Best dermal fillers – my detailed analysis for which are currently the best hyaluronic acid dermal fillers and for which treatment

Every company and every brand of hyaluronic fillers promises to be the best, to have the softest gel, and the longest lasting filler. But what is the real truth? Which brand is the best for you, and which filler should you choose for a specific treatment: nasolabial wrinkles, lips, nose, cheeks, quality of skin tone, or undereye bags? The internet, media and even patients are full of contradictory information. Too many marketing promises and distorted, biased medical studies. Not to mention the surplus of the “latest” and “best” dermal filler brands, sold in special offers on botch web portals, at disturbingly low prices. Although there are dermal fillers such as Radiesse (calcium hydroxylapatite crystals), Sculptra (poly L-lactic acid), and permanent fillers like Aquamid, in this article I will only analyse dermal fillers based on hyaluronic acid – as these are the only dermal fillers I personally recommend. The reason for this is that hyaluronic fillers are not permanent, they have no lasting effects, they yield the most natural results, and if necessary, can be removed and dissolved using a special enzyme.

Renowned brands

Most doctors stick to one brand of hyaluronic dermal fillers, which is common practice because it makes sense financially. If a doctor prefers the use of renowned brands such as Restylane, Juvéderm, or some other (i.e. Teosyal and Belotero hyaluronic fillers), then the patient is definitely in very good hands, because these brands offer a whole range of different fillers, with various densities, hyaluronic concentration, and molecule size, let alone years of medical testing and research. My nearly 15 years of medical experience in aesthetic medicine has shown me that no specific brand is ideal, which is why it is in every patient’s interest that their doctor has a selection of at least 2 of these brands of fillers. Of course, the mentioned dermal filler brands are not the only quality fillers on the market, so if you haven’t found your chosen brand among the ones listed above, there’s no need to panic.

Along with the aforementioned, at the end of this article I will recommend another 4 renowned brands of hyaluronic fillers, but it is important to point out: there are at least 200 brands of hyaluronic fillers on the market – and with the increasing popularity of aesthetic medicine, new brands are emerging every day, from South Korea, Japan, Russia, the Ukraine, South America. I am not sure of their quality in most cases, because of their rapid release on the market, without proper inspection and testing, not to mention imitation products. Before we begin this analysis of individual fillers, just a small warning: the best and safest brands of dermal fillers in Croatia can only be procured and administered by licensed medical doctors and dentists. For that reason, if you come across cheap offers for fillers not coming from a doctor, it’s likely you are dealing with brands that are not of the highest quality, or copies purchased online, which is a dangerous practice.

A brief reminder: What are hyaluronic fillers used for?

Before I give you my analysis, let us recall that hyaluronic dermal fillers, along with botox are the main tool of modern aesthetic medicine. Hyaluronic acid is a natural component of our skin, and its main task is skin hydration, as well as collagen reinforcement, and the restoration of elasticity. Our skin thus acquires a glow, stays firm, we have a healthier skin tone, and lost volume is restored in the face.

Modern fillers are actually stabilised hyaluronic acid, when squeezed out onto our hand, it resembles a hair gel texture. What is interesting, and what our colleague Željana Bolanča illustrated so well in a recent article (“The 1ml Trick”), is that if we squeeze 1ml of dermal filler onto a sugar spoon, it will only take up 1/3 of the spoon, but when you put yourself in the hands of a professional, then excellent and natural-looking results can be achieved even with such a small amount, while some other procedures require much more hyaluronic acid.

Restylane is Coca-Cola, and Juvéderm Pepsi-Cola

The history of hyaluronic dermal fillers is a relatively brief one. Bengt Agerup, a Swedish scientist and genius, was the first to stabilise hyaluronic acid in 1996. Up to then we only had inferior collagen and dangerous silicone fillers, but when the first dermal filler, Restylane, was produced in Uppsala, the world of aesthetic medicine changed forever. Over 25 million treatments using Restylane fillers have been performed all over the world to date. Restylane was for a long time the only filler available on the market, but Juvéderm appeared soon after. As I often like to joke, Restylane is the Coca-Cola of dermal fillers, and Juvéderm Pepsi-Cola, while all other dermal fillers are Cockta or a grocery store brand of Cola. Some are good, others not so good…

Most hyaluronic fillers are produced by fermenting bacteria in a laboratory, meaning they are produced in a natural and organic way (rare brands of hyaluronic fillers such as Dermavisca stem from animal sources – the fleshy comb of a rooster). This hyaluronic acid (the largest production plants of natural hyaluronic acid are in France and China) is used not only in dermal fillers, but in cosmetics and many creams, as well as in mesotherapy. Each brand of filler uses a different method and technology to stabilise and bind the hyaluronic acid, so that it can last in the skin for an average of 6-36 months. There can be a great difference between various dermal fillers. The stabilisation process and binding of hyaluronic acid varies with each brand, and the consistency of each filler is also different, as well as the concentration of hyaluronic acid, size of the molecules, and density. Furthermore, only some dermal fillers such as Restylane, Juvéderm and Teosyal contain lidocaine, a local anaesthetic. This, for me, is essential, because the treatments are less painful, and are a mark of a serious dermal filler brand.

Which filler is the best for which treatment?

Now we come to the practical and most important part of using fillers. I will reveal to you which brands I love the most, and which fillers I have on my shelves, but first let us begin with an analysis of the best fillers for some of the most popular treatments.

Lips

I will begin with the lips because in my many years of experience I have come across the greatest controversies especially when it comes to this treatment. Although it appears to be simple, it is one of the most difficult procedures in aesthetic medicine, and one which requires years of experience.

I, for example, was insecure about this procedure for the first 5 years of my career, especially in terms of choosing which filler was the best to use for it. Today I am proud to say that I perform hundreds of lip augmentations and contouring on a monthly basis, using my “heart lips” method. Despite being one of my favourite treatments (along with non-surgical correction of the nose and undereye bags using my “wow treatment”), we are still in a dilemma over which dermal filler is the best for the lips.

Restylane Classic is a dermal filler I used for years for lip augmentation. The results were excellent and yielded very natural and soft lips. It is still one of my favourite lip fillers because it contains the optimum concentration of hyaluronic acid.

Drawbacks? The results only last 6 months, and the lips are very swollen right after the procedure; however, the swelling dies off in just 24 hours.

Restylane Lyps is a newer version of Restylane Classic filler, with everything the same, except that results last over 9 months, because of the larger molecules and higher concentration of hyaluronic acid. The latest lip filler from the house of Galderma has a very fitting name – Restylane Kysse, which uses the new Emervel technology. There is no significant swelling following the procedure, the lips look exceptionally natural and very sensual, and results last over 9 months.

Juvéderm Ultra 3 is a very good lip filler from the house of Allergan, but offers subtle results that last for only 6 months. Allergan has recently launched its new Vycross technology, under which is its selected lip filler, Juvéderm Volift, although Juvéderm Volbella can also be used.

Juvéderm Volift may currently be the most popular lip filler in Croatia, which I myself use quite often. Results last for 12 months, there is no significant swelling following the procedure, but I have noticed minor swelling in some patients, which can be manifest as small balls and thickening of the upper lip after a couple of weeks. However, this problem quickly dissipates on its own, or after a massage.

Teosyal Kiss is also a very good dermal lip filler. As its name reveals, it is specially formulated for lip treatment. It yields great results, with minimal side effects. Although it is difficult for me to determine the best filler for this treatment, I would give the title to a specially designed lip filler – Restylane Kysse. Right behind are definitely Juvéderm Volift and Restylane Lyps. In most cases, only 1ml of filler is enough per treatment, and it is not recommended to do more than that. It is wiser to come back after a month’s time and add another 1ml if your doctor finds it appropriate. What is most important is that the results are natural, and the face proportional.

Undereye bags

Undereye bags are my main domain and subspecialty, so I am very specific and credible on this topic. Many doctors still believe that there is no dermal filler suitable for this procedure, but from my own personal experience and following many successful treatments, I can confirm that this is not true. With my 10-year experience and 7000 undereye treatments, there is no dilemma. This is a remarkable treatment that yields outstanding results, and the best fillers for it are Restylane Classic and Restylane Lyft (Perlane). Here it is possible, with great expertise, to use both thinner and thicker dermal fillers. Knowledge is what counts most. Over the years, I have tried using other dermal fillers in this facial zone such as Teosyal Redensity, Juvéderm Volbella, Belotero, and although they yielded adequate results, too much oedema was reported, and the effects were not as good as the above-mentioned fillers. Restylane is the absolute king for undereye bags. In 80% of cases, 2ml of dermal filler is enough to erase bags under the eyes – even extra-large ones. 10% of patients require only 1ml, while 10% need to come back for their third ml.

Non-surgical face-lifting / cheek augmentation

This increasingly popular treatment offers a natural facelift for skin that has lost volume and appears relaxed. With the expert administration of hyaluronic dermal fillers, there is no more need for a scalpel and surgery, because the butterfly facelift method, 8-point lift, or MD codes can yield very effective and natural results with non-surgical face-lifting, and requires the use of 2ml – 5ml of dermal filler. What’s more, the effects can last for even 18 – 36 months (because this treatment uses denser fillers with larger molecules). The first such filler on the market was Restylane Sub Q, but it has proven to be too hard a filler, and so over the last 5 years my favourite filler for lifting the face, cheeks and saggy skin around the chin is definitely Juvéderm Voluma. It is a wonderful filler with large molecules that provides an adequate lift, which can easily be injected. It is soft, the cheeks are visibly lifted, and that “doggy look” around the chin is gone.

For these procedures, I can also pay compliments to Restylane Volyme, which has recently emerged on the market. It is a new technology from the house of Galderma which is now keeping stride with Juvéderm. These two brands are unique in that they come in 1ml doses and can be injected with a syringe. Other brands either do not have these fillers with larger molecules (vital for an adequate facelift), or only offer 2ml ampules that can solely be applied through a cannula, which may be unsuitable for many patients. It is my opinion that in the majority of cases, fillers must be administered with a syringe and not a cannula, as this yields better and more accurate results, which is logical. From patient to patient, if we take into account their age, skin type and condition, at least 2ml of filler is needed for a non-surgical facelift, but the dosage can rise up to 8 – 10ml of filler, which is obviously administered in 2 to 3 separate treatments.

Nose

When it comes to the nose, dermal fillers should not be too dense due to the sensitive anatomy of the nose, yet must also have enough strength to lift and contour, fill in imperfections and align the nose.

In my opinion, Restylane Classic achieves perfect results with no side effects, I only use this and have done for years. Juvéderm, Teosyal, Belotero and other fillers, are also suitable for this treatment. As always, the most important factor is the expertise and experience of the doctor. If we select a proper brand of hyaluronic acid, along with a good quality doctor, in most cases 1ml is enough to yield results that last over 18 months.

Nasolabial wrinkles

The correction of nasolabial wrinkles is still the most sought-after dermal filler treatment. It is a procedure that is most easily performed with the longest lasting effects, and in many patients results last over 8 years. But, just a word of warning – I must emphasise that extensive knowledge, skill and expertise is also required here, not only to achieve the best results, but also because this zone demands detailed cognisance of its anatomy, in order to avoid side-effects such as vascular compromise, which cannot occur when administered by an expert, but becomes highly probable when one is in “unprofessional” hands.

Here, many dermal fillers are very suitable, and so one can choose from a wide pallet. The dermal filler should be thinner, with less molecules, such as is the case with Juvéderm Volbella or Volift filler, Restylane Classic, Teosyal Global Action or Belotero Soft filler. When dealing with shallow wrinkles, 1ml is enough for both wrinkles, but in many cases 2ml are required.

Rejuvenating the skin of the face, neck, décolleté and hands with stabilised hyaluronic acid (“skinboosters”)

Modern aesthetic medicine is turning more and more to treatments of the skin itself and its rejuvenation. Laser treatments, plasma treatments, and dermal rollers are increasingly popular, but hyaluronic preparations achieve the best results. The skin of the face, neck, décolleté and hands gain a new glow, while wrinkles, pores and scars disappear. Elasticity is restored, and the skin is firmer. In a treatment which I call medical mesotherapy, the best product is Restylane Vital Skinbooster. It’s greatest advantage is the technology of the syringe itself that has a special “clicker” to provide a precise dose with each prick of the needle. The latest product of this type on the market is Juvéderm Volite, which yields excellent results, but we must also mention Profhilo, a recent market launch by Ibsa. It is an innovative dermal filler that is something between a dermal filler and a skinbooster. This product promises skin rejuvenation with a minimal increase in volume. 1 – 3ml of filler are required for skin rejuvenation, in 1 to 2 separate treatments.

4 more respectable brands I recommend

Princess – a hyaluronic filler from Austria using SMART technology, which promises lengthier results

Perfectha – a French hyaluronic filler

Intraline – the latest filler on the Croatian market, comes from Sweden, also has a specially formulated dermal filler for men

Aliaxin – a modern dermal filler from the company IBSA in Italy

Tips for the end

I have personally been using Restylane fillers for 15 years now, but with the continued improvement in the technology of other brands, Juvéderm fillers have also become a prominent part of my practice. We sometimes use Teosyal, have also tried older brands such as Esthelis, and have used Belotero, Dermavisc, Intraline, Profhilo.

For me, Restylane continues to have the best fillers, and now with its latest Emervel technology, offers by far the largest selection of fillers with a variety of structures for different applications on the face, with top medical research and results. Juvéderm follows right behind with its new Vycross technology. It is a fantastic brand of filler which shares equal space on our shelves together with Restylane at the Polyclinic Milojević. My advice? Stick to fillers that give you the best results, but let’s be honest: all of the mentioned dermal fillers are of supreme quality and achieve superb results, but only when in the hands of an experienced and skilful doctor.

26, April, 2018Dr Milo Blogs