An International Perspective on Fillers in Dermatology—From an American Perspective

September 2012 | Volume 11 | Issue 9 | Original Article | 1089 | Copyright © September 2012

This manuscript is intended to give one an international perspective on the use of fillers around the world—what makes some of them special and what is the need and what is the purpose of having so many fillers in this global dermatologic community we live in. In the US, we have a finite number of fillers and only a handful more currently going through FDA testing. We demand much from our fillers in terms of safety and efficacy, and for all of us in the US, this is a very good reason to keep the numbers of fillers available to a reasonable number.

J Drugs Dermatol. 2012;11(9):1089-1093.


The past several years have seen numerous soft tissue filling agents ascend onto the cosmetic surgery scene. All of these different products claim superiority over the fillers that have become before them. They last longer than what we already have. They do not have the same reactivity as the fillers we already have. They have less adverse events than the fillers already tried and true in dermatology. Can they, in fact, all be better than what we already have? Can they all last longer, be less reactive, safer, and the end all of products that we need to rush out to buy and give to our patients?
If you look around the world you will immediately be amazed at the vast number of filler materials available. Why is it that the majority of these products have not yet found their way into the United States? These are questions we will attempt to answer in this article, as we look at the non-permanent fillers currently available in the United States (Table 1) versus what is available around the world (Table 2).
Now, the first question you may ask is why am I tasked with writing this kind of manuscript? As I plan for my next trip abroad, which will take me well over the five million mile mark for air travel in dermatology, I have been blessed by having been invited to speak at dermatology meetings all over the world. I watch and listen to all of the cosmetic presentations and constantly try to educate myself as to what the new products I see regularly are all about and what makes them special in the particular market I am in at a given time. I have seen many companies come and go; not only because of corporate acquisitions but also frankly because some of these products did not perform in the “real” world as promised. On the other hand, and to be fair to many of the companies I have come to admire, there are some wonderful soft tissue products out there that we, in the United States, should know about, and if possible, encourage to come to the United States. We will mention some of them in this article so you can become familiar with them.
Why are fillers so important in dermatology? First, they have found a wonderful niche that allows us to place a foreign substance into the skin and, for the most part, erase lines and wrinkles, or to volumize the skin itself. We are treating the aging process in a most non-invasive way, with little downtime and for the most part, with an incredible safety profile, at least for all the fillers now in the United States and for some of the products available outside of the United States. Fillers have become the third most common, non-invasive cosmetic procedure performed by cosmetic dermatologists all over the world, and only botulinum toxin A injections and laser/light procedures are more popular in the cosmetic, non-invasive world.1 As some have noted, we are now viewing fillers as more than just substances that we can inject into folds and furrows. We are seeing their potential as agents that we can successfully utilize into deeper areas within the skin, allowing contouring and thus a rejuvenative effect not appreciated when they first came to the market some 30 years ago.
The search for the ideal filler product has eluded us as well as companies since they advent of dermal fillers. The ideal filler must be easy to inject, must produce reducible results with each injection given, have longevity that usually translates to at least one year and perhaps as long as two years, be painless upon injection, nonallergenic (no skin tests required), noncarcinogenic, nonteratogenic, and will not migrate into other areas once injected into the skin. In addition, we all want the ideal filler to be able to be stored at room temperature, have a long shelf life, and be free from any and all transmissible diseases. The ideal dermal filler will have few if