The range, performance and usefulness of dermal fillers has expanded dramatically in the past 10 years. The original filler was Collagen, but it has been replaced with products that are easier to use and last a lot longer. Dr. Elliott uses temporary HA Gel fillers like Restylane® and JUVÉDERM®, Revanesse®, Belotero® & Emervel®. He also likes to use two permanent filler products, Bellafill® & Silikon 1000®. He strongly believes that only a skilled and experienced physician with a trained esthetic eye should perform filler treatment. He does not agree with the practice of using nurses to inject either fillers or cosmetic muscle relaxants.
Restylane® and JUVÉDERM®, Revanesse®, Belotero® & Emervel® are all non-animal source fillers. They are very similar in use, and have been developed to smooth out lines and wrinkles, shape and contour facial features and add volume, creating a more youthful look. These fillers are sugar gels. They are a substance found in all of our bodies tissues, which is why they are well tolerated and safe. You do not need allergy testing prior to treatment like with collagen.
Dr. Elliott categorizes the fillers he uses into 2 broad classes: temporary and permanent. He further subdivides these into reversible and non-reversible, and instant or gradual.
The permanent fillers currently available in North America are Bellafill® and Silikon 1000®. All other fillers are temporary. The only reversible fillers are currently the HA gels. Sculptra is not instant, but all others he uses are.
How Long Do They Last?
HA Gel Fillers
Filler durability varies between patients, doctors and the product used. In Dr. Elliott’s experience, HA gel fillers typically last 9-15 months. Exceptions to this include lips (expect 6 months) and the lower eyelid area (expect 8 months). Some of the longer lasting HA gel fillers that Dr. Elliott uses can last past 12 months. These products are generally not suitable for the lips or lower eyelid area. Nothing stays behind when the product fades. You just reabsorb it from the tissue.
Some patients may have experienced shorter duration of effect with HA gel fillers. In Dr. Elliott’s experience this is due to either under-filling by the injector, or rapid metabolizing by the patient. The former is due to trying to spread the filler too far (treating an area that requires 2cc with less than that). Preventing this scenario requires knowledge of how much the area requires and the decision to not undertreat by the injecting physician. Rapid metabolizing by the patient is uncommon and not predictable. Thankfully, for these patients, other classes of fillers are available. These include Radiesse, Sculptra and permanent fillers.
Radiesse provides instant results, but is not reversible (non-dissolvable). It is well suited to many areas of the face and body and is quite cost-effective. Other advantages include immediate soft feel and minimal swelling post-treatment. Results typically last 12-14 months. Radiesse is metabolized over time and will disappear completely.
Sculptra is unique. It is a collagen stimulator, rather than filler. It creates volume by stimulating your own collagen production, rather than by its own volume effect. Sculptra results are gradual, taking 8-12 weeks to evolve. Dr. Elliott uses a lot of Sculptra. He regularly trains other physicians in its use and is widely recognized in Canada as an expert in its use.
The appeal of Sculptra for Dr. Elliott and his patients is due to several characteristics: it is very cost-effective, results evolve in a gradual, subtle way, typically lasts 2 years, and commonly produces improvement in skin tone and texture. It is one of the main products that his patients will choose once they have tried temporary fillers, or need more extensive facial or body areas treated. In his experience, it has a very low rate of adverse effects and is very popular with his patients.
Bellafill is also unique. It is a permanent filler that Dr. Elliott has used extensively. He was the first Canadian physician to use it in early 2012 and it is increasingly popular with his patients as an alternative to temporary fillers. Bellafill is injected just like temporary fillers and provides an instant result.
Technique and esthetic skills are critical, as Bellafill is permanent. Dr. Elliott does not consider it appropriate for lip enhancement.
Medical-grade injectable silicon has been used as a dermal filler for at least 60 years. Dr. Elliott has used it for more than 10 years for scar correction and lip augmentation. Silicon is permanent, soft, cost-effective, and exceptionally well-tolerated when properly injected. Technique and esthetic skills are critical as silicon is permanent. In his experience, most patients will require 1 to 3 sessions for full correction of scars or lip enhancement.
+ How is treatment performed?
All fillers are placed by injection. Dr. Elliott does this via micro-cannula technique, rather than with needles. Today’s fillers contain lidocaine, which is a local anesthetic. As the filler is injected, the area goes numb. Combined with skilled and gentle micro-cannula technique, this means that Dr. Elliott’s patients experience much less pain than with traditional needle-based techniques.
+ How much downtime can I expect?
Filler treatment is a minimal downtime procedure. What this means is that you may get a little bruising and swelling in the area treated. In Dr. Elliott's hands, bruising is not common, but a little swelling is fairly normal. This is typically not noticeable to anyone but you. Having treatment and going back to normal work and social functioning the next day is the norm for his patients. Each facial area and filler is unique regarding post-treatment swelling. Dr. Elliott will discuss this with you prior to your treatment.
+ Is this painful?
Without anesthesia, any filler treatment is painful. The most painful area to have treated without anesthesia is the lip. Key factors in preventing and minimizing pain are the use of anesthetic (in the filler or separately), injector skill and technique, and the use of micro-cannulas.
Micro-cannulas are the alternative to needles for injecting fillers. The difference is the tip configuration. Needles have a sharp, cutting tip, whereas cannulas have a smooth round tip. Cannulas are safer, cause less bruising and are much less painful. They require different skills of the physician than needles. Dr. Elliott was one of the first Canadian physicians to begin using micro-cannulas in 2005 and has developed technique since. He began teaching other physicians in their use several years later and now regularly trains other physicians and nurses in his micro-cannula techniques.
Dr. Elliott will be able to discuss cost estimates during your consultation.
The only permanent synthetic filler is Silicon. Dr. Elliott uses Silikon 1000 as permanent filler for scars and for lip enhancement. It is licensed as a medical device in Canada and the US for use in the retina but has been used as dermal filler since the 1960’s. This is common in Medicine and is known as “off-label” use, where doctors have found another use for a medical device or medication.
Silicon used properly in the lips and in scars is seamless. It gives just as natural a look and feel as products like Restylane® and JUVÉDERM®, Revanesse®, Belotero® & Emervel®. The difference is that Silicon is permanent. It also must be built up gradually over 1-3 appointments.
In depressed or dimpled scarring from injury, chicken pox or acne, Silicon is the only filler that makes sense. A scar is permanent, and so should be the filler you use to correct it.