Are dermal and hyaluronic fillers the same thing? Which fillers should be used for the lips, which for the face, and which for the bags under the eyes? What is the price of the fillers? These are the questions frequently asked or searched by the patients
Each brand of hyaluronic fillers considers its fillers to be the best. They also advertise them claiming that they have the "softest" gels and most durable fillers. The Internet, the media, and even the patients are full of contradicting information.
Which hyaluronic fillers are the best?
There are too many marketing promises and distorted and biased medical studies. Not to mention that there are way too many "the newest" and "the best" brands of dermal fillers that are being sold on the Internet at alarmingly low prices.
But what is the real truth? Which brand do you consider to be the best and which filler should we choose for a specific treatment - nasolabial wrinkles, lips, nose, cheeks, skin quality, or bags under the eyes?
Hyaluronic fillers are dermal fillers, but not all dermal fillers are hyaluronic fillers. Even though there are dermal fillers that are not hyaluronic acid-based, such as Radiesse (calcium hydroxylapatite crystals), Sculptra (poly L-lactic acid), Ellanse (polycaprolactone) and permanent fillers, such as Aquamid, I am going to analyze only hyaluronic acid-based dermal fillers in this column - the only dermal fillers that I personally recommend. The reason for this is that hyaluronic fillers are not permanent, and thereby do not have permanent consequences, and they rarely have undesired side effects, such as lumps. Those fillers achieve the most natural results and, if necessary, they can be removed and melted with a special enzyme called hyaluronidase.
So, dermal fillers are a name for a group of fillers that include hyaluronic fillers as well.
Renowned brands of hyaluronic fillers
Most doctors usually get attached to one brand of hyaluronic dermal fillers. If a doctor gets attached to a renowned brand, such as Restylane, Juvéderm, or something else (e.g. Teosyal or Belotero hyaluronic fillers), then a patient is definitely in very good hands because those brands have a whole range of different fillers of various densities, hyaluronic acid concentrations, and molecule sizes. When we add years of medical research and tests to that, the results are inevitable.
No single filler brand covers everything
My fifteen-year experience in esthetic medicine has taught me that an ideal brand does not exist. This is why it is in the patient’s interest that their doctor has a choice of at least two of the aforementioned filler brands. Of course, the mentioned dermal fillers are not the only good-quality ones on the market, so if you still haven’t found your brand among them, no need to panic.
At the end of this column, I am going to recommend five renowned brands of hyaluronic fillers, including the already mentioned ones. However, it is important to point out that there are at least another 200 brands of hyaluronic fillers on the market and, with the growing popularity of esthetic medicine, new brands from South Korea, Japan, Russia, Ukraine, and South America have been emerging on an everyday basis. I am not convinced about their quality, I believe they are being put on the market way too soon without a real check and research, not to mention fakes of the original brands. Before we start the analysis of different fillers, here’s a little warning. The best and safest brands of dermal fillers in Croatia can be ordered only by licensed doctors of medicine and stomatology. Therefore, if you come across cheap offers for fillers, especially the ones not coming from certified doctors, there is a big chance that these are bad-quality brands or fakes from the Internet, and buying those can have extremely dangerous consequences.
A short reminder: What are hyaluronic fillers used for?
Together with Botox, hyaluronic dermal fillers are the main tool of modern esthetic medicine. Hyaluronic acid is a natural ingredient of our skin, and its main task is to moisturize the skin, but also support the collagen in the skin and improve its elasticity. The skin is glowing, it stays taut, the complexion is healthier, and the face can restore the lost volume.
How much is 1 ml of filler?
Modern fillers are stabilized hyaluronic acid which, when squeezed onto the hand, looks like hair gel. Interestingly, if we squeeze out 1 ml of a dermal filler onto a teaspoon, 1 ml fills only 1/3 of that spoon. However, in expert hands, excellent and very natural results can also be achieved with such a small amount, while some procedures require a lot more hyaluronic acid. Sometimes as much as 12 ml of filler is needed for something like a non-surgical face lifting in a person who lost a lot of facial volume, and the skin is loose and sagging. 12 ml of filler fits onto one tablespoon, so it’s not such a big quantity, and extremely natural results are achieved if it is applied by an expert professional.
Top five brands of dermal fillers and their rating based on experience
Best for bags under the eyes and facelift
It was invented in 1996 by Dr. Bengt Agerup from Uppsala in Sweden. Since it was the first stabilized hyaluronic acid, I often call it the "Coca-Cola" among fillers. When I first started practicing esthetic medicine, this was the only filler on the market and I trained on it. Restylane is still an "all-rounder" and it is one of the best fillers on the market. It is the world’s first stabilized non-animal hyaluronic acid filler (formulated with patented NASHA™ technology) - it is not of organic or animal origin. Today Restylane as a brand has a wide spectrum of fillers for different treatments on the face. For me, Restylane Classic is the best filler for non-surgical procedures on the nose and filling the bags under the eyes. Restylane Lyft has the biggest capacity for face lifting and as such is the best non-surgical facelift - lifting of the face and chin, and filling cheekbones. We should not forget to mention Restylane Vital Skinbooster for stimulation of collagen growth which is currently the best on the market and achieves excellent results in the rejuvenation of the face, neck, decolletage, and hands.
It covers a wide spectrum of treatments.
Restylane also has "OBT" (Optimal balance technology) fillers or "Emervel" technology characterized by soft and flexible gels that enable you to create contours and volume in the middle of the face. Here we can use several Restylane fillers, such as Volyme, Defyne, Kysse… Just as their names say, they have been created for specific areas and Kysse is a filler especially created for lips, and ever since they changed the filler needle, it is very easy to create beautiful, sensual, and natural lips using Kysse.
Longevity and other factors?
During the rating process, a few factors have to be taken into consideration, and one of the more important ones is definitely longevity. Of all the fillers I have worked with, Restylane has the best longevity in most of the treatments and facial regions. For example, the results on nasolabial wrinkles can last for up to ten years, on the nose for up to five years, bags under the eyes for three-four years, and on lips for six to 12 months. Side effects of this filler are very rare and mild which is especially important when we apply it to the bags under the eyes since the swelling is the slightest.
Another factor that I need to analyze is the injection design and technology of each brand, which is more important to the doctor than the patient. Injections of other brands are maybe anatomically better and easier to handle, so that’s why I gave it a mark of 9. Other than that, Restylane would be close to a perfect ten. Also, regarding the patients, Restylane contains a local anesthetic, lidocaine, for the procedure to be even less painful.
Another filler that I personally use the most is Juvederm by Allergan (recently bought by Abbvia) where Botox itself was invented. I call it "Pepsi Cola" among fillers because it was the second one on the market. Juvederm uses the most modern Vycross technology in hyaluronic fillers such as Volbella, Volift, Voluma, Volux, and Volite. A special filler created for the lips, Juvederm Smile is, for now, the only filler in Croatia that comes in a packaging of only half a milliliter for smaller corrections, even though Restylane will soon hit the market with the same product. Juvederm is one of the brands that together with Restylane and Galderma invest the most in the education of doctors and technology itself, with hundreds of scientific publications.
When we talk about lip augmentation, Juvederm Volbella is one of the best fillers and lately, it has been my favorite lip filler. This filler gives a soft, nice, and natural result that is visible for more than six months. On the other hand, Volux for shaping the chin and jawline is one of the hardest and long-lasting filers with a longevity of up to two years which has been confirmed by studies. It is used for chin augmentation, a so-called "Nefertiti chin" and a better-defined jawline. When we perform a facelift or non-surgical facelifting, Voluma is a fantastic filler and one of the best on the market for restoring the volume to the face. We use Juvederm Volite for skin rejuvenation using mesotherapy.
The fantastic thing is that throughout my career I have never had lumps from this filler or similar side effects. The needles are excellent, and since recently, we have an even thinner needle in Volbella for the lips, and it is also excellent for bags under the eyes. The injection anatomically sits very well in the doctor’s hand.
Juvederm has a very wide range of fillers that enables the safe application of treatments on the whole face. There is a very fine line when choosing the right filler for each region. I will sometimes choose Juvederm and sometimes Restylane for the same area, depending on the patient’s condition, skin thickness, etc. Therefore, the rating is the same.
Merz filler has recently been gaining popularity in the region, but it has been present and well-known in the world for much longer. Belotero also has a wide spectrum of different fillers for specific treatments, from Hydro filler for revitalization to Volume filler for cheek shaping and non-surgical lifting. What makes this company different is that they have two lip fillers - Shape and Contour - meaning one for the vermillion border and the other for the lip shape itself. This is extremely good and innovative and the reason why they have experienced such a boom in Croatia. Belotero is an excellent filler of good quality that has a lower density than other fillers which enables it to integrate better into the surrounding tissue. Due to all this, it gives even more natural results in certain conditions. The injection is anatomically very comfortable to work with, the needle is thin, and the filler contains quite a lot of lidocaine, so the procedure hurts less.
Where I see a problem with Belotero is its weaker performance in non-surgical facelifting, and that’s why I don’t use it as often as the previous two fillers. Insufficiently good results are especially visible in the case of bags under the eyes. There is another problem that is shown in the studies - its longevity which is from six to 12 months, and, in my experience, even less around the lips.
Belotero is a good filler, especially for a novice doctor and a patient who maybe wants to try the treatment for the first time since it’s soft, it degrades fast, and there are no side effects such as lumps, etc. However, this filler is definitely not enough for an expert who wants to achieve an excellent result.
Merz invests a lot in the education of doctors and scientific research, and it will always be one of the best brands of dermal fillers.
Teosyal by Teoxane closes the list of "the big four" in the world of hyaluronic dermal fillers. They have been improving their technology year after year. They also have a wide range of fillers for different purposes and treating different zones. Their RHA (Resilient Hyaluronic Acid) line is the first world line of hyaluronic acid-based dermal fillers with the FDA’s approval for treating static and dynamic wrinkles and fine lines on the face. They have RHA 1-4 with different concentrations of hyaluronic acid, which is very innovative and different from other fillers.
I would like to single out Teosyal Kiss for lips which defines the lines well using a small quantity. Redensity 1 and Redensity 2 turned out to be extremely good for skin moisturizing and rejuvenation, while Ultradeep is used for facial volumization. The injections are maybe slightly worse than the best ones, but they are still very safe and anatomically well-designed, and suitable for the application of fillers containing an anesthetic.
In my experience, Teosyal fillers last a bit shorter than the best similar fillers, and they also do not have an adequate product for the treatment of bags under the eyes, so their score is a bit lower in comparison with the best ones.
All in all, Teoxane is one of the best and largest brands of dermal fillers in the world. They also invest a lot in the education of doctors and congresses, and they will always be at the top of the market of esthetic medicine.
Neauvia filler is more and more present in the Croatian market, and it might be our next potential big player. A growing number of my colleagues are using it since it is new, innovative, and different. It is the only one of the five mentioned I have personally not worked with, but I can speak about it based on the experience of my colleagues and patients who praise it.
Just like all the companies on the market, Neauvia fillers also come with a whole spectrum of products. I would like to single out the filler for filling, but also stimulation of collagen which is a mixture of hyaluronic acid and calcium hydroxyapatite which means that it is the only one on this list that is not exclusively a hyaluronic filler, which is, in my opinion, a disadvantage. There are also lip fillers, Intense Lips, and Intense Flux for volume which has a high concentration of hyaluronic acid. This company is very innovative so, in their range, they also have Intense Rose filler for intimate area rejuvenation, and other 3 fillers that are branded for especially thick male skin, but it is questionable how successful they are in men’s skin rejuvenation and volumization.
The Swiss producer claims that this is the first entirely organic filler produced using a new technology that does not cause any kind of immunological reaction.
Neuvia, as the name itself says, is a new filler. New technologies have been applied in its development which is, on the one hand, exciting, but on the other hand, a disadvantage, and only time will tell if it can compete with the tried-out and good-quality fillers that have been present on the market for more than 15 years with concrete results. Another reason for a somewhat lower rating is its longevity which is up to 12 months, which is shorter than the competition.
What about other dermal fillers?
Among around 200 filler brands present in the world, I can single out a few more according to my experience. One of them is definitely Profilho for stimulation, i.e., self-rejuvenation and facelift. Among the fillers that are being used in Croatia, Aliaxin by IBSA should also be mentioned. Filmed is a new filler that is breaking through with a bright future, and I believe it will surprise us all in the coming years.
Many fillers are excellent, and some represent everlasting quality, such as Restylane and Juvaderm, which are, as I have already said, "Coca-Cola and Pepsi" in the world of fillers. "Cockta" is here as well, and some that manage to keep up and some new ones that have managed to surprise us all. However, in the whole story, the most important part is the doctor, their expertise, and the experience they will apply to a specific case and in so doing use the best materials available on the market.
What should we be careful about?
The best fillers on the market also have their "fakes" that can be extremely dangerous, so the only way to avoid them is to go to a professional, experienced, and certified esthetic doctor or stomatologist. Avoid beauty salons, private houses, and unusually low prices, which are sometimes lower than the purchase price for the material (the purchase price for the best and tested filler brands is around 1000 - 1400kn for 1 ml of hyaluronic filler).
Get informed and don’t risk your health and beauty.