Dermal fillers are gel-like substances that are injected into or beneath the skin to restore lost volume, improve the appearance of folds, lines, and creases, or contour the face. The dermis is the thick, middle layer of skin that cushions the body from harm. It protects the skin and deeper layers, helps the body to regulate its temperature, and allows you feel sensations. Among its many functions, it gives your skin its structure so it can hold its shape.
When Restylane was introduced in the United States in 2003, its was intended for the mid to deep dermis of the skin, namely the nasolabial folds (laugh lines)—the shadowy area between the side of the nose and mouth corners. Other fillers such as Perlane, now rebranded as Restylane Lyft, and Juvederm Ultra/Ultra Plus were introduced, all of which were intended to be implanted in the dermis. Hence, the term “dermal fillers” became the catch phrase.
Nowadays, we have a much wider variety of fillers. The ones that create more lift can be injected deeper than the dermis into the fat layers or even on top of bone. For this reason, the term “soft tissue fillers” would be more correct.
In the early days of cosmetic fillers, bovine collagen was used. Bovine means it came from a cow source. Collagen is a protein material, and since bovine collagen and human collagen are not exactly the same, patients had to be skin tested ahead of their treatments to make sure they were not allergic to the collagen. Restylane was actually invented in 1996 in Sweden, but was approved by the Food and Drug Administration (FDA) in 2003. Restylane is a non-animal, stabilized hyaluronic acid gel filler. Unlike collagen, hyaluronic acid is not a protein. It is a sugar substance common to all living things, requires no prior skin testing, and is therefore consider ideal as a biomaterial.
To date, in the United States, we have over twenty different types of hyaluronic acid fillers. These include Restylane-L, Restylane Lyft, Restylane Silk, Restylane Refyne, Restylane Defyne, Restylane Kysse, Restylane Contour, Juvederm Ultra XC, Juvederm Ultra Plus XC, Juvederm VOLUMA XC, Juvederm VOLLURE XC, Juvederm VOLBELLA XC, Juvederm VOLUX XC, Belotero Balance+, Revanesse Versa+, Revanesse Lips+, RHA Redensity, RHA 1, RHA 2, RHA 3, and RHA 4.
