Whether you believe it or not, surgeons have tried using dermal fillers for over one-hundred years now. The first surgeons attempted injecting liquid parafin (yes, really) into the noses of men with syphilis to fill out the classical pug nose deformity. Their efforts were met with devastating consequences some months later however when the parafin moved and caused necrosis of the skin of the nose. Fortunately however the last 100 years has brought with it some technical advances bringing us the modern options we have today.

The first of the modern generation of fillers came on to the market in the early 1980s with the collagen fillers, Zyderm and Zyplast. Collagen was revolutionary at the time in that the products could be taken off a package on the shelf and (usually) safely injected into the face to fill out wrinkles, lips and facial contours. Collagen fillers however, revolutionary as they were, were far from perfect. The collagen was derived from Cow’s hide and consequently was associated with a 1 in 20 chance of an allergic reaction therefore everyone had to have a skin test carried out two weeks prior to having the treatment. Even that wasn’t full proof however and some patients who had a negative skin test still went on to have an allergic reaction when the full treatment dose was administered. Other problems with collagen included a limited duration of action, with the results generally lasting only 8-12 weeks at a time. There was also a theoretical possibility of the transmission of disease from cow’s to humans.

In the mid-1990s Swedish company Q-Med launched the first ever hyaluronic acid based dermal filler: Restylane. Hyaluronic acid is a glycoprotein present in normal skin and joints. It is manufactured by genetically engineering bacteria to produce it and because of the non-animal source there is a much lower risk of allergic reaction (approximately 1 in 2000) therefore it can be injected without the need for a skin test. Best of all it lasts longer than collagen, approximately 3-4 months between injections.

Since Q-Med introduced their hyaluronic acid filler to the market there have been many other companies who have jumped on the hyaluronic acid band wagon, producing more refined and technically advanced versions of the gel. New brands of hyaluronic acid such as Teosyal and Juvederm Ultra which are manufactured to give a smoother result and have increased cross linking between molecules. The increased cross linking means that the molecules are more stable making them more difficult for the body to break down and therefore causing the results to last longer. Treatments with Teosyal or Juvederm ultra typically last in the 8-12 month range – a vast improvement from previous products.