The list of filler options keeps growing all the time. The most recent approved filler, Volux, is FDA approved for a very specific purpose: jawline augmentation. It may seem unusual to have one product for such a unique use but that is the reason there are so many types of fillers. Each area of the face is best treated with a product that has very specific characteristics to achieve the desired result. 
This article will help you to understand WHY? Before you can understand which choice is best for you it is valuable to understand the differences between the fillers available today.
First, let’s go through a little history about fillers. In the 90’s, filler came to market in the form of collagen injections derived from bovine(cow) tissue. This treatment was cumbersome as it required a skin test to determine if a patient may be allergic to the bovine collagen. In the late 90’s, human based collagen injections were available eliminating the need for the skin test but came with some limitations in the duration of effect and the ability of the product to ‘plump’ the skin to correct wrinkles.
In 2003, Restylane became the first FDA approved hyaluronic acid (H.A.) filler in the US. This product changed the way injectable products could be used to correct lines and wrinkles and the signs of aging.
Since then, the vast majority of fillers are still hyaluronic acid (H.A.) based. The evolution in H.A. fillers has been made by varying different properties of the H.A. molecule in the filler. This includes the way in which the H.A. is ‘crosslinked’ or connected on a molecular level, the concentration of H.A. and the cohesivity of the gel. One common way used to classify filler is g-prime, which is the measurement of the both the product’s viscosity and it’s elasticity. In other words, how runny and pliable the product is.
To understand G-prime in terms of treatment, think about what you are trying to accomplish with the injection. If you are looking to plump lips and smooth lip wrinkles, would you want to use a soft and pliable filler or a firm and rigid one? Of course you would want to use the filler that is soft and pliable. This will allow the filler to move naturally with your lips as you talk, laugh and smile. On the other hand, if you are trying to restore volume in the cheeks a soft, ‘runny’ gel will not be firm enough to create the desired projection and lift. You need a product that is firm and will stay in place to restore the structure that was once present before fat and bone was lost through the aging process.
When considering facial fillers, we evaluate the face in sections based upon what our goal is in that particular area. The midface (cheek) is generally an area where lift and projection create the desired outcome, requiring a filler that is firmer. The lips and small fines lines are usually within dynamic areas of the face, which benefit most from a soft and pliable product. The lower face has multiple areas with variable underlying support and can benefit from a range of moderately firm to softer filler.
Midface
MIDFACE - Consider the midface consisting of the cheeks and cheek bones, the structural
components of the face. In this area we commonly want a product that is intended to restore volume or create projection and lift to improve the position of the skin that has changed over time.
In order to accomplish this, we usually use Juvederm Voluma (G-prime 531), Restylane Lyft (G-prime 274), or Restylane Defyne (G-prime 231). Those products are thicker and can produce more projection and stay in place. Think of it like placing a pillar of support beneath the skin to push the skin in the desired direction.
Fine Lines and Lips
FINE LINES AND LIPS – Unlike the midface, when treating fine lines and lips we want a soft, supple product that will move dynamically with facial movements. This area is most commonly treated with Juvederm Ultra (G-prime 111), Restylane Kysse (G-prime 151), or Juvederm Volbella (G-prime 274). Each of these products are easily moldable and spreadable. Those characteristics make them ideal for highly dynamic areas around the lips and mouth.
Lower Face
LOWER FACE – This is a very broad area with some variation in the desired outcome. This area encompasses the oral commissures (corner of the mouth where the upper and lower lip meet), naso-labial folds (lines from the nose around the mouth), and marionette lines (lines from the corner of the mouth to the chin).
Each of these areas has a varying degree of movement and cause for the changes seen with aging. They are also significant contributors to what we recognize as an aged appearance.
We use products that are firm but moldable to provide the degree of movement desired for each area. Juvederm Ultra(G-prime 111), Juvederm Ultra Plus(G-prime 136), Restylane(G-prime 531), Restylane Defyne (G-prime 213). This category of fillers would be considered a mid-range of pliability in order to create both the ‘plumping’ and pliability desired for the movement in the area.
Jawline and Jowls
JAWLINE and JOWLS– This area has become much more prevalent recently thanks to the launch of Allergan’s new product Volux. Volux is FDA approved to improve moderate to severe loss of jawline definition. The product has a remarkably high G-prime which helps it to achieve a consistent ‘shaping’ of the jawline unlike any other product.
What's Next?
We have discussed G-prime and its role in the differentiation of fillers. There are also several other factors that we take into consideration, molecule size, cross-linking, and concentration. With all of the variables in products it underscores the importance of an experienced, patient centric practice focused on you as an individual. When considering filler treatment, you want to consult a trained medical provider who will gain an understanding of what your concerns are, perform a full assessment of your face, and complete the treatment. You do not want to meet with a ‘consultant’ or sales person, as they may not have the best insight into how to to achieve your goals based on your unique anatomy and physical characteristics.
Consultations at FAC are complimentary and a valuable to both learn about the reasons you see changes in the mirror and develop a plan to achieve the results you want.
| HA Filler Comparison | ||||
| Filler | Stabilization | Characteristic | Longevity | G' |
| Juvederm Ultra | Hylacross | High molecular weight. Thinner than Ultra Plus | Up to 1 year | 111 |
| Juvederm Ultra Plus | Hylacross | High molecular weight. Thicker than Ultra | Up to 1 year | 136 |
| Juvederm Voluma | Vycross | Variable molecular weight. Most lifting vycross | Up to 2 years | 353 |
| Juvederm Volbella | Vycross | Variable molecular weight. Most pliable of vycross | Up to 1 year | 274 |
| Restylane | NASHA | Uniform particle size. High G' but pliable | More than 6 months | 565 |
| Restylane Defyne | NASHA | Less elastic and thicker than Kysse. | Up to 1 year | 151 |
| Restylane Lyft | NASHA | Uniform particle size. Larger particle than restylane | More than 6 months | 549 |
| Restylane Kysse | XPresHAn | Very elastic and pliable. | Up to 1 year | 151 |
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