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Selecting of the Right Dermal Filler - Restylane, Perlane, Juvederm, or Bellafil?

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If the patient is an appropriate candidate for treatment with a soft tissue filler, the clinician must then determine which agent should be used. The properties of fillers vary widely, and agents cannot be blindly interchanged. As an example, the use of polymethylmethacrylate microspheres (PMMA) in the lip or in areas of thin skin is not recommended due to a high risk for implant visibility, lumpiness, or beading after injection. 

The desired duration of effect must also be considered; fillers that are eventually degraded in tissue, such as hyaluronic acid, offer the advantage of reversibility in the case of undesirable placement, but require multiple subsequent treatments to maintain the desired effect . Permanent fillers should only be used in carefully selected patients; the use of biodegradeable agents is particularly advisable for cosmetic patients who are receiving a filling agent for the first time. 


Realistic expectations for treatment outcomes must be thoroughly discussed with patients, as optimal patient satisfaction is dependent not only on the clinician’s technical skill, but also on the fulfillment of patient expectations. In addition, the risks associated with the use of the selected filler should be carefully reviewed with patients prior to treatment.

An informed consent document should confirm that the patient understands of the potential adverse effects and expected treatment outcome. Digital photographs should be taken before and after treatment are useful for clinical follow-up and for documentation of pre-existing asymmetries or defects.

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