What’s the Difference Between Hyaluronic Acid and Non-Hyaluronic Acid Dermal Fillers?

Gone are the days of inferior and even dangerous collagen and silicone fillers. Thankfully! There’s a (relatively) new treatment on the block: hyaluronic acid dermal fillers. Unlike their predecessors, which left a slightly rubbery effect, hyaluronic acid fillers even wrinkles and smooth furrows, leaving a natural complexion. That’s a facial filler miracle! With celebrities and influencers promoting the wonder treatment, there’s no surprise that it’s sweeping the cosmetic world by storm.

Except, there’s always something new. Amidst a market bustling with brands and products, there’s a myriad of non-hyaluronic acid dermal fillers, both new and old, jostling for supremacy.

So, what’s the difference? Which works better? And what should you be telling your clients? That’s what we’re here to find out.

Hyaluronic acid fillers: What’s the deal?

Hyaluronic acid is by far the most popular dermal filler available. Last year, a staggering 3.4 million injections were completed. With the pressures of video conferencing, that figure is set to repeat in 2021. But what’s in the little vial we inject?

Hyaluronic acid is a soft, gel-like substance injected into the dermis. Unlike other fillers, hyaluronic acid is a naturally occurring substance found primarily in the eyes and joints. Chemically, it is an anionic, non-sulfated, glycosaminoglycan – appearing like a string of benzene rings with various functional groups connected by an oxygen bond.

It’s this unique structure that gives the compound its amazing properties. Indeed, its water-binding capacity is phenomenal – it can hold up to 1,000 times its volume of water – helping to provide safe subdermal volume after injection.

There are two primary types of hyaluronic acid:

• Cross-linked
• Non-cross-linked

The difference involves creating cross-links between the molecules. Naturally, this affects the consistency and viscosity of the gel, resulting in higher longevity. However, it may not be suitable for fine wrinkles, which require a less viscous, softer treatment.

Examples of hyaluronic acid fillers

There are many different dermal filler brands available. Here are some of our most popular:

• Saypha®: Relatively new to the dermal filler world, Saypha from Croma-Pharma has made a big splash. Their range of products has gained a reputation for perfect viscosity, non-animal ingredients, and no skin discoloration.

• Belotero®: Specialising in lightweight products to treat fine lines like crow’s feet, Belotero is unparalleled in its effectiveness. The downside: the results don’t last as long.

• Juvéderm®: After producing the first hyaluronic acid filler on the market, Juvéderm maintained its reputation for high-quality products. Their Juvéderm Ultra 3, for instance, is renowned for being amongst the best lip fillers available.

Non-hyaluronic acid dermal fillers: What you need to know

Aside from hyaluronic acid, there are four other kinds of non-hyaluronic acid dermal fillers. Silicone is no longer included, as it is considered dangerous. These include:

1. Polymethylmethacrylate (PMMA)
2. Poly-L-lactic acid (PLLA)
3. Collagen
4. Calcium hydroxyapatite (CaHA)

Polymethylmethacrylate (PMMA)

Formulated from non-absorbable PMMA microspheres, once injected into the subdermal layer, it stimulates encapsulation by fibroblasts. This, in turn, triggers tissue creation through fibroplasia, creating long-lasting results.

Currently, Artefill is the only PMMA filler approved by the FDA. It consists of PMMA microspheres suspended in bovine collagen. There have been some concerns about this formulation, however. Early versions caused granuloma formation at a rate of 2.5%. Thus, many have reservations about using this product.

Poly-L-lactic acid (PLLA)

Similar to PMMA, PLLA stimulates fibroblast synthesis and collagen regeneration. Unlike different dermal fillers, therefore, results last for up to two years. Patients typically undergo several treatments for a significant effect, driving up the cost of the procedure. To date, only Sculptra is FDA-approved.

Adverse effects primarily involve nodule formation. The incidence rates are low, being less than 1% with proper administration, however.

Collagen

Amongst the oldest dermal fillers available, collagen is a naturally occurring substance comprising a large proportion of connective tissues. Sourced from either human, bovine, or porcine donors, this non-hyaluronic acid dermal filler has a low complication rate. Nevertheless, many have noted that the results are significantly inferior to standard results expected from hyaluronic acid.

Typically used in the treatment of wrinkles and scars.

Calcium hydroxyapatite (CaHA)

Calcium hydroxyapatite may seem like a radically different dermal filler – being the primary ingredient in mineral bone. However, the results are incredible. Longer lasting than hyaluronic acid, CaHA microspheres do not migrate to neighboring tissue. Nor are they readily absorbed and broken down. That means results that last. Albeit, with a more viscous formulation, it’s less than ideal for fine lines and wrinkles. It is still perfect for adding significant volume to cheeks or lips.

It also has a remarkable side effect profile and does not need to be patch tested. There are no known cases of any immunogenicity reactions.

Radiesse is the only FDA-approved version currently available. And can be purchased from our store