What determines how long my filler results will last?
Since a large part of my practice is focused on injectable aesthetic treatments such as fillers, not a day goes by that I’m not asked the question, “How long do fillers last?”. This is a difficult question to answer because the answer depends on several factors which I am going to try to explain below. There many different fillers on the market however most of them are hyaluronic acid (HA) based fillers. The only non-HA fillers currently approved by the FDA are Sculptra, Radiesse, and Bellafill. HA fillers like Restylane work by filling in wrinkles. The hyaluronic acid gel that that makes up these fillers is injected deep to the wrinkle and essentially "pops" out the wrinkle. While some studies have shown that HA fillers encourage some collagen production, these "line fillers" usually work by adding support to the wrinkle at its base. Once the HA filler is broken down by the body, it needs to be replaced. Biostimulatory fillers on the other hand work by stimulating collagen production. The "filler" is therefore not really the product but the collagen that it stimulates. The filler particles will be broke down by the body relatively quickely however the collagen can in many cases last for years. That is why biostimulatory fillers like Sculptra typically last longer than hyaluronic acid based fillers like Restylane and Juvederm.
List of factors that determine filler longevity
- Type of filler used
- Part of the face treated
- Particle size
- Crosslinking and concentration of hyaluronic acid
- Amount of filler used
- Different patients, different metabolism
Type of filler
First, how long a filler last depends on the type of filler used. For example, a hyaluronic acid based filler like Restylane may last 9-12 months while Sculptra, a biostimulatory filler, may last up to 2 years. Radiesse and Bellafill are other examples of biostimulatory fillers.
Of the hyaluronic acid based fillers, larger particle fillers like Restylane Lyft tend to last longer then smaller particle fillers like Restylane Silk. This is because smaller particle fillers have more surface area exposed to degradation and larger particle fillers have less surface area for an equivalent amount of filler. Restylane Lyft typically last 9-12 months while Restylane Silk last 4-6 months.
Where the filler is injected on the face also influences how long the filler last. For example, filler injected into the undereyes tends to last longer than filler injected into the lips. In my experience, fillers injected into the temples and undereyes tend to last the longest while fillers injected into the lips tends to last the shortest time. In my opinion, these differences in longevity are based on the amount of motion in the treated area. The lips and mouth move a lot and so filler tends to last shorter periods when injected into these areas. Here is a list of areas typically treated with fillers listed in order of filler longevity from top to bottom with 1 being the longest lasting and 6 being the shortest lasting areas.
- Cheeks, nasolabial folds, chin, jawline
- Marionette lines
Cross linking and HA concentration
The proprietary technologies used to manufacture the fillers also impacts the longevity of the fillers. In general, higher crosslinking and higher concentration of hyaluronic acid leads to a longer lasting filler. The different technologies used to make fillers include:
- NASHA – used in Restylane, Restylane Lyft, and Restylane Silk
- XpresHAn/Optimal Balance Technology – used in Restylane Refyne, Restylane Defyne
- Vycross – used in Juvederm Voluma, Juvederm Volbella, and Juvederm Vollure
- Hylacross – used in Juvederm Ultra and Juvederm UltraPlus
Of these technologies, it is said that Vycross technology tends to last longer than the others because of crosslinking of low molecular weight and high molecular weight hyaluronic acid. The thought is that the combination of low and high molecular weight HA leads to more efficient cross linking and better filler longevity. However, over the last few years, Vycross based products have had a number of issues with nodules and inflammatory/immune reactions and so I tend to prefer the Restylane family of fillers in my practice. I also don’t believe that Juvederm Voluma last 2 years as Allergan likes to say.
Amount of filler used
The amount of filler used per site also influences how long a filler last. For example, cheek injection with 2 syringes of Restylane Lyft will have a longer lasting result then the same cheeks injected with 1 syringe of Restylane Lyft. In addition to the amount of filler, I believe that regular treatment of the same parts of the face with filler leads eventually to better longevity. For example, lips treated for the first time with filler may last 4-6 months. However, with regular treatment, the same filler may last longer.
Every patient is different
Finally, every patient’s body metabolizes fillers differently. Restylane Defyne may last 9 months in the nasolabial folds in one patient while another patient with slower metabolism may see results lasting 12 months.
Based on my extensive experience with the FDA approved fillers on the market today, I believe that most patients should expect to have filler treatment every 9-12 months except when the lips are being treated. With the lips, most patients need maintenance treatment every 6-9 months. Sculptra last up to 2 years but I usually recommend a maintenance treatment once a year using 1-2 vials.