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Spa, MD: The Results-oriented Revolution

By: Jeffery S. Dover, MD, and Amy Kamin
Posted: May 29, 2008, from the June 2008 issue of Skin Inc. magazine.

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Semi-permanent fillers. Semi-permanent fillers fall between a short, lasting injectable and a permanent injectable, depending on the type of filler and the quantity used. The duration of its effectiveness is somewhere between 6–12+ months. The source of semi-permanent fillers is either natural (purified hyaluronic acid with naturally occurring complex sugar and fat) or synthetic (biodegradable polymer of polylactic acid and hydroxyl apatite). See Semi-permanent Filler Options on Page 62 for more information about the various options available.

Permanent fillers. Permanent fillers have permanent side effects. These materials must be used judiciously and with the right candidates. It is best to first treat these individuals with temporary fillers to be sure they like the result before injecting a permanent filler. The two presently available in the United States are silicone and Artefill. The former is approved for injection in the eye to treat recurrent retinal detachment. When used as a filler, it is considered an off-label use.

Artefill is the first permanent injectable filler approved by the FDA. It consists of synthetic beads of methyl methacrylate in a base of bovine collagen. After injection, the bovine collagen slowly dissipates leaving behind the permanent portion of the product—the synthetic beads of methyl methacrylate. Due to its permanency, it is recommended to do a series of injections for the gradual filling of defects in order to eliminate overcorrection and lumps. Because its source is bovine collagen, allergic reactions are possible. See Permanent Filler Options for more information about the two types.


Physicians and nurses must select which material and technique is the best suited for a patient’s particular type of defect, its location, and its desired results. Some want a natural look, while others prefer a more noticeable change. Technique is important in producing the desired results when using injectables. The experience and artistic ability of the physician certainly contribute to satisfying results.

Linear threading. The length of the needle is injected into the wrinkle’s center. The material is injected either as the needle is advanced (anterograde injection) or while it is gently pulled back (retrograde injection); or it can be injected in both directions.