Which Fillers Do We Use and Why?

By Kate Dee, MD

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 Silk, are very soft and silky. Yet others, like Restylane® Refyne and Defyne, have been designed to be flexible, to allow the face more natural movement.

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 favorite filler for the lips is Restylane® Silk. It gives great volume, but remains soft and smooth and is rarely lumpy. 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. Another filler I like for lips is Refyne, because it is also very soft, flexible and it does not swell up as much as other fillers do, but is not quite as volumizing as Silk.

For cheeks, 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 cheeks– it would not have enough substance to hold the tissues up. It would just melt away and be a waste of money.

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. Right now my favorite for this area is Refyne, because it is so moldable and soft. Silk works well too, as long as you are not using too much of it in this location. 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.

For the lower face: 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). JUVÉDERM® Ultra Plus, Restylane® L and a new filler called Revanesse® Versa™ are all good options for the lower face as well.

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 Silk 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 like Silk, 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 206-800-7379 or schedule a consultation here.