The last two years have been rough for collagen-based dermal fillers—and it shows in the announcements by two leading manufacturers, 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 filler of choice for many dermatologists. Considering donor tissue origins, it’s natural that questions could arise. Plus, collagen-based fillers require skin allergy testing and are relatively short-lived.

As in many markets, money drives the evolution of new products, and facial 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. Juvéderm, Perlane, Restylane, Radiesse, and Sculptra currently dominate the US market. Dermatologists report HA, PLLA and PMMA fillers as bring 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 in those instances. But Restylane Fine Lines is one HA product that makers hope to cover this application.

What will the world of fillers look like in the future? Who can say? But certainly change is afoot. 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.