What Are Dermal Fillers? A Comprehensive Guide

Curious about dermal fillers and how they work? These popular, minimally invasive treatments can smooth wrinkles, restore lost volume, and enhance facial features with little to no downtime. Here's what you need to know.

What Are Dermal Fillers?  

Dermal fillers, also called facial fillers or soft tissue fillers, are gel-like substances injected into the skin as a cosmetic treatment. These FDA-approved products help address fine lines, wrinkles, volume loss, and shallow contours. 

Plastic surgeons, cosmetic surgeons, trained nurses, and physicians’ assistants can inject dermal fillers in areas around your eyes, nose, and mouth to reduce the visible signs of aging and restore a more youthful appearance. Injectable dermal fillers are a minimally invasive cosmetic treatment with no downtime.

Some of the key ingredients in dermal fillers include:

• Hyaluronic acid (HA)

• Calcium hydroxyapatite (CaHA)

• Poly-L-lactic acid (PLLA)

• Polymethyl methacrylate (PMMA)

Types of Dermal Fillers

Hyaluronic Acid Fillers  

Hyaluronic acid is a natural component of skin and connective tissue. It is hydrophilic, meaning it attracts and retains moisture and helps to make skin look smoother. Hyaluronic acid's safety and efficacy have made it one of the most common key ingredients in injectable fillers. 

Hyaluronic acid fillers can soften fine lines and skin creases, such as crow’s feet and frown lines. They can also restore fullness and softness to the face. Different dermal fillers contain different sizes of hyaluronic acid (HA) molecules. Smaller HA molecules are used to correct fine lines, and larger molecules for deeper wrinkles.

Calcium Hydroxylapatite Fillers  

Calcium hydroxylapatite injectable fillers treat deep wrinkles and skin creases. These dermal fillers can also contour the jaw and restore volume in the cheeks. Results last for 1 to 3 years.

Poly-L-Lactic Acid Fillers  

PLLA is a synthetic, biodegradable polymer developed to treat severe facial fat loss in HIV patients. It is now FDA-approved as a cosmetic treatment and can provide results lasting up to 2 years.

Polymethyl-Methacrylate Fillers  

PMMA consists of tiny microspheres suspended in a smooth gel. These dermal fillers help to smooth fine lines and wrinkles, soften acne scars, add volume, and lift sagging skin.

Facial Fat Grafting

Doctors can take fat from one part of your body and inject it into your face to improve fullness and smooth fine lines. This is called facial fat grafting or fat injections. This medical procedure is more complicated than injectable fillers because it involves liposuction to extract the fat before placement at the injection site. Outcomes may be variable and patient-dependent.

What Type of Facial Fillers Are Best?

The best dermal filler depends on your needs and aesthetic goals. Different fillers address different concerns.

Hyaluronic acid (HA) fillers are generally considered the most natural-looking. They are a popular choice for both smoothing fine lines and adding volume to areas like the lips and cheeks. HA is a naturally occurring substance in the body, making it a safe and effective option. 

Each person’s face and signs of aging are unique. It is crucial to work with a qualified provider who understands the importance of developing a personalized treatment plan. This plan will be tailored to your needs and goals, ensuring your results are unique.

Common Brands of Dermal Filler Products

Benefits of Facial Fillers

Improve Fine Lines and Wrinkles 

Injectable fillers work by adding volume. This helps to smooth wrinkles and skin creases. They create a smoother skin surface by minimizing the depth of wrinkles. Placing the filler under the skin helps plump and smooth it. Fillers effectively restore volume and add to skin hydration.

Correct Volume Loss  

Hyaluronic acid (HA) fillers act like sponges, drawing in moisture to create a volumizing effect. Other types of dermal fillers, such as calcium hydroxyapatite (CaHa), restore lost volume by stimulating collagen and elastin formation. Collagen and elastin are natural skin proteins that give skin its smooth and youthful appearance.

Enhance Facial Contours and Features

Dermal filler procedures enhance facial features and contour by adding volume, smoothing lines, wrinkles, and skin folds, and creating a more defined facial silhouette. By strategically placing fillers in areas like the cheeks, jawline, and chin, clinical and aesthetic dermatology practitioners can lift, sculpt, and balance facial features, resulting in a more sculpted appearance.

Long-Lasting and Natural-Looking Results  

Filler injections can give long-lasting results, anywhere from 6 months to 5 years. You can get natural-looking results with subtle improvements in facial aging. However, choosing a cosmetic or plastic surgery professional who understands facial anatomy and individual goals is important.

Minimally Invasive Cosmetic Procedures  

Dermal filler procedures are done in a doctor’s office. They are a minimally invasive outpatient procedure; you can go home immediately. Recovery usually takes a few hours to a couple of days.

Side Effects and Risks of Dermal Fillers

Possible side effects of dermal fillers include undesirable aesthetic results, such as:

• Undercorrection

• Overcorrection

• Lumps

• Palpable filler under the skin surface

• Asymmetry

Other side effects of face fillers can include:

• Acne-like skin eruptions

• Bruising

• Bleeding at the injection site

• Infection 

• Skin damage 

• Scarring

• Skin necrosis (death of skin tissue due to interruption of blood flow)

• Skin rash or redness

• Swelling

• Itching

Serious complications from dermal fillers are very rare. However, if a dermal filler is accidentally injected into a blood vessel, it can lead to blocked blood flow. The adverse events will depend on the location of the blockage. In the skin, it can lead to skin wounds and skin necrosis. If the eye is involved, it can result in blindness.

Rarely, a severe allergic reaction can occur, resulting in skin rash, hives, itching, swelling, and difficulty breathing. Seek emergency medical care at the first sign of an allergic reaction. Many of these risks can be minimized by choosing a board-certified injector with extensive training in facial aesthetic procedures.

Considerations For Face Fillers

Are Fillers Suitable For All Ages? 

No, fillers are not suitable for all ages. The safety of these injections has not been studied during clinical studies in people younger than 18. Some injectable fillers are FDA approved for people 21 years and older. Most people get fillers in their 40s and 50s when signs of facial aging first appear. However, some people proactively get fillers in their 20s and 30s. 

Additionally, there are other contraindications—such as active skin infections, bleeding disorders, pregnancy, or known hypersensitivity to filler components—and patients should undergo a thorough evaluation by their physician to confirm they meet all eligibility criteria.

Importance of a Board-Certified Injector  

It’s very important to get dermal fillers from qualified professionals. Laws vary by state, but generally speaking, physicians (MDs or DOs), nurse practitioners (NPs), registered nurses (RNs), and physician assistants (PAs) are legally allowed to perform facial cosmetic injections. In some states, non-physician injectors must be supervised by a physician.

Remember that while many injectors may be legally allowed to provide cosmetic injections, they lack the medical knowledge, experience, or aesthetic sense to give you excellent results and ensure safe outcomes. 

A board-certified facial cosmetic surgeon should ideally provide Botox-type injectables and dermal fillers with aesthetic injectable experience. Board-certified cosmetic surgeons have a deep understanding of facial anatomy, receive special training, and must pass rigorous examinations. This will ensure you get natural-looking results and minimize your risk of side effects.

How Much Do Fillers Cost For The Face?

The cost of dermal filler procedures depends on the type of filler used for the treatment, the amount of product needed to achieve your aesthetic goals, and your location and provider. Generally speaking, you can expect to pay anywhere from $500 to $750. 

Remember that the results are not permanent; you need touch-ups and repeat treatments to maintain them. Since dermal fillers are a cosmetic procedure, they are not covered by health insurance.

What To Expect From Fillers

How Long Do Face Fillers Usually Last?

Depending on the type of filler, they can last anywhere from 6 months to two years. Some fillers, like PMMA, are considered semi-permanent because their results can last up to 5 years.

What Should You Expect During A Filler Treatment?  

Here’s what happens during a dermal filler treatment:

1. Your doctor will obtain a medical history and perform a thorough facial assessment and mapping. They may mark injection sites on your face with lines and wrinkles or require augmentation. Your provider may also photograph the treatment areas.

2. Next, your provider will cleanse your skin with an antibacterial agent and use a local anesthetic (numbing cream or injection) to reduce discomfort. Chilling the skin can also reduce injection site pain. 

3. The dermal filler Injections themselves take only a few minutes to perform, typically under 15 minutes. However, if multiple areas are being treated, it can take 30 to 60 minutes.

4. The last step is cleaning your skin of markings and giving you an ice pack to reduce discomfort. You will be observed in the clinic briefly before going home. 

How Painful Are Facial Fillers?

Most patients tolerate dermal filler injections well with only mild discomfort and no need to take pain medication. Your doctor will use an anesthetic or chill the skin before the injections to reduce pain. 

What Happens When You Stop Getting Fillers?

When you stop getting filler injections, the effects will gradually fade, and the treated area will return to its original appearance. This means the added volume in areas like cheeks or lips will decrease, and wrinkles that were smoothed out may reappear. However, stopping fillers does not cause premature aging or make the skin worse than it was before. 

Which Is Better - Botox or Fillers?

Dermal fillers and Botox are both cosmetic procedures that use injections to address aging concerns. However, they work differently and target different areas of the face. Dermal fillers add volume to restore lost fullness and smooth static wrinkles and lines, while Botox relaxes muscles to reduce dynamic wrinkles caused by facial movements.

Dermal fillers generally last longer than Botox. Botox results typically last for 3 to 6 months, while fillers can last anywhere from 6 months to 2 years or even longer, depending on the type of filler used. 

Making An Informed Decision   

It’s important to consult a plastic surgeon or cosmetic surgeon who can understand your aesthetic goals. They can show you before-and-after pictures of other people who got dermal fillers so you have realistic expectations about what this cosmetic treatment can and cannot achieve.