Seeking a quick, minimally invasive approach to reducing some of the signs of age?   Learn about soft tissue fillers.  Between the advancements in the safety of these products as well as our improved understanding of their use, fillers may be a good option for maintaining a more youthful appearance.

Soft tissue fillers comprise a large group of products of differing chemical composition.  This discussion is limited to hyaluronic acid (HA) fillers, which are based on a normal component of our extracellular matrix.  HA fillers have the advantage of being reversible, if needed, with the use of the enzyme hyaluronidase.  HA fillers are not permanent which, in my opinion, is an advantage in the event of an undesirable result.

Hyaluronic Acid (HA) Fillers

Currently, the following families of HA fillers are available in the United States:

  1.  Allergan’s products:  Juvéderm Voluma®, Juvéderm Ultra® and Ultra Plus®, Juvéderm Volbella® and Juvéderm Vollure™.
  2. Galderma’s products:  Restylane® Lyft, Restylane®, Restylane® Silk, Restylane® Refyne, Restylane® Defyne
  3. Merz Aesthetics’ Belotero Balance®.

While these products all contain hyaluronic acid, they differ in some alterations to the molecules and concentrations which affect their viscosity, “stickiness,” “thickness” and longevity.  Essentially, the thicker, more viscous products are used in the deeper areas of the upper cheeks to restore volume and provide lift.  The thinner, less viscous products are used to deal with subtle lines and deficiencies in the areas in and around the lips.  Middle-of-the-road products are typically used for prominent creases between the nose and mouth (nasolabial folds) and between the south and chin (“marionette” lines).

Juvéderm Vollure™, Restylane® Refyne, and Restylane® Define have only recently been released in the United States.  Consequently, specific information regarding the concentration, viscosity, thickness, etc. for these products is not immediately available.  Based on the information currently available, I rank these product families as follows (starting with the thinnest and less viscous products and ending with the thickest most viscous products):


  1. Restylane® Silk
  2. Restylane®
  3. Restylane® Refyne
  4. Restylane® Defyne
  5. Restylane® Lyft


  1.  Juvéderm Volbella®
  2. Juvéderm Vollure™
  3. Juvéderm Ultra®
  4. Juvéderm Ultra Plus®
  5. Juvéderm Voluma®

I have not listed the Merz products as they currently have a limited line of FDA approved products available in the Untied States.

In terms of cost, the Galderma products are generally somewhat less expensive than the Allergan products.  In terms of duration of effect, the Allergan products have generally been approved by the FDA for longer lasting periods of time.

Potential Risks

While there are many aesthetic benefits to the use of HA fillers, there are also some potential risks.  These risks range from minor issues such as temporary bruising to uncommon, but potentially catastrophic problems, such as scarring or blindness.  Other potential problems include skin discoloration, small blebs or bumps in the skin, aesthetically displeasing results and, uncommonly, nodule and abscess formation.  Your physician should be familiar with the underlying anatomy of the face, proper product selection, and how to inject to achieve aesthetically pleasing results.