Dermal Fillers: Uses, Types, Candidates, Risks, Cost and More

• Dermal fillers can treat age-related wrinkles and add plumpness to facial contours.
• All dermal fillers produce immediate results and some continue to produce additional improvements over weeks to months.
• Temporary fillers last between six months and two years, while semipermanent fillers can last longer.
• Dermal fillers are relatively safe and are well-tolerated by most people.

Dermal fillers are very popular cosmetic treatments that can reduce the appearance of wrinkles, fill in scars to reduce the signs of aging and restore youthful facial contours. 

According to the American Society of Plastic Surgeons (ASPS), the annual number of filler procedures performed in 2017 saw more than a 300% increase over those performed in 2000. Their wide availability, immediate results and relatively low cost have contributed to their continued rise in popularity. 

What are dermal fillers?

Dermal or soft tissue fillers are injectable synthetic or natural compounds that can smooth out age-related wrinkles, add volume to sunken skin areas and conceal depressed scars. They can also augment and define facial contours as well as other body areas. 

Most fillers work by mechanically adding volume to the injection areas, while some can also stimulate the skin to produce natural collagen, adding to the filling effect. There are many different types of dermal fillers that differ in their uses, effectiveness and safety.

Fillers vs. neurotoxins

Fillers and neurotoxins are fundamentally different in their uses and the way they work. While fillers are best for static age-related wrinkles and fine lines, neurotoxins are more effective for dynamic wrinkles which are caused by repetitive muscle movements. 

Neurotoxins, such as Botox, Dysport and Xeomin, are a purified extract of a bacterial toxin that can temporarily weaken the contractions of muscles in the injected areas, reducing the appearance of wrinkles. Neurotoxin injection areas include forehead frown lines and wrinkles around the eyes and mouth.

What Are Fillers Used For?

Soft tissue fillers are most commonly used on the face where they can fill in wrinkles and fine lines as well as add volume and plumpness. Fillers can also be used to treat wrinkles in other body areas and to conceal scars.

Facial area

Dermal fillers are most commonly used on the face to fill in and smooth out age-related wrinkles. These areas include:

• Nasolabial folds, which are fine lines running from the nose to the borders of the lips
• Marionette lines, which are vertical lines running from the lip borders to the chin
• The area between the eyebrows (sometimes used in combination with neurotoxins)
• The tear trough or the area below the lower eyelid
• The chin

Other uses

Fillers can also add volume and augment the appearance of other areas including the lips, nose, temples and cheeks. They can be used for a variety of other indications such as improving the appearance of acne scars, smoothing out earlobe folds, filling lines on the forehead, and rejuvenating the hands. They can also be used for buttock augmentation.

What fillers can’t do

Dermal fillers are limited in the degree of correction they can provide. People who need more extensive correction may benefit more from surgical procedures such as facelifts.

Types of Dermal Fillers

Broadly speaking, dermal fillers can be classified into two types: temporary and semipermanent. Differences in chemical composition account for the variation in their effectiveness as well as their uses and side effect profile.

Temporary fillers are biodegradable and gradually lose their effect over six months to two years. They include those that are based on hyaluronic acid (HA), poly-L-lactic acid (PLLA), calcium hydroxylapatite (CaHA) and collagen.

Semi-permanent fillers can produce significantly longer-lasting results. Polymethyl methacrylate  (PMMA) is the only semi-permanent filler currently approved by the Food and Drug Administration (FDA) for use in the United States.

Hyaluronic acid fillers

HA is a natural complex sugar that is found in the skin, cartilage and body fluids, as well as many other types of body tissues. 

HA fillers can be used to add volume in the cheeks and lip borders, as well as smooth out wrinkles around the eyes and mouth, and nasolabial folds. Results can last as long as two years.

These fillers are by far the most popular type of filler. In 2018, over two million HA filler injections were performed in the United States, accounting for almost 80% of all filler injections.  

Popular HA-based filler brands include Juvederm, Restylane, Belotero Balance and Elvess.

Poly-L-lactic acid

PLLA is a synthetic, biocompatible compound that has been used in surgical stitches and medical devices for decades. As a dermal filler, its main ability is to stimulate natural collagen synthesis in the skin in treatment areas. 

PLLA is used to treat lower face wrinkles such as smile and marionette lines, and chin wrinkles. It may also be used off-label for the treatment of cellulite, and elbow and knee wrinkles.

Sculptra is the only PLLA filler currently approved by the FDA for use in the United States. 

Calcium hydroxylapatite

CaHA is a mineral compound that is naturally found in bones and teeth. In addition to its direct volumizing effect, CaHA can stimulate the production of skin’s natural collagen, augmenting the filling effect.

CaHA can treat facial wrinkles, add volume to the chin and cheeks, and add definition to the jawline.

Radiesse is the most popular CaHA-based dermal filler.

Collagen

Fillers that contain the natural compound collagen have fallen out of favor due to the introduction of newer, more effective synthetic compounds such as HA. Collagen is extracted from animal sources so it has a relatively higher risk of causing inflammatory and allergic reactions compared to other fillers. An allergy test may be necessary before collagen injections to avoid possible reactions.

Polymethyl methacrylate

This is a nonbiodegradable synthetic filler that is injected in a collagen-containing suspension. The collagen adds immediate volume, while the PMMA crystals stimulate natural collagen production by the body over time. Since it contains animal collagen, an allergy test should be performed before receiving PMMA injections.

PMMA is often used to augment lips and fill in deeper furrows and depressed scars. Results can last as long as five years.

Bellafil is an FDA-approved PMMA dermal filler.

Candidates

Adults who have mild-to-moderate wrinkles or who want to add volume and plumpness to skin areas such as the lips, cheeks or nose may benefit from dermal fillers. The ideal candidate should be in good health with no medical conditions or allergies, does not smoke, and is able to maintain good skin hygiene following the injection.

The Procedure

Dermal filler injection is a simple outpatient procedure that is fairly similar for all types of fillers.

After disinfecting the predetermined injection site, your doctor may apply a topical or injectable anesthetic such as lidocaine to help with the discomfort. Some types of fillers may have the anesthetic already combined in the syringe.

Your doctor will then ask you to remain still while they inject the filler. Depending on the treatment area and the degree of correction needed, you may need multiple injections during the session. In some cases, you may need additional injections at follow-up appointments.

The procedure, including preparation time, should take 30 minutes to 1 hour. You may go home immediately afterward.

Aftercare

Following the procedure, you should avoid strenuous physical activity and direct sunlight for 24-48 hours. You should also keep the treatment area clean and avoid touching it unnecessarily. If you experience discomfort, you can apply ice packs or take Tylenol. 

How long do dermal fillers last?

Most fillers are biodegradable, which means the body naturally absorbs the filler over time. Almost all fillers last between six months and two years with the exception of PMMA, which can last two to five years. Many people will opt to repeat the treatments after six to nine months to maintain consistent results.

Face fillers before and afters

Risks and Side Effects of Dermal Fillers

Dermal filler injections are generally safe and well-tolerated minimally invasive procedures. However, they still carry some risks:

• Bleeding, bruising or swelling: minor bleeding or redness after injection is normal; people with bleeding disorders or those taking blood thinners have a higher risk
• Allergic reactions: higher risk with collagen-containing products; can be avoided with allergy testing
• Infections: uncommon; good skin hygiene can further reduce the risk
• Skin damage: poor injection technique may disrupt the blood supply to the skin resulting in skin damage or necrosis (tissue death)
• Nerve damage: accidental injury to nerves supplying the skin may cause numbness or pain
• Poor aesthetic outcome: asymmetry or lumps may result from poor injection technique by inexperienced providers

Fat Injections as Fillers

Fat transfer involves taking fat tissue from the patient’s body using liposuction (usually from the thighs, abdomen or buttocks) and grafting it into the target area. This has the benefit of not introducing any foreign materials into the body, and reducing the chances of local reactions and infections.

Since it uses natural body cells, fat transfer produces long-lasting results that can be considered permanent. Fat transfer is a more invasive procedure that may require general anesthesia. Results may be less predictable than synthetic filler injections as not all of the transplanted fat cells survive.

Fat transfer is often used in the temples, nose, jawline and buttocks.

Cost of Dermal Fillers

The cost of dermal filler treatment is highly variable with the type of filler and the amount used. 

• Hyaluronic acid fillers such as Juvederm Voluma cost about $1,600 – $2,000 for cheek treatments or $800 – $1,600 for nose or chin treatments
• Sculptra costs $600 – $1,000 per vial; you can expect to pay about $1,600 for most facial treatments
• Radiesse costs about $1,500 for typical facial treatments
• Bellafill costs $1,000 – $1,500 per syringe; most people require 1–2 syringes for typical treatments

How to Pick a Cosmetic Doctor

When choosing a cosmetic doctor, it is important to choose a competent provider that you feel comfortable with. You should confirm whether they are board-certified by the American Board of Medical Specialists. You may also want to ask about the experience they have with the particular treatment you are considering, and if they can share before and after photos for you to get a sense of their aesthetic standards. 

Takeaway

Dermal fillers are a safe and effective treatment for mild-to-moderate facial wrinkles and scars, and for adding volume and plumpness to the skin. Most side effects are mild and self-limited and more serious side effects are rare.

Temporary fillers last about one year and require additional treatment sessions, while semipermanent fillers can last up to five years. Although temporary fillers are relatively affordable, most people need to repeat the treatments about once or twice a year and the costs of maintenance treatments can therefore become costly.