Belotero Balance (Merz), an injectable hyaluronic acid dermal filler, has been approved by the FDA for temporary correction of moderate-to-severe facial wrinkles and folds. Several other hyaluronic acid products are also available for this indication (e.g., Restylane, Perlane, Juvéderm). They have supplanted bovine collagen products, which persist for a shorter time and cause more allergic reactions.

Some Medical Letter consultants have suggested that our recent article on dermal fillers (Med Lett Drugs Ther 2007; 49:39) should have included stronger warnings about the risk of fillers that are not biodegradable, such as Artefill. The polymethylmethacrylate (PMMA, the same material that makes up Plexiglas) beads in Artefill can over time, even with the best technique, cause foreignbody granulomas and hypertrophic scarring, which may require surgical removal. Granulomas and nodules have been especially frequent when Artefill was injected into the lips. Complications are less likely with hyaluronic acid products such as Hylaform, Juvéderm or Restylane.

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Several injectable products are available for soft tissue augmentation of wrinkles and folds. These fillers are often used in conjunction with botulinum toxin type A (Botox) injections.