- Hyaluronic acid (HA) fillers can hide wrinkles and lines and create a plump, youthful look.
- Results typically last up to 18 months in most treatment areas.
- HA fillers are safe with few mild side effects.
- A vial of HA filler costs $600-$1,000 and the number of vials used depends on the treatment area.
Dermal fillers are treatments that can combat the signs of aging such as wrinkles and furrows and rejuvenate the face by augmenting the lips, cheeks, and other areas.
Among injectable fillers, hyaluronic acid is a popular choice due to its versatility, effectiveness, and few side effects.
What Are Hyaluronic Acid Fillers?
Hyaluronic acid (HA) is a type of sugar that is naturally found in many types of body tissues, including skin, connective tissue, and joints.
Among its many biological functions, HA is important in tissue hydration, joint lubrication, immune response, and tissue repair. In the skin, it is a major component of the natural skin barrier.
Hyaluronic acid is used as a soft tissue filler. Its unique physical properties, such as its large water-binding capacity, along with its long track record of effectiveness and safety make it a popular choice as a dermal filler.
How do they work?
HA is a humectant, which means that it can hold moisture; it can bind up to 1,000 times its volume in water. This contributes to its effectiveness as a dermal filler as it pulls and retains water, enhancing the volumizing effect while also adding hydration.
HA fillers are injected into the skin through a needle or cannula to fill in sunken skin areas, smoothen wrinkles and fine lines, and add volume and plumpness. Effects are visible immediately after the treatment.
Types of Hyaluronic Acid Fillers
Although all hyaluronic acid dermal fillers are based on the same HA molecule, a number of physical and chemical properties of HA can be altered by manufacturers to influence their products’ performance and outcomes.
Modifications include the particle size of the HA used, degree of crosslinking between molecules, the concentration of HA, and the consistency and viscosity of the gel. These variations account for differences in the effectiveness, longevity, and appropriate injection sites of different HA dermal fillers.
Juvederm is a family of HA-based dermal fillers that encompasses the following products:
- Juvederm Voluma XC: Approved by the United States Food and Drug Administration (FDA) for adding volume to the cheek and midface area.
- Juvederm Ultra XC: FDA-approved for lip augmentation and smile line correction.
- Juvederm Ultra Plus XC: For wrinkle and smile line correction; lasts longer than Ultra XC.
- Juvederm Volbella XC: Approved for lip augmentation and correction of perioral (around the mouth) lines.
- Juvederm Vollure XC: Approved for the treatment of lines and wrinkles around the nose and mouth including nasolabial folds (lines between the nose and the edges of the lips) and smile lines.
The hyaluronic acid used in Voluma, Volbella, and Vollure is highly concentrated and crosslinked to provide long-lasting results.
All Juvederm XC products come premixed with a numbing agent (lidocaine) to reduce the discomfort from the injections.
Restylane is a line of hyaluronic acid fillers that includes:
- Restylane: For the correction of moderate to severe wrinkles and lines such as nasolabial folds; can be used for lip augmentation. Restylane-L includes lidocaine.
- Restylane Lyft: For adding volume to the cheek and treating moderate to severe facial wrinkles and folds. Lyft is the first and only HA filler approved by the FDA for correcting volume deficiency in the back of the hands.
- Restylane Silk: For lip augmentation and correction of wrinkles around the mouth.
- Restylane Refyne and Restylane Defyne: For the correction of laugh lines such as nasolabial folds and marionette lines (vertical lines from the edges of the lips to the chin). Refyne is for mild to moderate lines and furrows while Defyne is for moderate to deep lines.
Belotero Balance is an HA filler that is manufactured to produce a soft and cohesive gel. It is best suited for the correction of fine lines and wrinkles around the mouth such as nasolabial folds, smile lines, vertical lip lines, and chin wrinkles.
Other members of the Belotero family such as Belotero Intense and Volume target more severe wrinkles and may have different uses. However, these products are not currently FDA-approved in the United States.
Revanesse Versa (previously Revanesse Ultra) and Revanesse Versa + are HA-based dermal fillers that received their FDA approval in 2017. Revanesse is approved for the treatment of moderate to severe wrinkles and folds such as nasolabial folds.
Revanesse Versa + includes an anesthetic, lidocaine, but is otherwise similar to the original Versa. Versa + was launched in the United States in 2019.
Teosyal is a range of HA dermal fillers that utilizes a technology called RHA (Resilient Hyaluronic Acid) that increases the gel’s ability to bounce back to its original shape after stretching.
Some members of the Teosyal family of products (RHA 2, RHA 3, RHA 4) received their FDA approval in 2017. Teosyal is expected to become available in the United States in the near future.
What Are Hyaluronic Acid Fillers Used For?
Hyaluronic acid fillers are quite versatile in that they can be used to achieve different goals in different areas of the face and the body.
Some HA fillers can also treat volume loss in the earlobes as well as wrinkles and volume loss in the back of the hands. They can also fill in depressed scars and depressions in the skin under the eyes and the cheeks.
How Long do Hyaluronic Acid Fillers Last?
When used to correct lines, wrinkles, and depressions in the face, hyaluronic acid fillers last between 12 and 18 months on average. When large volumes are injected for cheek augmentation or jawline sculpting, results can last up to 24 months.
On the other hand, lip augmentation using HA fillers lasts between six and nine months.
In order to maintain results with HA lip fillers, treatments need to be repeated at regular intervals. For the best results, most experts recommend that you get your repeat treatment one to two months before the results from the previous treatment have worn off.
For example, if results are expected to last 18 months, you may wish to repeat the treatment after 16 to 17 months of the initial treatment.
Side Effects of Hyaluronic Acid Fillers
Hyaluronic acid fillers are quite safe when applied by an experienced medical professional. Most side effects are mild and resolve without treatment.
- Redness, swelling and bruising due to minor tissue trauma.
- Discomfort that can be reduced by using a filler with lidocaine or a topical anesthetic.
- Mild itching and/or rash.
More serious side effects that may require treatment are rare; these include:
- Infections from non-sterile injection technique.
- Nodules from local tissue reaction.
- Filler migration or poor aesthetics due to poor injection technique by an inexperienced provider.
- Injury to blood vessels if accidentally injected into a blood vessel. This can lead to tissue death (gangrene) or blindness if a clot forms and move to the vessels that supply the eyes.
How Much do Hyaluronic Acid Fillers Cost?
Hyaluronic acid fillers are typically available in vials or syringes of 1 cc (1 mL). Most HA fillers cost between $600 and $1,000 per syringe. The cost can go up in areas of the country with a higher cost of living.
The number of syringes you use plays a big role in determining the final cost of treatment. For example, most people get good results with one to two vials of filler for nose or lip injections while cheek augmentation generally requires at least two to four vials.
Consequently, you can expect to pay around $800 to $1,600 for lip injections and $1,600 to $2,000 for cheek augmentation.
Repeat treatments generally require the same or a slightly smaller amount than the initial treatment. Some providers may offer discounts on repeat treatments or when you use more than one vial. They may also offer installment plans to help with the payments as insurance generally does not cover filler treatments.
Other Types of Fillers
Other types of dermal fillers are available and, depending on your particular needs and goals, may be more appropriate for you.
Calcium hydroxylapatite (CaHA)
Calcium hydroxylapatite (Radiesse) is a mineral-like, biocompatible dermal filler. It is used for the correction of moderate-to-severe facial wrinkles, to add volume to the cheeks and jawline, and to rejuvenate the back of the hands.
Radiesse typically lasts between 12 and 18 months and may last longer in some cases.
Poly-L-Lactic acid (PLLA)
Poly-L-Lactic acid (Sculptra) is a dermal filler that can stimulate the body to produce new natural collagen in the treatment area. This can add to the filling effect and produce long-lasting results for up to two years.
Sculptra can treat nasolabial folds, marionette lines, and other facial wrinkles. Off-label, it is sometimes used for buttock augmentation and for treating depressed cellulite areas.
Polymethyl-methacrylate microspheres (PMMA)
Polymethyl-methacrylate microspheres (Bellafill) is composed of biocompatible microspheres that can stimulate collagen production by the body. It can be used to correct smile lines and certain types of depressed acne scars.
PMMA is considered a semi-permanent filler as results can last up to five years.
Using liposuction, fat tissue can be harvested from the buttocks, thighs, or abdomen and then injected into the treatment area.
Although this can produce relatively long-lasting results, the procedure is more invasive than traditional fillers and the results are less predictable.
Hyaluronic acid dermal fillers are a safe and effective treatment for wrinkles and lines and for adding volume to localized areas of the skin. Results are temporary and can often last for over a year. Maintenance of the results requires repeat treatments. A typical treatment session costs up to $1,600 and can be more if a large volume of filler is used.
- Papakonstantinou, E., Roth, M., & Karakiulakis, G. (2012). Hyaluronic acid: A key molecule in skin aging. Dermato-endocrinology, 4(3), 253–258. doi:10.4161/derm.21923
- Baumann, L. (2007), Skin ageing and its treatment. J. Pathol., 211: 241-251. doi:10.1002/path.2098
- Ahmet Tezel & Glenn H. Fredrickson (2008) The science of hyaluronic acid dermal fillers, Journal of Cosmetic and Laser Therapy, 10:1, 35-42. DOI:10.1080/14764170701774901
- Micheels, Patrick & Sarazin, Didier & Tran, Christian & Salomon, Denis. (2016). Effect of Different Crosslinking Technologies on Hyaluronic Acid Behavior: A Visual and Microscopic Study of Seven Hyaluronic Acid Gels. Journal of drugs in dermatology : JDD. 15. 600-606. researchgate.net/profile/Christian_Tran/publication/302969213_Effect_of_Different_Crosslinking_Technologies_on_Hyaluronic_Acid_Behavior_A_Visual_and_Microscopic_Study_of_Seven_Hyaluronic_Acid_Gels/links/5b4f446faca27217ff9fa2af/Effect-of-Different-Crosslinking-Technologies-on-Hyaluronic-Acid-Behavior-A-Visual-and-Microscopic-Study-of-Seven-Hyaluronic-Acid-Gels.pdf
- Weinberg MJ, Solish N. Complications of hyaluronic acid fillers. Facial Plastic Surgery : FPS. 2009 Dec;25(5):324-328. DOI:10.1055/s-0029-1243081
- Bass LS, Smith S, Busso M, McClaren M. Calcium hydroxylapatite (Radiesse) for treatment of nasolabial folds: long-term safety and efficacy results. Aesthet Surg J. 2010 Mar;30(2):235-8. doi:10.1177/1090820X10366549
- Brown SA, Rohrich RJ, Baumann L, Brandt FS, Fagien S, Glazer S, Kenkel JM, Lowe NJ, Monheit GD, Narins RS, Rendon MI, Werschler WP. Subject global evaluation and subject satisfaction using injectable poly-L-lactic acid versus human collagen for the correction of nasolabial fold wrinkles. Plast Reconstr Surg. 2011 Apr;127(4):1684-92. doi:10.1097/PRS.0b013e318208d371
- COHEN, S.R., BERNER, C.F., BUSSO, M., CLOPTON, P., HAMILTON, D., ROMANO, J.J., RULLAN, P.P., THALER, .M.P., UBOGY, Z. and VECCHIONE, T.R. (2007), Five‐Year Safety and Efficacy of a Novel Polymethylmethacrylate Aesthetic Soft Tissue Filler for the Correction of Nasolabial Folds. Dermatologic Surgery, 33: S222-S230. doi:10.1111/j.1524-4725.2007.33365.x