Permanent Fillers

Injectable dermal fillers are a non surgical procedure that can improve many signs of skin aging on the face, such as fine lines and wrinkles, smile lines, crow's feet, nasolabial folds, and marionette lines. Dermal fillers can also correct volume loss, plump thin lips, enhance contours, and improve acne scars in facial skin. There are several types of dermal fillers available, some are permanent and some temporary dermal fillers.

What is dermal filler therapy?

Dermal filler therapy is a minimally invasive cosmetic treatment in which soft tissue fillers are injected below the surface of the skin to add volume and fullness, fill lines, and enhance shallow contours. There are several different types of dermal fillers available. Each of these substances is designed to treat different cosmetic issues or signs of skin aging. The various dermal fillers vary in the time they take to work and how long the results last. Based on this, dermal fillers get labelled as permanent or temporary fillers. Some of the common types of dermal fillers are listed below:

Calcium hydroxylapatite (Radiesse)

This is a temporary filler that is used to treat moderate to severe wrinkles and creases like marionette lines.

Hyaluronic acid (brand names Juvederm, Restylane)

These are some of the most popular temporary dermal fillers. It is used to treat acne scars, marionette lines, frown lines, crow's feet near the eyes, and more.

Polyalkylimide (Aquamid)

This is a semi permanent filler that is used to treat deeper wrinkles in the face, enhance the cheeks, as well as plump thin lips.

Polylactic acid (Sculptra)

This is another semi permanent filler product. It does not give immediate results. Rather, the effects of the treatment are visible gradually over a few months. It is used to treat deep nasolabial folds, correct laugh lines, and augment thin lips.

Polymethyl-methacrylate microspheres PMMA (Bellafill)

This is a more permanent solution to facial wrinkles. It is effective in filling pits of scars and perform lip augmentation. PMMA usually requires several treatment sessions. It can take up to 12 weeks to get the full effects of this type of permanent filler.

Your dermatologist will show you a menu and help you decide between the various temporary and permanent fillers at your initial consultation. Both types of treatments are simple office-based procedures that can significantly enhance your appearance with minimal risks and side effects and little to no recovery time.

What are permanent fillers made of?

The most common type of permanent filler, PMMA or Bellafill, is an injectable collagen dermal filler that is bovine in origin (it is sourced from calves). It consists of non-resorbable microspheres of polymethylmethacrylate (PMMA) that act like a scaffold and provide structural support to the skin. The permanent filler contains a small amount of local anesthetic, lidocaine, to provide comfort during the injection treatment.

Difference between temporary and permanent facial fillers

The main difference between temporary and permanent fillers is the duration of time that they last. Temporary dermal fillers, such as hyaluronic acid (Juvederm, Restylane) and calcium hydroxylapatite (Radiesse), last anywhere from 6 months to 12 months depending on the area that is treated and how many injections of the temporary fillers you get.

A semi permanent dermal filler is more viscous than temporary fillers. Therefore, it takes the body longer to break it down and absorb it. Consequently, the results of semi permanent facial fillers like poly-L-lactic acid last longer than temporary fillers, anywhere from 12 to 18 months.

Permanent facial fillers have the highest viscosity of all dermal fillers. The body cannot decompose permanent fillers as quickly, and therefore, the results can last as long as 5 years. However, permanent fillers can only be injected into certain parts of the face with thick skin, such as the nasolabial folds.

How long do permanent fillers last?

Injections of permanent fillers like PMMA Bellafill are considerably more long lasting than injections of temporary fillers like hyaluronic acid. The results from a permanent filler treatment can last as long as 5 years. However, it is important to have realistic expectations from permanent filler injections. They are not cure-all injections or a lifelong solution. Permanent fillers can only do so much, and ultimately, you may need to go in for a surgical approach like a facelift if you are looking for more dramatic results that last.

What are the longest lasting filler injections?

Temporary fillers like hyaluronic acid are highly effective in filling in wrinkles and hydrating the skin to give it a more youthful appearance. The ingredients in these temporary fillers are naturally occurring substances found in the skin. The body gradually breaks down these substances until the dermal filler disappears and the wrinkles reemerge. This is why the effects of temporary fillers fade over time.

How long the results of the injections last depends on how quickly the body breaks the material down. The lifespan of the dermal filler is also affected by other factors, such as the treatment area and your lifestyle. In general, temporary and permanent fillers retain their effectiveness as follows:

6 months or less

Temporary fillers like some of those in the Juvederm, Restylane, and Belotero ranges used to improve facial wrinkles, typically last around 6 months 

6 to 12 months

Restylane Silk and Juvederm Volbella are formulated to last up to one year by resisting movement that reduces the effect of dermal fillers.

1 to 2 years

Sculptra, Radiesse, and Juvderm Voluma are some of the longest lasting temporary fillers and are used for chin augmentation, cheek enhancement, and in other areas of the face such as the jawline.

5 years or more

Products like PMMA (Bellafill) can improve your appearance for 5 years or more. They are made of materials that the body cannot break down easily. This is what makes these fillers permanent.

The pros and cons of permanent fillers

The biggest advantage of permanent fillers like Bellafill is that you don't have to go back to the plastic surgery office twice a year to get more injections. Meaning, you can go in for a consultation, get the permanent fillers treatment done, and not have to bother with regular tweaking. The correction in facial volume and improvement in facial wrinkles is more long term and the treatment is non surgical. This is the main reason patients are interested in PMMA permanent filler injections. An added advantage is the cost saving. Because permanent fillers last longer, patients don't have to pay for repeat treatments.

However, there are some disadvantages to permanent fillers. Unlike, temporary dermal fillers, there is no room for error with permanent filler procedures. Permanent filler products are made from substances that are not naturally found in the body and are not decomposed easily. In contrast, temporary fillers like hyaluronic acid are made for substances that naturally occur in the body. Therefore, there are enzymes that can be used to break down the filler material if a patient does not get optimal results. With permanent fillers, on the other hand, the plastic surgeon has to get it right the first time, since there is no eraser enzyme or reversal agent available. That's why it is critical that you choose an experienced provider if you're going in for permanent fillers.

Another disadvantage of permanent fillers is that the body recognizes these products as foreign substances and may try to get rid of them by forming granulomas. Granulomas are small, hard lumps that develop at the injection site. If a patient develops a granuloma, they may need steroid shots or surgery to remove it.

Should you get permanent dermal fillers?

Permanent fillers are appropriate for some people. For example, in a person with a dip or volume loss in the nose after a surgical nose job, a permanent filler is a reasonable alternative to fat transfer. Permanent fillers are also appropriate in people with skin divots (pockmarks) or atrophic scarring (indented scars) of the face.

It is worth noting that once a patient has permanent filler injection, they cannot mix it with temporary fillers because of a high risk of infections and other side effects and complications.

How much do permanent fillers like Bellafill cost?

The cost of one syringe of permanent filler like Bellafill can be anywhere from $1,000 to $1,500. The cost of your permanent filler procedure will depend on how many injections you need. Other factors, such as where you live and the experience level of your provider, can also affect the cost of permanent dermal filler treatments.

Choose the filler that gives you choices

Both temporary and permanent dermal fillers can enhance your looks and correct the signs of skin aging. Each type of filler has its pros and cons. When you are presented with the menu, you can choose temporary or permanent fillers depending on your aesthetic goals and lifestyle. If you select permanent fillers, there are some things you must keep in mind.

• The procedure should be performed by a qualified cosmetic surgeon, physician or dermatologist.
• The permanent filler procedure should take place in a sterile environment to reduce the risk of side effects like infection.
• Your provider should have extensive experience with fillers in general and permanent fillers in particular.

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