With so many dermal fillers on the market, it is easy to get confused and overwhelmed with the choices. The following article will outline some of the nuances between the products to make your decision a bit easier.
The Basics
Hyaluronic acid is a natural polysaccharide found in all living species, so it is very well tolerated and a great choice as a dermal filler. Another great perk is that it can be reversed. A simple injection of hyaluronidase (Vitrase or Hylenex) erases the gels within 24 hours most of the time. This is especially advantageous for new injectors and gives a sense of comfort.
The Choices
Allergan, Galderma and Merz all make dermal fillers consisting of non-animal based hyaluronic acid gels. The products vary by their concentration, cross linking and particle size.
Allergan makes the Juvéderm family of products: Juvéderm® Ultra XC, Juvéderm® Ultra Plus XC and Juvéderm Voluma® XC. Juvéderm Ultra and Ultra Plus are both 24mg/ml and are 90% cross-linked. They differ in their degree of cross-linking, Ultra Plus having a higher degree. Voluma has a proprietary Vycross technology, giving it higher lift capacity.
Galderma makes the Restylane family of products: Restylane® Silk, Restylane-L® and Restylane® Lyft. These products are all 20mg/ml and 80% cross-linked, but differ in their particle size. Restylane Silk is the smallest and is approved for the lip area. Restylane-L is the mid-size particle and Restylane Lyft is the largest (previously Perlane).
Merz makes Belotero®, which is 22.5mg/ml. The unique property of Belotero is that it has various particle sizes to reduce the incidence of the Tyndall Effect. This is useful when trying to chase after very superficial, fine etched lines.
My Experience
I prefer to use a “lighter” product when working on superficial lines or lips. If I need to get just underneath the surface of the skin, for instance in vertical lip lines, I will usually use Belotero to avoid a blue hue. For the vermillion border and body of the lip, I prefer Juvéderm Ultra XC or Restylane Silk. I am partial to Restylane-L for the tear trough, occasionally Belotero.
If the lines that I am trying to fill are deep, I will use something more cross-linked or with a larger particle size, such as Juvéderm Ultra Plus XC or Restylane Lyft. If I want to volumize in the midface or sculpt with a hyaluronic acid as an injectable implant, I resort to Voluma or Restylane Lyft.
Above is just a brief summary of the hyaluronic acids and my personal preference regarding different uses. This is just a guide to get you started — there is a role for each and many of these roles will overlap. The key is to get your own experience and see what you are comfortable with.