As one gets older, the effects of age, heredity, the sun, gravity and lifestyle take their toll on the skin of the face and body. The face being the most exposed part of the body is the part where the skin changes are most obvious, and that part is what everybody worries about first in an effort to keep looking young.

Face changes are obvious. There is increased development of wrinkles and folds as the underlying subcutaneous tissue thins out and there is loss of volume and fullness. Another reason for the formation of creases and folds in the skin of the face is the continual or frequent usage of the muscles of expression in the skin. Initially the usage of these muscles cause the formation of dynamic wrinkles which disappear when the muscles of that particular part of the face relax. Thus we get what are popularly known as frown lines or glabellar lines (between the eyebrows), forehead lines (horizontal lines on the forehead on looking up, also called surprise lines) and crows' feet (the lines radiating out from the corners of the eyes). Ultimately these dynamic wrinkles become more permanent and remain even when we relax the muscles of expression. Think of a piece of paper that is folded and opened repeatedly. In the end the initial mild fold becomes permanent and prominent.

The upper face is not the only part of the face affected by age and the other factors mentioned above. Moving downwards we see the nasolabial folds, the deep grooves running from the sides of the nose to the corners of the mouth. Beyond that, running from the corners of the mouth in almost the same direction as the nasolabial folds, are the marionette lines, so-called because these lines make the person look like a puppet.

The solution to these problems is a simple, relatively inexpensive and safe injection of a gel-like substance known popularly as a facial filler or skin filler into the underlying area of the skin. Injection of this volume under the skin will cause the skin to balloon up and recover its lost fullness, at the same time causing the overlying wrinkles or folds in the skin to become shallower to the point they even disappear. These fillers are useful not only to remove folds and creases, but there is also a use for them to augment volume on the face as well as other parts of the body. Thus we can change the shape of the nose for those who are somewhat flat-nosed, augment the cheeks in those who have hollow cheeks, enlarge the lips for those who want sexier, bigger lips, or even enlarge the chin of those whose chins are smaller than desired. Fashion trends change, and fillers can be used to enlarge those body parts which are desired fashion of the day. Moving down the body, one can enlarge the breasts with fillers, or enlarge the buttocks to enhance perceived sexiness.

Ideally the substance injected should be safe to the human body and not cause any side effects, be as close in chemical composition as the naturally occurring substances in the skin as possible, and be able to last. Technically a lot of formulations have been introduced in recent years that try to approximate this ideal state of affairs.

They are:

Hyaluronic Acid. Hyaluronic acid is a natural component of the dermis of the skin. It forms the extracellular matrix and gives the skin its volume and turgidity. Because hyaluronic acid is a naturally occurring substance in the human body, fillers made from this material do not excite any allergic reaction and are considered perfectly safe. The hyaluronic acid may be modified in certain brands so that it lasts longer in the body before being absorbed. Examples of popular hyaluronic acid fillers are Juvederm (also popularly referred to as Juvaderm or Juviderm), and Restylane (also known as Restalyne or Restalyn). Hyaluronic acid fillers can last from a couple of months to 6 months (Restalyne) to 1 year (Juvaderm)

Collagen. A major component of the extracellular matrix, it is responsible for skin strength and elasticity. Collagen fillers are usually derived from bovine sources and may give rise to allergic reactions. Thus allergy testing is usually recommended if one uses collagen fillers. Examples of collagen fillers of bovine origin are Zyderm and Zyplast. Another type of collagen filler derived from human skin is less allergenic. Examples of these are Cosmoderm and Cosmoplast. How long do collagen fillers last? About 3 - 6 months.

Hydroxylapatite. This is a non-toxic, biocompatible mineral found naturally in human teeth and bones. Small microspheres of hydroxylapatite suspended in a gel-like medium, such as Radiesse, are used as fillers for moderate to deep wrinkles and facial folds and cheek augmentation. How long does Radiesse last? About 12 - 18 months.

Human Fat. This forms the most natural of fillers, as this is derived from the patient's own body fat. This fat is usually harvested by liposuction from the buttock fat or abdominal fat, washed, and reinjected into wrinkles and folds. Liposuction, however has its own risks. How long do fat injections last? This depends on the technic of harvesting of the fat cells (less traumatic harvesting and less disruption of the live fat cells allows for a longer-lasting result), and the area of injection ( the effect lasts longer in areas where there is less movement such as the back of hands and the cheeks, and shorter in areas where there is constant movement such as the lips and mouth areas). Averaging at least 3 years.

PMMA (Polymethylmethacrylate).Popularly used for buttock augmentation (Brazilian butt), polymethylmethacrylate is non-absorbable and is considered a permanent filler. Artefill is a filler composed of PMMA microspheres mixed with bovine collagen. How long does Artefill last? Generally lifelong.

Poly-L-lactic Acid.Currently indicated for the correction of facial fat loss in people with HIV. The brand is known as Sculptra. Effects last for about 2 years.

These are the major types of facial fillers in common use by esthetic practitioners. It is recommended that you seek the advice of your trusted experienced esthetic doctor before you decide to embark on any filler injection to get the best results.