Juvederm, Restylane, Belotero – what’s the difference?

Every time you turn around, someone has launched a new injectable filler. In the last three years the FDA has approved a new filler every six months! It can be hard to know whether each new filler is just a marketing gimmick, or a true improvement.

Look no further. In this post, I explain the differences between the many fillers on the market, and how I choose the right one based on your goals.

How do fillers work?

With age, the face loses volume, and the skin loses elasticity. So, like a deflating balloon, the loose skin folds and forms wrinkles. Neuromodulators (like Botox) get rid of dynamic wrinkles by paralyzing the muscles that pull and wrinkle skin. Fillers can plump up the skin back to its original shape, smoothing out static wrinkles from the inside out. HA fillers absorb water and can swell to 3 or 4 times their original size, adding more fullness. Since HA is a natural sugar, the body slowly absorbs it, and its effect gradually wears off.

HA fillers have two components. First, there are large, stiff, HA chains. They have many HA molecules that are linked together. Second there are small “free” HA particles. These behave almost like a liquid because they are not stuck to each other and can move around easily.
So the syringe of filler is like jello that has been gently whisked. There are large bits (the “cross-linked” HA), and small bits (“free” HA), but everything is still made of jello.

What makes one filler different from another?

This is the million dollar question. As you can imagine, companies spend tremendous amounts of time and money improving their filler products. There are five technologies currently on the market.

Restylane NASHA technologyRestylane manufacturing facility

NASHA: Restylane, Lyft, and Silk

This was the first HA filler technology, launched in 2003. Imagine a block of jello pushed through a strainer. All the pieces of jello will be the about same size. This is basically how Restylane, Lyft, and Silk are made. Restylane and Lyft can provide a good deal of power, and they are quite stiff. The particles in Silk are very small, so it is quite soft and pliable. But it also has lower durability as a result.

Hylacross: Juvederm Ultra and Ultra Plus

Hylacross was Juvederm’s original technology. In this method, a chemical process is used to join together many different equal-sized bits of jello into larger chunks. By controlling how tightly the pieces are joined together, the filler can be made softer or stiffer. But it tends to act more like a single very flexible piece of jello rather than individual chunks.

Vycross is like a jar of big and small rocks. It packs in the HA more tightly.Hylacross vs Vycross. Vycross HA is more tightly packed.

Vycross: Juvederm Voluma, Vollure and Volbella

This is Juvederm’s newest technology. Unlike Hylacross, it joins together bits of HA of many different sizes. The difference between Hylacross and Vycross is like the difference between a jar full of rocks and a jar full of rocks and pebbles. Vycross allows the HA to be more tightly packed. As a result, Vycross fillers –

  • last longer than Hylacross,
  • don’t cause as much swelling,
  • can be made stiffer, giving a more powerful lift
  • or made softer, for sensitive areas like the lips or eyelids
Restylane OBT tech - increased cross-linking makes the filler stifferChanging the cross-links changes the filler behavior

Optimal Balance Technology (OBT): Restylane Defyne and Refyne

OBT is a bit like Hylacross in that it joins together equal sized bits of jello into larger chunks. But the OBT technology can vary both the size of the jello bits and how tightly they are linked. So a variety of different fillers in terms of lifting power and stiffness can be created. For example, Restylane Refyne is a soft, pliable filler while Defyne is stiffer and more powerful.

Dynamic Cross Linking Technology (DCLT): Belotero Balance

This is quite different than the technologies used by Juvederm and Restylane. DCLT joins together bits of HA, then stretches out the big HA piece, and makes more joints. It’s like stretching out a spring and adding more internal springs to it. This makes Belotero extremely flexible, soft, and spreadable. To stretch my analogy a bit, it’s almost like butter rather than jello.

Dr. Purushottam Nagarkar, University of Texas Southwestern Medical Center, Dallas, Plano and Frisco
Dr. Nagarkar on the science behind HA:

HA science can get very complicated very fast. However, the key is understanding how the various fillers interact with the body, and how to match the right filler to the right area. Using a filler in the wrong area can be a waste of money (because you won’t see much improvement). Or worse, it can be dangerous and disfiguring. In the end injecting fillers is an art – it requires understanding anatomy, filler tech, and knowing how to safely get the maximum effect with the minimum filler.

So how do I choose the right filler for you?

There’s a few types of uses for fillers. Each of these uses requires particular filler characteristics.

Hollowing: Cheek bones and temple

In areas like the cheek bones or the temples, the filler is meant to provide significant fullness. It needs to have high power since it has to provide lift to a large area. Stiffness is not as much of an issue because fillers in these areas aren’t usually easy to feel. Depending on the details of your situation, I would choose Juvederm Voluma, Vollure, or Restylane Lyft.

Deep lines: Laugh lines

This area requires a powerful lift, but the filler can’t be too stiff. A stiff filler here can feel very unnatural. I usually choose between Juvederm Ultra Plus, Vollure, Volbella, or Restylane for this region.

Fine lines: Lower eyelid and mouth

The skin in these areas is very thin and delicate. Any filler I use here has to be soft, and flow easily. The best options are Juvederm Volbella, Restylane Refyne, and Belotero Balance.

Conclusion

Hopefully it’s clear that each HA option has its pros and cons. Filler technology has certainly improved since 2003 when Restylane was first introduced in the US. That being said, the older fillers can still be a good option depending on the situation. As with any other medical treatment, the most important thing is expertise. An “old” filler injected by a skilled doctor will always be better than a “new” filler in the hands of someone who doesn’t understand the science or anatomy.