Non-hyaluronic acid fillers

This month, our columnist, cosmetic doctor, and founder of Luxe Skin Dr Usman Qureshi (aka Dr Q) fills us in on the injectable alternatives to hyaluronic acid

As dermal filler use becomes more widespread, more types of fillers are introduced. Hyaluronic Acid (HA) is still the most favoured injectable filler and is likely to remain so for a long time, due to the reproducibility and predictability of its results. HA complications are now well known and its reversibility makes it a great product for novice injectors and experts alike. However, it does lack somewhat in the longevity department. Although MRI scan and microscopy shows the presence of HA filler at 20 years, the visible effects tend to wear off after 12 months in the majority of the cases. Here, we look at some alternative fillers that have emerged and how they compare to our beloved HA.

CALCIUM HYDROXYAPATITE (CAHA)

CaHa has been shown to last beyond 12 months. It stimulates collagen, resulting in improved skin tone and texture. CaHa has been around for several years, giving it a good safety profile and the results improve over several weeks and appear natural. The most well-known CaHa filler is Radiesse. Some hybrids have recently appeared, such as Allergan’s HarmonyCa, which has HA added to give immediate and longer-acting results.

The main side effect of CaHa is the formation of nodules which often require corticosteroid injections. Vascular occlusion is a real complication which is difficult to correct due to the irreversibility of the filler.

POLYCAPROLACTONE (PCL)

PCL is another collagen stimulator designed to improve effectiveness over time with results lasting beyond 24 months in some cases. It is good for volumising the face. Again, the product is not reversible like HA. The results are natural and subtle, improving over time. Ellanse, launched in 2009, holds PCL within microspheres. A new PCL product on the market is Gouri, which is a fully solubilised PCL with no microspheres, producing a smooth product that is easy to inject and spreads, giving a blanket coverage.

POLY-L-LACTIC-ACID (PLLA)

Sculptra is a collagen stimulator that has PLLA encased in microspheres. A series of injections are needed, with results expected to last over two years and the increase in collagen production seen gradually. It is favoured by patients who want an increase in their body’s collagen stores. The result is gradual yet effective, without the overfilling appearance noticed with excess use of HA. Lanluma is the new PLLA filler, producing similar effects to Sculptra, marketed for body volumising, but also has a version for facial use. Both products are arguably very similar and the decision to pick one over another may come to cost and ease of use.

POLYDEOXYRIBONUCLEOTIDE (PDRN)

This polymerised polynucleotide-based gel filler is a new entrant to the regenerative skin treatments market. It has great lifting potential and is suitable for use on the face and body. It encourages the growth of fibroblasts, collagen and elastin, while also hydrating the skin by attracting water molecules. The lifting effect is visible instantly with improved skin quality, reduction in scars and signs of photoaging to follow.

AUTOLOGOUS FAT TRANSFER

Lipofilling should not be forgotten when talking about fillers. Autologous fat transfer involves harvesting the body’s own fat through liposuction and then processing it to recover clean macro, micro and nano fat, which can then be injected into the face or body. This procedure has the added benefit of reducing unwanted fat while adding it to the required regions. Large and small quantities of fat transfer can be done in this way. Although some fat is reabsorbed, the remaining amount gives long-lasting results.

I have seen a changing trend in the aesthetics industry towards regenerative and restorative medicine rather than enhancement. More people are now chasing the “natural look” through intervention. It seems people want to look like their younger selves, rather than like a supermodel. The collagen-stimulating products are attracting more people towards cosmetic procedures, as they are encouraging the body to increase its own collagen and elastin stores, even though this stimulation is through synthetic means. I don’t believe that these new fillers will replace HA, but rather work alongside it and may be adopted by people who have been previously put off by the “filler look” you see around, due to poorly executed HA fillers.

DR USMAN QURESHI

Dr Usman Qureshi (aka Dr Q) is a cosmetic doctor and founder of Luxe Skin by Doctor Q in Glasgow. He focuses on non-surgical and minimally invasive cosmetic procedures for the face and body.