Dermal fillers and combinations of fillers for facial rejuvenation.

Until recently, the use of dermal fillers was limited in the United States by the small number of products approved by the Food and Drug Administration. The products now approved for use in the United States have opened up the range of possibilities for combinations of products that are synergistic in their effects. Combinations of products may be discussed in temporal or anatomic relationships. Temporal combinations refer to the use of different fillers at different times, whereas anatomic combinations refer to the use of different fillers in different parts of the face. Before discussing how the various fillers may be used in combination, it is worthwhile to consider their use in isolation. Soft-tissue augmentation products under consideration in the present article include the hyaluronic acids (HA), poly L lactic acid (PLLA), calcium hydroxylapatite (CAHA), porcine collagen, and silicone.