Fillers, skin boosters and collagen biostimulators are all injectable aesthetic treatments. But what’s the difference between them? Are there any specific reasons why we should choose one over the other? Can they be combined for an improved result?
Fillers, skin boosters and collagen biostimulators are all unique
Aesthetic treatments often have different modes of action. Their purpose is to make us look younger and enhance aspects of our skin quality, but they each do it in different ways.
Fillers, skin boosters and collagen biostimulators are commonly referred to as injectables. They are injected into the skin in contrast to other forms of aesthetic treatments such as chemical peels that are used on the skin’s surface. Apart from that, they all have their own unique properties. Let’s start looking at fillers.
Fillers are used to fill specific areas of the face
Fillers, as the name indicates, are used to fill. For example, a filler can be used to fill a wrinkle to make it less visible.1 It can also be used to fill the lips to give them a bit more definition and volume,2 or for shaping the contours of the face.3
Fillers are not injected all over our facial skin but are instead injected into specific areas. They may have slightly different properties, depending on where they are supposed to be used. For example, Restylane® Shaype™ is a firmer filler that can be used to define the chin, whereas Restylane® Kysse™2, which is intended for the lips, has a medium firmness and flexibility.4
Although this may seem a bit technical, the purpose is to give healthcare practitioners several tools to work with so that treatments can be individualized to each person – to help us look the way we want to.
Many fillers are based on hyaluronic acid5
What is injected when you have a filler treatment? If you were to take a closer look at a filler syringe, you would see that many contain a kind of transparent gel. The gel is based on a substance called hyaluronic acid. Hyaluronic acid occurs naturally in our bodies where it binds water and lubricates our tissues.6
Hyaluronic acid breaks down and reforms quite fast in the body, so if you would inject it as it is, the body would clear it out in a couple of days. The hyaluronic acid used for fillers is therefore “stabilized” with a cross-linking technology to help it last longer than hyaluronic acid in its naturally occurring form.7
In general, a filler treatment lasts between 3 to 24 months, depending on where the filler is injected, the kind of filler used and how fast the body breaks it down (which may differ from person to person).8
Skin boosters are used on a larger area of the skin
Skin boosters are also sometimes based on hyaluronic acid. However, skin boosters are not injected in specific areas. Instead, multiple small injections are spread over larger areas to restore the skin’s hydrobalance and to improve skin elasticity.9
As the gel microdroplets stabilize, it helps maintain the effect of the treatment for 12-15 months.*10,**11. For example, in a study which tested Restylane® Skinboosters™ Vital9 on hands, radiant-looking skin improvements were sustained for up to 15 months.*10
Restylane® Skinboosters™ has been shown to improve the skin in many more ways, in addition to improving the skin’s hydrobalance and elasticity. The treatment provides deep hydration that can help reclaim the skin’s healthy-looking glow and can reduce acne scarring.12 It has also been shown to reduce skin roughness13 and big pores.13
Collagen biostimulators are also used on a larger skin area
Collagen biostimulators are used on a larger area of the face. However, they do not contain hyaluronic acid. Instead, they contain a substance that can stimulate collagen formation in the skin. One example is microparticles of poly-L-lactic acid.15 It breaks down to a kind of lactic acid. Lactic acid is a natural substance that the body produces when breaking down carbohydrates. It’s also produced by certain bacteria when fermenting foods like sauerkraut or sourdough bread.
Collagen is a fibrous protein that forms a supportive three-dimensional network in the skin. As we grow older, this supportive network gradually breaks down and becomes fragmented. Collagen breakdown and fragmentation are major causes of skin aging, with typical signs including sagginess, skin roughness, and wrinkles.15
The purpose of collagen biostimulators is to stimulate the skin’s own production of new collagen, to help it look younger. One such collagen biostimulator is Scupltra®16 that has been shown to increase skin collagen with up to 66.5% in three months.17
The increase of collagen can change the skin’s appearance in many ways. For example, Sculptra® improves aspects of skin quality by enhancing its radiance and elasticity.18 The treatment also improves the appearance of wrinkles and folds for up to 24 months.19,20
At what age can you use injectables?
Fillers can be used by adults from 18 years and above. When we are in our 20s or 30s, fillers are primarily used for beautification or to help correct minimal imperfections.21 Once we reach our 40s, fillers are also used to help add a little volume where it has been lost due to aging, for example in the cheeks, and to reduce the look of wrinkles and folds.21
Skin boosters can also be used by adults of all ages. Regardless of whether we are in our 20s and 60s, for example, we may wish to improve skin hydration and reduce big pores.
Sculptra® is typically recommended for people aged 40 years and onwards. This is when we tend to experience a loss of skin firmness and show visible signs of sagging skin.21
Can different injectables be combined?
In general, certain different injectable treatments may be combined, though they are typically not performed at the same time. For example, you may wish to improve skin hydration (with a skinbooster treatment) and at a future point add a bit of volume to the lips.
A qualified healthcare practitioner can explain if it’s possible to combine treatments in your specific case and design a treatment plan that is suitable for you. They can also tell you about potential associated side effects and risks.
*15 months after initial treatment with Restylane® Skinboosters™ to boost skin quality in the hands, patients agreed (N=100). Compared with before having treatment with Restylane® Skinboosters™ VITAL. As assessed by Subject Satisfaction Questionnaire. 91.4% and 83.9% respectively. 100 patients formed the intent-to-treat patient population.10
**As assessed by the GAIS, patients who self-reported as “somewhat”, “much”, or “very much” improved. Patients received bilateral facial treatment with Restylane® Skinboosters™ VITAL: one side via needle, the other via cannula, injected over three treatment sessions spaced 1 month apart.11
References:
1. Restylane® Classyc™ Canadian Instructions for Use. 2023. 2. Restylane® Kysse™ Canadian Instructions for Use. 2023. 3. Restylane® Lyft™ Canadian Instructions for Use. 2024. 4. Öhrlund Å, New method to study the balance of firmness and flexibility for HA fillers, Galderma Development, Uppsala, Sweden, Presented at AMWC Monte Carlo, Monaco; 5. Lundgren, B. et al.; Using a New Photo Scale to Compare Product Integration of Different Hyaluronan-Based Fillers After Injection in Human Ex Vivo Skin, J Drugs Dermatol. 2018 Sep 1;17(9):982-986; 6. Necas J. et al, Hyaluronic acid (hyaluronan): a review, Veterinarni Medicina, 53, 2008 (8): 397–411; 7. Coleman S.R., Cross-Linked Hyaluronic Acid Fillers, Plast Reconstr Surg. 2006 Feb;117(2): 661-5; 8. Fallacara A. et al, Hyaluronic Acid in the Third Millennium, Polymers 2018, 10(7), 701; 9. Restylane® SKINBOOSTERS™ Vital Canadian Instructions for Use. 2023. 10. Wu Y et al. J Cosmet Dermatol 2020;19(7):1627–1635. 11. Gubanova E et al. Poster presented at IMCAS, Jan-Feb 2015, Paris, France. 12. Dierickx C et al. Effectiveness and Safety of Acne Scar Treatment With Non animal Stabilized Hyaluronic Acid Gel Dermatol Surg 2018; 44 Suppl 1: S104–S18; 13. Lee B et al. Rejuvenating Effects of Facial Hydrofilling using Restylane VitalArch Plast Surg 2015; 42(3): 282–287; 14. Kim J., Effects of Injection Depth and Volume of Stabilized Hyaluronic Acid in Human Dermis on Skin Texture, Hydration, and Thickness, Arch Aesthetic Plast Surg 2014; 20(2): 97–103; 15. Fischer GJ. et al., Looking older: Fibroblast Collapse and Therapeutic Implications, Arch Dermatol. 2008 May;144(5):666-72; 16. Sculptra® Canadian Instructions for Use. 2022 17. Goldberg D, et al., Single-arm study for the characterization of human tissue response to injectable poly-L-lactic acid, Dermatol Surg. 2013;39(6):915-922; 18. Bohnert K et al. Randomized, Controlled, Multicentered, Double-Blind Investigation of Injectable Poly-L-Lactic Acid for Improving Skin Quality, Plast Reconstr Surg 2019;127(4):1684–92; 19. Narins RS et al. A randomized study of the efficacy and safety of injectable poly-L-lactic acid versus human-based collagen implant in the treatment of nasolabial fold wrinkles, J Am Acad Dermatol 2010;62(3):448–62; 20. Brandt FS et al. Investigator global evaluations of efficacy of injectable poly-L-lactic acid versus human collagen in the correction of nasolabial fold wrinkles Aesthet Surg J 2011;31(5):521–8; 21. Haddad A. et al.; Managing the Aesthetic Patient; J Drugs Dermatol. 2019 Jan 1;18(1):92;