The last two years have seen a decrease in the use of collagen-based dermal fillers—and it shows in the announcements by two leading makers, Allergan and Johnson & Johnson, that they will no longer produce their respective collagen products (the human-derived CosmoDerm and CosmoPlast, the bovine Zyderm and Zyplast for Allergan; the porcine Evolence for Johnson & Johnson). For more than two decades, collagen has been the preferred filler for many cosmetic surgeons. Considering the origins of donor tissue, it is understandable that questions could arise. Plus, collagen-based fillers require skin allergy testing and are relatively short-lived compared to the next generation of fillers.

As in many markets, money drives the evolution of new products, and dermal fillers are no exception. The popularity of non-animal hyaluronic acid (HA) dermal fillers (known as replacement fillers because they replace lost volume) and PLLA and PMMA fillers (known as stimulatory fillers because they stimulate collagen and fibroblast production) has been strong in the recent past. Radiesse, Juvéderm, Perlane, Restylane, and Sculptra currently dominate the US market. Dermatologists report HA, PMMA, and PLLA fillers as being more versatile, longer-lasting, bulkier, and better for deep-volume filling than collagen.

But what about fine and thin line use, such as for foreheads or smokers lines around the mouth? Collagen was usually considered better for those applications. But Restylane Fine Lines is one HA product that makers hope to take over what used to be collagen territory.

What will the world of dermal fillers look like in the future?  Change is certainly underway. Although fillers that indirectly stimulate fibroblast production are holding sway, direct injection of fibroblasts with Human Dermal Fibroblasts (HDFs) may be a trend. UK dermatologists are currently testing Valveta, a filler derived from the foreskins of male babies that is reputed to repopulate skin with healthy young cells and be long-lasting, if not permanent.