According to Dr David M. Duffy, M.D., is a Torrance, Calif., board-certified dermatologist who holds teaching appointments at the University of California, Los Angeles, and the University of Southern California, there is no such thing as a perfect dermal filler. However, by selectively employing the existing range of choices and matching them to specific patients' will yield the best results, he says. People should be cautious about using permanent fillers though they give satisfactory results in carefully selected patients.

Choosing the right dermal filler
s. Dermal fillers approved by the Food and Drug Administration (FDA) are extremely safe.
b. Results vary from patient to patient and are based upon volume employed in what time frame, location, type of filler and individual patient characteristics.
c. Some temporary fillers like collagen and hyaluronic acid offer versatility, safety and instant gratification.
d. The best thing about temporary fillers is that the results are temporary.
e. Temporary fillers are ideal for superficial defects.
f. With temporary fillers, there is no danger from amaurosis or tissue necrosis when intra-arterial injection occurs.
g. Permanent fillers, such as ArteFill (polymethylmethacrylate/bovine collagen, Artes Medical) and silicone are more cost effective and convenient.
h. It is important for patients to be tested for allergies.

Disadvantages of permanent fillers
a. Permanent fillers are less versatile and success depends heavily upon injection technique.
b. It may negatively interact with certain drugs or inflammatory processes even years after injection.
c. Treatment for such complications is difficult.
d. Such fillers are injected deeply and doctors recommend avoidance of overcorrection.
e. Some of the problems of permanent fillers are delayed complications and interactions with trauma, bacteria, viral infections and other inflammatory processes such as allergies.
f. Patients with histories of autoimmune disease personally or in their family should avoid permanent fillers.

Disadvantages of temporary and semi permanent fillers
a. These could cause beading, bruising, clumping, erythema, short duration and patient disappointment.
b. Most of these contain aspirin or other anticoagulants.
c. Also, superficial injection into inflexible tissues can result in beading or "doughnutting," which denotes an elevation at the periphery of rigid ice-pick scars.
d. However, animal-sourced hyaluronans should be avoided.
e. It should also be remembered that, at times, there are traces of bacterial proteins in non-animal sourced hyaluronic acids, which can lead to hypersensitivity reactions.