Injectable dermal fillers – all you need to know

With 12 years and counting of experience in the use of injectable dermal fillers, running a busy cosmetic practice in Paddington, we’ve come to be very familiar with the various injectable dermal fillers available, their strengths and weaknesses, uses and misuses.

Doctors are disallowed by the Australian Therapeutic Goods Administration (“TGA”) to mention these dermal fillers by name in a website, nor are we allowed to mention their active ingredients. Please bear with us as we attempt to inform you without using these specific terms.

Non-permanent dermal fillers

The dermal fillers we obliquely refer to here as Agent RAgent P, Agent S, Agent E and Agent J are all composed of the same substance. This substance occurs naturally in your body and is essentially a long complex sugar molecule, with around 100 grams of it residing in skin and in joints. The dermal filler manufacturers transform the substance slightly to ensure it lasts many months rather than a few hours (as it does in nature), but otherwise it is essentially a sugary goo (don’t worry: each syringe represents only about a hundredth of a sugar cube – 20 to 24 milligrams – so it won’t upset your diet!).

Agent R is the best established dermal filler of this group, having been around for maybe 15 years or so. 20mg/ml concentration of “sugary goo” x 1.1ml in the syringe. These days Agent R comes with local anaesthetic pre-loaded in the syringe, making treatments easier and more comfortable. If you squeeze Agent R out on to your fingers, you can detect that the consistency is ever-so-slightly particulate, like finely crushed Aeroplane jelly. This helps the sugary goo stay in place, be it in lips, around eyes, or in other lines around the face. We like Agent R.

Agent P is the same as Agent R, excepting that the particles are a little larger, creating a slightly firmer dermal filling effect that may last a little longer than Agent R. It is slightly more expensive.

Agent S is the same as Agent R and Agent P, excepting that the particles are bigger again, in fact 1mm in diameter. Agent S comes as a 2.25ml syringe, which is twice the size of an Agent R syringe and is therefore twice the price. Agent S is good for building up cheeks, and lasts longer than agents R and P on account of the larger particle size taking longer to break down.

Agent E is made of the same sugary goo as the others, but is more liquid in consistency, without the particles. It is therefore the softest, but also the runniest, of this group of dermal fillers. 22.5mg/ml concentration and exactly 1.0ml in the syringe (the promoters say the syringes are “overfilled” with 1.1ml, but they are not. They are merely systematically mis-labelled). It doesn’t have its own anaesthetic pre-loaded, so you need some anaesthetic prior to having Agent E injected (or at least some ice applied, or perhaps some inhaled laughing gas as well, which we keep for such a purpose). We like Agent E for soft lip enhancement, but find it too runny to place near eyes.

Agent J is liquid like Agent E, but not as runny. No particles. 24mg/ml concentration of sugary goo and 1.0ml in the syringe. Comes with anaesthetic preloaded in the syringe but at an extra price from the manufacturer, making Agent J the most expensive option of the sugary goo fillers. Still, it gives quite soft lips, and is firm enough to place near eyes. We like Agent J as well.

Each of these has its place, and we carry them all.

Permanent injectable dermal filler

There’s only one permanent injectable dermal filler available in Australia, which we will call Agent A.

If you squeeze Agent A onto your fingers you will find it is a soft liquidy goo like Agent J (above), but at the chemical level it is composed (22.5mg/ml, like Agent E) of a compound that is *not* sugar-like and does *not* exist naturally in the body and so does *not* break down with time.

We like Agent A in specific situations.

When a patient has had a non-permanent dermal filler on multiple occasions to the one place and can definitely say they want a permanent dermal filling effect, Agent A has a place.

When an older patient comes in looking for filling, Agent A is a good choice.

However, we have found that Agent A carries a certain risk of side effects that we don’t see with the non-permanent fillers. Patients have to understand this. The risk is very small but not entirely negligible, and the great great majority of patients stay happy with their results

Volume builder

Two products available in Australia work to build volume.

Agent RR is composed of particles chemically similar to bone, mixed with a natural organic gel. When initially applied it fills like a regular filler, but because the bone-like particles (don’t worry, these are only 30 microns wide) stimulate your cells to make more collagen, we see a prolonged effect of 12-24 months depending on the site injected amongst other things.

If you squeeze Agent RR onto your fingers, it is like a thick white toothpaste.

We find Agent RR has a special place in building and opacifying the thin skin on the backs of your hands. We also use it to build long-lasting volume in faces and facial lines. It is too white and thick to put in lips or around eyes, in our opinion.

Agent SS actually comes as a powder which we have to mix with local anaesthetic a full two days prior to injection (once mixed, it’s committed to you, so we get prepayment). The powder is composed of a natural sugar derivative that prompts your collagen-building cells to … build collagen. So, in the weeks and months after treatment, collagen and therefore volume and firmness builds in and under the skin. This effect can last three years.

Agent SS is great stuff because the effects are so longlasting and look so natural. Aside from fat transfer, it’s the only reasonable way to fill in the broad concavities of the temple or the cheeks that occur in slim individuals as they age (“runners’ face”).

The NSW Health Department agrees, as they have agreed to partially fund treatments with Agent SS for individuals with HIV experiencing facial lipoatrophy related to their HIV medication.

So why isn’t there a queue out my door of patients lining up for Agent SS?

Firstly, it takes a few weeks to a couple of months to work. In this “now now NOW” age, may patients don’t have the patience for this.

Secondly, you generally want several treatments. Some patients are satisfied after one, but others need 4 or 5. All takes time. All costs money.

Thirdly, the treatment has to be carefully but widely distributed under the skin so as to avoid lumpiness and ensure an even result. We at Peach have NEVER (to our knowledge) caused a lump with Agent SS, but that’s because we are very careful to spread it widely.

And finally, there’s a bruise risk. Moreso than with other fillers. Now, in the scheme of things, anything that can give you three years of a fuller younger-looking face is probably worth a few days of bruising, but people still baulk at it.

And Fat?

Can’t finish without saying something about fat transfer.

The greatest way to achieve youthful filling of your face is with your own fat.

In all probability you have more than enough spare fat on hips or saddlebags or abdomen available for us to use to give you a fuller smoother and ultimately younger-looking face.

Whereas the above-mentioned commercial fillers cost $600 – $1000 per ml to inject (at Peach at least, and up to twice as dear elsewhere), we can easily harvest 50ml or 100ml or more fat for facial transfer. As much as you need.

You can’t be allergic to your own fat. You won’t get a foreign body reaction to your own fat. We can always put in more fat. We can always take out (by suction or by lipodissolve) excessive fat.

And fat transfer includes, of course, the stem cells residing in the fat. It’s early days yet in the stem cell story, but these cells may help further rejuvenate the appearance of your face.

Click the above links for more information on facial fillers, or book an appointment with us.

02 9368 0100