of hyaluronic acid fillers being launched onto the scene, and there are now hundreds of fillers out there.

But without confusing you too much, here is a quick guide, with some facts, myths and innovations, from 2 of the best and leading dermal fillers currently dominating the European and American markets.

RESTYLANE

FACTS – Restylane and Perlane were the first hyaluronic acid fillers invented over 15 years ago by a Swedish genius Bengt Agerup in Upsala. This clever scientist first invented NASHA, non animal ,stabilised hyaluronic acid, and hence  transformed the world of aesthetic medicine. There are now many copies and new fillers on the market, but with the longest track record of good results and great safety, this filler is still the gold standard, the original, the “coca cola” of dermal fillers

MYTHS – The biggest myth I hear from patients is that this filler does not last as long as some like Juvederm, and more importantly, that it is a filler which is more likely to leave lumps, and possible the “tyndall effect”, of a blue line under the skin, in my experience these are facts which are not true. Restylane in my mind is the best filler, with the longest lasting results. Some of my patients for naso labial lines have results for up to 7 years, and eyebags for up to 4 years! And safety of the results? Indeed, this filler is an “advanced” filler, so yes, in inexperienced hands, lumps or blue lines are more possible than with for instance the Dermavisc filler for instance (discussed below), but in expert hands, Restylane is by far the best tool, allowing the best shaping, moulding and the most efficient natural results

INNOVATIONSIt may be the “oldest” filler, but the innovations from Galderma never stop. The skin rejuvenating SKINBOOSTERS like Restylane Vital and the brand new “clicky” syringe are incredible, and a little bird tells me that a Restylane mixed with growth factors is just around the corner!

JUVEDERM

FACTSJuvederm is the second oldest filler on the market and with the aesthtetic giant “Allergan” behind it (Allergan is the pharmaceutical company behind our other friend Botox), Juvederm has taken over a large chunk of the aesthetic market in the US and Europe, and is still the fastest gowing filler in the world. A great filler, with fancy packaging no doubt, but I do have some doubts about this filler, and still believe it to be the second best in the world of fillers, behind the original Restylane. Juvederm in my opinion is a filler which should NEVER be injected in the tear trough areas under the eyes as Juvederm fillers give a lot more swelling than some other brands. Granted, the thicker filler Voluma is probably the best volumising filler on the market, and I use this filler a lot!

MYTHS – The main myth I would like to dispel is that Juvederm is somehow magically the filler which gives the longest lasting results! Great marketing from Allergan, as with great adverts and “convicning” medical proof, many now truly believe that this filler does ineed do exactly what is says on the tin, but dear readers, my 10 year experience in the industry has taught me that ALL hyaluronic acid fillers have a similar longevity, and indeed how long your results will last relies more on the skill of your doctor!

INNOVATIONS – The Juvederm range has always like a cameleon, had a great capacity to reinvent itself, and the latest is the launch of their “new” Vycross technology, which includes the new fillers Voluma, Volift and Volbella. Nice fillers, and with  less swelling than with the older Juvederm 3, and Juvederm 4. Indeed, Allergan  were the first to come out with fillers with lidocaine local anaesthetic, but is the Vycross technology truly new and innovative? Many in the industry claim that this is just an older technology like Surgiderm, relaunched and repackaged! Allegedly!

Festina Lente… Lets move on quickly but carefully. For in order not to lose you at this point of what is proving to be a longish blog, lets take a look at 3 more popular European fillers, but a little more concisely.

TEOSYAL

FACTS – The favourite for some aesthetic greats such as Jean Louis Sebagh, and I can understand why. From Teoxane laboratories, Switzerland, Teosyal has firmly established itslef as the third best filler in the industry. A solid filler, with good moulding capacity and a wide range of fillers, it is a good but not a great filler. Their tear trough filler for instance (Teosyal Redensity) is in my experience not an effective one at all!

MYTHS – As with all companies, Teoxane claims that their hyaluronic acid is a product from the most supreme state of the art technology, BUT , in truth  ALL hyaluronic acid fillers come from very similar technologies, with slight twists and differences which make some better than others. And did you know, most of the bacterial hyaluronic acid on the market is bought from a large factory in China, before it is stabilised in to various filler brands?

INNOVATIONS – Teosyal certianly has the widest range of fillers, forever coming up with new ones, and has innovative names for their fillers such as Teosyal Kiss, and I will let you guess where that filler is used!

EMERVEL

FACTS – A great new filler which over the last couple of years has entered the market. Also from Galderma, I guess the only problem is that only a few months after a big launch of the Emervel range of fillers, Galderma took over Q-med , the makers of the king of fillers Restylane!! “Oh my goodness, what do we do now?” I am sure was the cry by the Galderma bosses, and hence this good filler has taken a while to come to the fore, but with good thicker fillers like Emervel Volume, this range is making it’s mark on the market for sure.

MYTHS – Newest is not always the best, and the myth that just because this new hyaluronic acid technology is the latest and the most cutting edge, that it is the best is not of course true. Restylane was the original formula, (like in the Cola world where Coca Cola which is still the best formula), and  is still the top filler to beat, and has the longest safety record.

INNOVATIONS -  Nothing particularly new or bold has come from this range, but being a new kid on the block, new members to the range, and innovations with their nice syringes are always around the corner.

DERMAVISC

FACTS – I thought I would throw this filler into this blog to make things a little more interesting! A filler which is becoming ever more popular on the continent and in countries like Sweden and Croatia,  and one which is on its way to the UK for sure. The fascinating fact about this filler is that it is the first successful filler on the market which is not bacterial in origin, but actually of animal origin!! “Animal!” I hear you say, but this is a perfectly safe filler harvested from rooster combs (poor roosters!”), and a filler which can be injected safely without the need for an allergy test. I have tried it, and indeed even gave some courses on it. It is an OK filler, with some not bad results, but it is different from other fillers, and it does not give as strong results, and they do not last as long. And I must admit, the short safety track record worries me, as does the animal origin. Non animal fillers for me!

MYTHS – Bochus Biotech, the makers of Dermavisc will claim that this “purer” filler of animal origin is much better and safer than the laboratory non animal fillers, but my dear reader, I would claim completely the opposite!

INNOVATIONS – This being the first good animal origin filler is an innovation in itself, and an innovations to be applauded despite som of my doubts described above. However, this filler is the only one on this list which does not have lidocaine added to it (treatments with fillers with lidoacine are much less painful), an innovation which Biotech will have to push through quickly if this filler is to survive this tough market!

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