Fillers: Volume replacement vs. volume enhancement

The first generation of fillers were volume enhancers. When they were injected they plumped up the skin and they were used primarily to soften lines. Collagen was the first of these fillers that achieved wide usage.  Although  collagen  had many advantages, its relatively short lifespan  left the door open  for other fillers.

The next generation of fillers to come into general use was the hyaluronic acid fillers (Restylane,Juvederm and their derivatives). These fillers are similar to collagen in their effect in that they act as volume enhancers. New volume enhancers, including one containing built in local anesthetic are in the pipeline.
However, the primary role of fillers has shifted from one of softening facial lines to regional volume enhancement (Facial sculpting).  A new type of filler, the collagen stimulator, has made this practical.
The collagen stimulators act primarily by stimulating the body to make new collagen. The currently available popular collagen stimulators are Sculptra  and Radiesse . These fillers have the advantage of being longer lasting than the currently available volume enhancers and, because of their greater filling ability they are more suitable for filling larger volumes, which is what is necessary for facial sculpting.
There is another collagen stimulator, Artefill, which is said to produce permanent results. This has so far had very limited acceptance because of its high cost and the fear of producing adverse effects that would be very hard to treat.
My current feeling is that for most purposes, Radiesse has become the filler of choice. It has an unmatched combination of safety and durability. Sculptra lasts longer, but has a propensity to produce nodules. New fillers are being developed and hopefully we will have even more versatile and longer acting safe fillers in the not too distant future.

Gerald N. Bock MD
Stockton, CA
California Skin Laser Center