Dermal Fillers Overview
Dermal fillers can soften facial creases and wrinkles, plump up thin lips, and enhance shallow facial contours. This guide provides answers to the most common questions regarding this popular aesthetic treatment.
What are Injectable Fillers?
Injectable fillers, as the name implies, are soft tissue “fillers” that are injected into the skin to restore lost volume, smooth out fine lines and deep wrinkles, and enhance your face’s natural contours.
Fillers have been steadily growing in popularity, recently reaching more than 1 million patients per year. Overall, it can be a cost-effective way to look younger without invasive surgery or extensive recovery time.
Injectable fillers are composed of either natural or synthetic materials, and are injected directly into the skin at a specific depth. Once there, they “plump up” the area to the point that the targeted wrinkle, depression, or fold disappears.
In most cases fillers work between 6 months and two years, although results have been shown to last longer with repeated treatments. There are several semi-permanent fillers available as well, with effects that can last up to five years or even longer.
Cosmetic products of this type have a lot of different names, but they all essentially refer to the same procedure. So remember, if you see names like “dermal fillers,” “soft tissue fillers,” “injectable cosmetic fillers,” “facial fillers,” or “wrinkle fillers,” they all refer to the same thing: injectable fillers.
Also be sure not to confuse injectable fillers with Botox Cosmetic and other similar neurotoxin products like Dysport (abobotulinumtoxinA) or Xeomin Aesthetic. Although Botox does involve an injection, it is mostly used to stop muscle movements that cause certain wrinkles — it doesn’t fill in the underlying skin and only serves to erase dynamic wrinkles. As a matter of fact, the two procedures are so different some people choose to have both done for a dramatically younger-looking face.
Common Areas Treated
Primarily, injectable fillers are used for facial rejuvenation or to modify the size and/or shape of certain features. Dermal fillers are mainly used in the face, but can also be used in other parts of the body.
To understand the different ways wrinkles can be treated, you must first understand that there are two distinct types of wrinkles: dynamic and static.
- Dynamic wrinkles are those that appear when you make facial expressions, like forehead lines, frown lines, and crow’s feet.
- Static wrinkles, on the other hand, are facial lines that are always there, even when your face is at rest.
The face is often the first part of the body to start showing the passage of time. Injectable fillers can be used to fight a variety of concerns related to facial aging, including:
- Smoothing out vertical and horizontal lines across the forehead and around the eyes
- Filling in hollows beneath the eyes
- Erasing the malar bags located on the upper cheeks, below the eyes.
- Increasing volume in the lower cheeks or temples, which can occur when fat pads beneath the skin shift out of position
- Enhancing the overall shape of the cheeks, restoring fullness
- Adding volume and smoothing out laugh lines that run from the nose to the mouth (nasolabial folds)
- Plumping up thin lips (lip enhancement) and smoothing out vertical lines around the lips
- Re-contouring the jawline
- Reshaping the nose, in a procedure known as a non-surgical nose job
- Smoothing out indented scars from acne or chickenpox
While your face is usually the first body part to reveal your true age, your earlobes can also give you away.
One of the ways your ears prematurely age is through too much sun exposure. Even though most people remember to put sunscreen on all over, the earlobes are often overlooked, resulting in unnecessary damage. Elongated earlobes can also make you look older.
As you age your skin starts to lose collagen, which gives it its elasticity. This leads to drooping in the earlobes, especially if you wear heavy, dangling earrings. Because of factors like these, injectable filler earlobe rejuvenation, or “earlobe lifts,” are becoming more and more popular.
This treatment can repair:
- Partially torn earlobes
- Earlobes stretched due to heavy earrings
- Loss of volume in the earlobes
Even more so than the rest of your body, your hands take a beating over the years. As a result, they can often give away your age. Loss of collagen, volume loss, and sun damage can make the skin on your hands look wrinkled and thin.
Fillers containing dermal stimulants can encourage the production of collagen, and result in improved tissue volume and longer-lasting results.
Injectable filler hand rejuvenation procedures are growing in popularity and can help with a number of issues, including:
- Fine lines and deep wrinkles on the backs of your hands
- A bony and thin appearance
- Prominent veins on the backs of your hands
Though not specifically approved by the FDA to augment other parts of the body, soft tissue injectable fillers can also be used to increase the size or fullness of the:
Currently, filler treatments targeting the body are considered off-label in the United States.
Similar to the rest of your body, the vaginal labia are subject to the signs of aging. However, in this intimate location, the concern isn’t just about appearance, it’s also about comfort. “Labia puffing,” or vaginal rejuvenation, can address both.
As you age the labia majora begin to lose their elasticity and tone, and start to develop wrinkles. This is usually in part because of a drop in estrogen levels, which can be caused by a number of factors including childbirth, menopause, or significant weight loss.
As the labia majora thins over time, the labia minora might become more noticeable. The end result is a flat and sagging labia.
Aside from aesthetic concerns, these changes can also be uncomfortable. The labia majora acts as a cushion, and loss of tone and firmness can cause discomfort or pain.
Injectable fillers can help address these concerns by:
- Tightening the skin
- Decreasing skin wrinkling
- Increases the volume of the labia
However, labia puffing is also considered an off-label use of dermal fillers.
Are Dermal Fillers Right for You?
The majority of people who decide to receive injectable fillers want to treat the signs of premature aging. These people aren’t ready to commit to more invasive surgery, are in good health, and don’t smoke. Patients are usually over the age of 35, but people as young as their 20s often opt for fillers to correct minor imperfections, or to enhance their appearance.
If you have any of the following concerns, you might be a good candidate for dermal fillers:
- Deep nose to mouth lines, or laugh lines (also called nasolabial folds)
- Crow’s feet at the corners of the eyes
- Marionette lines, which run from the corners of the mouth to the chin (also called melomental folds)
- Forehead lines
- Smoker’s lines around the mouth
- Loss of volume in the cheeks
- Thin or poorly shaped lips
- Minor nose deformities such as a nasal hump
- A receding chin
- Indented acne scars
- A loss of fat volume in the face due to HIV/AIDS
- Thinning tissue on the backs of the hands with prominent veins
- Tissue volume loss
- Minor body contouring improvements
In addition to these concerns, the best candidates also understand the benefits and limitations of injectable fillers. Some of the features that might make fillers a better option for you than other procedures include the following:
- You’re looking for fast results: Injectable fillers are specifically designed to offer fast and effective results after only a single treatment. Results are immediate, but swelling and bruising may conceal or obscure them. For this reason, it can take up to 2 weeks for the swelling and bruising to subside and for the final results of treatment to appear.
- You don’t like the idea of surgery: Injectable fillers might be able to give you similar results to surgery, without the increased risk of infection, prolonged recovery time, or the long list of potential surgical side effects.
- Your issue isn’t severe: Most patients who undergo injections of dermal fillers have only mild to moderate skin concerns. A forehead lift, blepharoplasty surgery or facelift procedure might be able to resolve these issues, but it might be excessive. Patients who are only looking for “touch ups” make the best candidates.
- You’ve already tried other non-surgical options: Injectable fillers can often give results where other methods have failed. Sometimes fillers will even improve on other treatments’ lackluster results.
The best candidates have a realistic understanding of the procedure as well as the results they can expect. It is important to recognize that fillers can make only small, subtle adjustments to your appearance. They won’t give you a whole new look.
Types of Dermal Fillers
Typically, injectable fillers only have a temporary effect. This is because they are usually comprised of materials that are slowly absorbed by the body. The vast majority of FDA-approved dermal fillers fall into this category, but there is a wide variety of types and brands to choose from.
Hyaluronic acid (HA) is a naturally-occurring chemical that is found in nearly all living beings. High concentrations of hyaluronic acid can be found in the soft connective tissues of your body, as well as in the fluid surrounding your eyes. It can also be found in some cartilage and joint fluids. Most importantly, about half of your total supply is in your skin.
In your body, HA acts like a network that transports critical nutrients from the bloodstream to the skin cells. As a result of its biocompatibility, this glycosaminoglycan or complex sugar makes an excellent injectable filler.
Once injected into the body in gel form, this chemical is able to combine with water and swell, creating a smoothing and filling effect. It brings water to the surface of the skin, giving it a fresh and supple look.
On average, this kind of filler lasts for about 6 to 12 months, although there are several brands that have been found to last up to 2 years in clinical trials. In some cases, hyaluronic acid used for injectable fillers is chemically altered to make it last a bit longer in the body.
There are a number of hyaluronic acid based injectable fillers approved by the FDA to deal with a variety of cosmetic issues:
- Restylane Fillers
- Restylane Injectable Gel for moderate to severe facial wrinkles and folds, such as the nasolabial folds, as well as lip augmentation.
- Restylane-L Injectable Gel for moderate to severe facial wrinkles and folds, and lip augmentation.
- Restylane Silk for wrinkles around the mouth and lip augmentation.
- Restylane Lyft with Lidocaine for moderate to severe facial wrinkles and folds, or in patients with age-related volume loss.
- Juvederm Injectable Gel Fillers
- Juvederm 24HV, 30, and 30HV for the correction of moderate to severe facial wrinkles and folds.
- Juvederm Voluma XC for cheek augmentation to correct age-related volume loss in the mid-face.
- Juvederm Volbella XC for lip augmentation and correction of wrinkles around the mouth.
- Prevelle Silk for the correction of moderate to severe facial folds and wrinkles.
- Belotero Balance for smoothing wrinkles and folds in the face, especially around the nose and mouth.
Another naturally occurring substance found in the human body, calcium hydroxylapatite is a mineral-like compound that is part of your teeth and bones.
This filler is suspended in a gel-like substance, and is usually used to fill moderate to severe laugh lines, frown lines, and marionette lines, as well as wrinkles on the backs of the hands. Calcium hydroxylapatite is also used to enhance the fullness of the cheeks and facial contours.
An interesting quirk of this filler material that is important to note is that once it is in the body, it will appear on x-rays, hiding underlying features. This type of filler usually lasts around 18 months before being absorbed by the body.
Brand names that have been approved by the FDA include:
- Radiesse Fillers 1.3CC & 0.3CC for the restoration and/or correction of facial fat loss as a result of HIV, and to treat facial folds and wrinkles.
- Radiesse as an implant to correct volume loss in the backs of the hands.
Yet another substance that’s found naturally in your body, collagen is present in your bones, cartilage, skin, and tendons. In fact, your body naturally creates 27 different kinds of collagen. The collagen that is found in your skin is essential for your skin’s strength and elasticity.
As we age, this collagen slowly starts to break down, causing laxity. This leads to wrinkles and sagging. In an effort to fight these visible signs of aging, many people turn to collagen injections to replace what has been lost to time. Since it’s a natural component of your skin, there is very little worry of side effects.
Purified collagen injectable fillers used in soft tissues can be from pig (porcine), cow (bovine), or human cells. This is the shortest lasting kind of injectable filler, with results only lasting for three to four months.
The FDA approved name brand collagen fillers include:
- Zyderm Collagen Implant for use in the skin to correct contour deficiencies of the soft tissue.
- Zyplast for the mid to deep layers of skin to correct contour deficiencies.
- Cosmoderm 1 Human-Based Collagen for injections into the outermost layer of skin to correct contour deficiencies, like wrinkles and acne scars.
Injectable fillers that are made from animal sources can cause an allergic reaction. This includes some forms of collagen. It is something you’ll discuss with your injector prior to any treatment. In some cases, a patch or allergy test can be done to make sure you’re not in any risk.
Poly-L-Lactic Acid (PLLA)
The only non-naturally occurring substance used as a temporary injectable filler is poly-l-lactic acid (PLLA). It’s a biodegradable, biocompatible (meaning not harmful to your body), man-made polymer.
PLLA has been used in surgical products like dissolvable stitches and bone screws for over 20 years. Thanks to its synthetic design and long history of use in other products, there is no need to test for allergies prior to treatment with this filler option.
PLLA was first approved by the FDA for the treatment of loss of volume in the face, especially for patients with HIV/AIDS. It’s a popular option for the treatment of deep wrinkles and facial folds.
PLLA tends to have longer lasting results than other products, making it useful for rejuvenating the eyes, lips, and all areas of the face that show signs of aging. The brand Sculptra has even earned the nickname “liquid facelift” for its ability to create a fuller, youthful appearance.
The longest lasting of all the temporary injectable filler options, PLLA is administered via a series of injections delivered over the course of a few months, and generally lasts up to 2 years. The results of this option are a little slower to present themselves, instead becoming increasingly visible over a period of a few weeks (the results of other fillers tend to appear immediately).
For now, only one brand of PLLA-based injectable filler has been approved by the FDA:
- Sculptra for the treatment of volume loss in the faces of patients with HIV.
- Sculptra Aesthetic for the treatment of shallow to deep laugh lines, as well as other facial wrinkles.
Are Some Fillers Permanent?
There are several approved permanent or semi-permanent injectable fillers. Each offers the same advantages as temporary soft tissue fillers, with the added bonus of significantly longer-lasting results.
This is a man-made, biocompatible polymer used in medical devices, like bone cement and intraocular lenses. However, unlike PLLA, PMMA is not biodegradable, which helps it last much longer than temporary fillers.
When used as an injectable filler, PMMA microspheres, or beads, are suspended in a gel-like solution that also contains collagen. The PMMA beads are tiny and smooth and can’t be absorbed by your body at all, creating a permanent scaffolding for your own soft tissue to grow on.
The only FDA-approved PMMA injectable filler to date is Bellafill, which is used in the facial tissues around the mouth. After the injection, your initial results will only last about 6 months, until the collagen degrades and is absorbed by your body.
That being said, the PMMA beads will remain and allow your own tissues to build upon them. This filling effect can last for about 5 years, with some patients’ results lasting over 10 years.
The “ultimate” permanent filler, an autologous fat transfer uses fat taken from your own body to fill defects or deep wrinkles.
The most important difference between a fat transfer and other types of injectable fillers is that a fat transfer doesn’t add any foreign material to the body. That makes this option particularly appealing for people who are allergic to products like collagen. It also means this procedure doesn’t require FDA approval.
This option is essentially a graft, which will heal and integrate into its new location. This makes a fat transfer truly permanent, although the natural effects of aging can impact results.
There are generally three steps involved in this procedure:
- Lipoplasty to harvest fat from one area of the body, usually the jowls, abdomen, thighs, or buttocks.
- Filtering the fat and cleansing the cells for transfer.
- Injecting the fat cells into the target area.
This injectable filler option can target concerns that any temporary filler can target, including creases in the forehead or between the eyebrows, hollows under the eyes, and lip wrinkles.
Fat transfer can also improve the contour of the nose, the jawline, and the temples. The technique can even be used to correct scars, sunken or hollow areas, or any area of the face or neck that has lost fat volume. However, the most popular area to target with fat transfer nowadays has become the buttocks, in a procedure known as a Brazilian butt lift.
Some of these areas will only need a single fat injection for long-lasting results. Other areas might require more injections to reach your goals.
How Soon Will I See Results?
Over the first few days, your face will slowly settle into its final position, allowing the results of the injectable fillers to become more apparent.
In most cases, your results will be fully revealed after only a few short days. In rare cases these results might be a bit uneven. Follow-up injections and touch-ups might be needed to correct any unevenness, but a careful consultation with your doctor will be needed to understand what caused the unbalanced look in the first place. When the final results are apparent, the vast majority of patients are very happy with their results.
If there is a fullness in a specific area, gentle pressure and massage can help redistribute the filler more evenly. In most cases fillers don’t move around too much once injected, however, if this is necessary, it’s best to leave it to your injector to do during this two week follow-up. Don’t try to redistribute the product on your own.
About two weeks after your initial treatment you should be heading back in for an important, routine follow-up. During this appointment your injector will check on your results. If necessary, they’ll discuss with you the possibility of further molding or the addition of more filler for a better, more even result.
How Long do Fillers Last?
Your body will begin to naturally absorb the injected solution sometime between 3 and 12 months after your injections, depending on the specific type of filler you and your doctor have chosen. This is a perfectly normal process, and will give you a good idea of when you should schedule repeat injections.
It’s important to remember that the results of fillers are not permanent, even if the filler substance is considered “permanent.” In fact, even the longest lasting permanent filler results will usually begin to fade between 5 and 10 years after the procedure. The continued aging of your face, and how quickly your body absorbs the fillers will ultimately affect how long your results last.
Decisions regarding maintaining your results will be left up to you. Most doctors will suggest repeat injections every 6 to 9 months (perhaps longer depending on your filler of choice) to ensure your results last. That said, the choice to stick with regular injections, to try more invasive and permanent surgical options, or to simply forego any future procedures, is in your hands.
Cost of Dermal Fillers
The final cost of injectable fillers will be determined by your injector based on the type of filler used, and your particular needs. This can make predicting the price difficult.
Under most circumstances, injectable fillers are not covered by health insurance, but some providers may offer flexible financing plans. Be sure to discuss your options.
In general, the average cost for some of the most popular types of fillers per treatment are:
- Hyaluronic acid (brands including Juvederm and Restylane) — $500 upwards
- Calcium hydroxylapatite (Radiesse) — $600 upwards
- Porcine/bovine-based collagen (Zyderm, Zyplast) — $250-$800
- Human-based collagen (Cosmoderm, Cosmoplast) — $500-$1,500
- Poly-L-lactic acid (Sculptra) — $800 upwards
- Polymethylmethacrylate (Bellafill) — $1,000
- Fat transfer — $1,500 upwards
Are Injectable Fillers Safe?
Generally speaking, today’s injectable fillers are very safe. However, pregnant women or those who are breastfeeding should wait to undergo the procedure. This is only a precaution. Also, potential patients still suffering from acne should address their acne first. Skin conditions like acne can increase the possibility of infection after your injections.
Certain types of fillers, especially those made from bovine collagen, may cause an allergic reaction, so it’s not uncommon to have a skin test before treatment to rule out allergies. It’s always a good idea to understand what your chosen filler is composed of to make sure you avoid any ingredients you’re allergic to, or ethically opposed to (such as porcine-based fillers for vegetarians, or Muslims).
Certain medical conditions, like an auto-immune disease or rheumatoid arthritis, can also make you a poor candidate for collagen fillers.
Side effects and complications are extremely rare, but some short-term negative reactions that might appear during the first few days of recovery include:
- A mild rash
- A feeling of fullness or tightness in the injection area
Overall, the best way to ensure that you’re a good candidate for injectable fillers is to have a frank conversation with a qualified cosmetic practitioner.
How Long do Filler Treatments Usually Take?
The time frame for your treatment will depend on two things: your goals and which filler you use. For most procedures, the actual injections take about 10 to 25 minutes, with a few follow-up appointments over the next several months if necessary.
This, however, does not include the time you will need to allow for the necessary discussion with your injector before any treatment can begin.
It’s very important that you discuss your medical history and any current conditions you are experiencing. Specifically, you should inform your injector if you are pregnant, breastfeeding, or if you have a history of excessive scarring or skin coloration disorders.
You should also let your injector know if you are taking any blood thinning medications or if you’re undergoing any therapy that can decrease your body’s immune response.
Is the Procedure Painful?
For most dermal fillers, your injector will use a very small needle, and you should only feel a slight pinch. In most cases the procedure is entirely painless.
Many injectable fillers also include lidocaine, an anesthetic, to help numb the treatment area. Some injectors will even use a topical numbing cream to treat the entire area before the injections to minimize any possible discomfort.
Some injectors might also provide a cold compress for better comfort and reduced swelling right after the injections.
How Can I Prevent Swelling, Bruising, and other Side Effects?
The most effective way to avoid any potential side effects is to select your injector very carefully. If possible, try to find a injector who has extensive experience with injectable fillers, and has a strong understanding of facial anatomy.
While minor bruising and swelling may occur in the days following your injections, side effects can be minimized by following these steps:
- Cease using blood thinning medications for a couple of weeks before your treatment.
- Specific medications and supplements include aspirin, Ibuprofen, vitamin E, fish oil, and ginseng to name a few. Make sure you discuss all your medications and supplements with your doctor beforehand.
- Avoid any heavy exercise on the day of your treatment.
- A high level of aerobic activity increases the blood flow throughout your body. If you work out right before your treatment, this increased blood flow can lead to bruising where the needle breaks the skin.
- Eat a salad with dark, leafy greens before your treatment. A nice salad with spinach, kale, and avocado slices contains a heaping helping of vitamin K, which can help stop bruising. If you prefer fruit, try kiwi and fresh pineapple, which are also great sources of vitamin K and bromelain.
- Make sure you plan your treatment accordingly. One of the most important aspects of injectable filler treatments that often goes overlooked is timing. Ideally, you should try to schedule your appointments at least two weeks before any big events, just in case you have any swelling or bruising.
- Plan a low sodium diet for a few days. Swelling is a common side effect of injectable fillers, and salt in your diet can make it worse. Stick to a reduced salt diet for about two days before and two days after your injections. Consider combining treatments. For many patients, combining Botox with a dermal filler can provide amazing results. You might also want to use injectable fillers in conjunction with facial cosmetic surgery.
- Tell your doctor of any existing health issues. For example, if your treatment will be around your mouth, and you’re prone to cold sores, tell your doctor. Your clinic will most likely prescribe antiviral medication to prevent an outbreak.
What Can I do to Speed up Recovery?
One of the greatest advantages of injectable fillers is that the recovery time is so brief, it’s often practically non-existent. In fact, most patients experience no downtime at all following their dermal injections. You’ll most likely be able to go back to your usual activities right away.
Recovering after dermal filler treatments is usually extremely simple. Your injector will most probably give you a list of instructions to follow that covers the following points:
- Stay away from contact sports or other strenuous activities for a week or more.
- It’s also important not to rub or massage the area for a few days. This helps to make sure that the injected material stays where it’s supposed to until completely healed.
- Before using a cold compress, discuss it with your doctor.
- Many filler advice sites on the Internet suggest using ice or a cold compress on your injection sites to curb swelling. This is an excellent guidance for certain injectable fillers, but some should never be iced, as there is a risk of frostbite.
- Try Arnica montana to help with any bruising. Although there is little to no scientific research into its properties, Arnica montana, sometimes called wolf’s bane, has been used for centuries. Many people rave about this homeopathic remedy’s apparent ability to reduce pain, swelling, and bruising. Talk to your injector before taking this supplement.
- Try sleeping on your back for a while. Especially the first night after your treatment, it’s a good idea to stay on your back with two pillows beneath your head. Keeping your head elevated at all times for the first few days will help keep swelling and bruising to a minimum.
- Stay away from the gym for a couple of days. Too much exercise right after your treatment will increase the blood flow throughout your body and will increase the chances of bruising.
- Forego saunas, steam rooms, or jacuzzis for a several days. Similar to exercising, these hot and humid environments can increase the blood flow in your skin, and lead to unnecessary bruising.
- Avoid flying for approximately a week after your treatment. The change in air pressure that is a necessary part of air travel can affect how the filler settles beneath your skin.
- Don’t touch the treated area. Unless you’re putting sterile Arnica montana or another cream recommended by your physician on your skin, try not to touch the injection sites for at least 6 hours after your treatment. This gives the needle pricks time to heal and close. After 6 hours you can gently wash the area with a mild soap and water.
- Stay out of the sun. Too much sun exposure before your swelling has gone down can make it worse and last longer. Be sure to stay out of direct sunlight until all the initial swelling and redness has faded. Use sunscreen with a high SPF if you must go into the sun.
- Consider a high quality makeup or cover up. Bruising and swelling aren’t uncommon, especially if the treatment is around your eyes. For this reason it’s a good idea to invest in a good concealer to hide any bruising for the few days before it fades. Make sure your makeup and applicators are sterile to reduce the risk of infection.
Can Dermal Fillers be Reversed?
The beauty of this kind of treatment is that if you are unhappy with the results, all you have to do is wait. Most injectable filler results diminish over time, so you’ll return to your original look soon.
Injectable fillers are made of materials that are biocompatible, which means they work well with the body and are not harmful in any way. In fact, most fillers are synthetic versions of chemicals that are found in your body naturally. What this all means is that over time, usually several months, these biocompatible ingredients break down and are naturally absorbed and eliminated by your body’s natural metabolic process.
If you’ve received a hyaluronic acid based filler and find that too much was injected, or you just aren’t happy with the results, there is a treatment that can reverse your results. Hyaluronidase is a substance that, when injected into the target area, dissolves hyaluronic acid. This treatment can be performed by your injector.
Can Fillers be Combined with Other Treatments?
Yes. It’s very popular to combine fillers with all sorts of other treatments, including Botox. In general, Botox is best for helping with the upper third of the face, where injectable fillers are generally best for the lower two thirds. This combination is one of the most common, and most effective for a full face rejuvenation without the invasiveness of a surgery.
Fillers can also be combined with just about any other cosmetic treatment, and are often paired with facial peels, laser treatments, and other facial procedures for a more youthful appearance.
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