By Kate Dee, MD
Which are the best dermal fillers to use? Every injector has her/his own preferences for what filler to use and for what purpose, and there are some very important considerations. All fillers are different in both texture and use. Some fillers, like Restylane® Lyft and JUVÉDERM VOLUMA®, are fairly stiff and firm. Some, like Restylane Refyne, are very soft and silky. Some, like Restylane® Refyne and Defyne and Kysse, have been designed to be flexible, to allow the face more natural movement.
At Glow Medispa, we have a cumulative 22 years experience in dermal fillers. Read more to find out which ones we recommend.
For example, many women want fuller, plumper lips. I can tell you that I’ve seen just about every filler placed in the lips. But in my opinion lips should be soft and smooth and silky, like... lips. My favorites filler for the lips is Restylane® Refyne and Restylane® Kysse. Refyne gives moderate volume, but remains soft and smooth and is rarely lumpy. It is flexible and very natural looking and does not swell up as much as other fillers do. It is the softest filler available on the market today. Kysse is more volumizing that Refyne, giving the fullest look, while remaining flexible and natural in appearance. This is in contrast to JUVÉDERM® Ultra Plus and Restylane® L, both of which are mainstays for lips. However, those tend to be too stiff and lumpy. Almost everyone who has had JUVÉDERM® in their lips will say they’ve had a lump before. The lumps are not visible to others, but you can feel them with your tongue. I’d prefer to skip the lumps.
For the cheekbones, I like JUVÉDERM VOLUMA® and Restylane® Lyft. These fillers are firm and are placed along the cheek bones to give volume to the cheeks. You need strength and firmness to fill out the cheeks, and because the placement is deep, issues with lumpiness are rare. You would never want to place a soft filler in the along the cheekbones-- it would not have enough substance to hold the tissues up. It would just melt away and be a waste of money. Another filler that is great for the softer parts of the cheeks is Restylane® Contour.
The area under the eyes (the tear troughs) are very delicate. A soft filler is best: one that won’t be lumpy (similar to the lips) and one that won’t press on any of the nerves or vessels in this area. Ideally, tear trough filler should be one that doesn’t swell too much because swelling under the eyes can be very bothersome. The under-eye area is safest treated using a canula. This is a blunt-tipped tube that is less likely to injure a vessel and cause bruising. The technique developed for this area uses Restylane® L slightly diluted with saline. This provides the structure and softness that is needed in this delicate area.
Most people do not need more than one syringe of filler for the tear troughs. I have heard some horror stories of people getting the wrong filler or too much filler in this spot. One patient told me that she’d had 6 syringes of Voluma placed under her eyes, and she had records to prove it. This was not only the wrong filler, but way too much of it! She said it was like having life-sized sausages there. It took multiple visits to dissolve it, and even then her eyes were swollen for more than a year. Needless to say, she has sworn off filler forever. But used properly, filler can be safe and very helpful to improve the look of tired, sunken eyes.
What are the best fllers for the lower face? For the nasolabial folds, marionette lines and perioral lines, it is important that the skin be flexible enough to make normal facial expressions. That’s why I like Refyne and Defyne so much for these areas. These are fillers designed both to hold their shape and to be flexible (think of a gumby doll). Lots of other fillers are OK for the lower face: JUVÉDERM® Ultra Plus, Restylane® L, RHA fillers and Revanesse® Versa™ are all options for the lower face as well. But my preferance is for the flexible fillers as they look more natural.
There are a few fillers that I choose not to use in my practice:
JUVÉDERM VOLBELLA®: initially I loved the way this filler worked. It is similar to Refyne but swelled a little less and came in half syringes. It was very popular. However, there have now been multiple reported cases of late painful nodules with repeated use of Volbella, and I have discontinued its use.
JUVÉDERM® VOLLURE™: I was never a great fan of Vollure due to its price point (expensive) and its inferiority to Refyne and Defyne in the lower face, and now there are reports of late complications with it, similar to those of Volbella. We no longer offer it.
Radiesse®: this is a calcium hydroxyapetite filler that is non-reversible. Because you can’t dissolve it, it is less safe than the Hyaluronic Acid fillers. We no longer offer it.
Belotero®: this is a very nice soft filler, but it does not last very long (only a few months). It just wasn’t worth the money.
Bellafill® (AKA artefill): this is an artificial “permanent” filler that lasts 5 years or more. This is also non-reversible, and especially unsafe because you cannot get rid of it from the body other than surgically.
As I said at the beginning of this post, every injector has favorites. I base my selection of what filler to use based on the needs of the patient, location of injection and safety. If you are interested in finding out more about fillers, we are happy to help. Call us at 206-228-7281 or schedule a consultation here.