There is no best filler. It really depends on what is best for you in terms of your biology and your needs. The “best filler” will depend on many factors including:
1. The length of time the filler will last.
2. The area on the face that needs to be filled.
3. Your skin type, thick or thin, if you have sun damage or acne scarring.
4. The amount of “fill” that is required (fine wrinkles, etched wrinkles, troughs and major volume – cheeks and mid-face).
Hyaluronic acid fillers have become the “gold standard” these days. I believe the other fillers still have niche roles and I still frequently use them. The reason that hyaluronic acid fillers have become so popular is because they are softer than the other fillers, they are more forgiving (harder to feel or see bumps) in thinner skin and soft tissue, they can last up to 12 or 18 months in some locations, they are cheaper than other longer lasting fillers and they can be reversed instantly with a solution of hyaluronidase if needed.
The two major hyaluronic acid players are Juvederm (by Allergan) and Restylane (by Medicis). The major hyaluronic acid fillers can differ in the “particle size” of the hyaluronic polymer, the cross-linking of the polymers and the final concentration of the hyaluronic acid in the syringe. Juvederm has a wider range of particle sizes and Restylane has a more uniform particle size. Both have similar concentrations and cross-linking of hyaluronic acid. The variations of these products have greater concentration or cross-linking to achieve better and longer lasting correction at the expense of a thicker, less forgiving product in thinner skin.
The bottom line is that each of my patients is evaluated first, then I discussed the different filler options available for each area of concern and finally we select a filler to give the best correction for that area. I photograph each patient before and after the treatments to follow the patient’s progress and document the length of time each correction lasts. I insist that patients return two weeks after a treatment so we can reevaluate the treatment area and determine if any additional corrections are necessary.
I use radiesse and evolence as well. I tend to reserve these for patients who have already experienced fillers and are comfortable with fillers in the skin and are ready for more longer lasting results.