Injectable Dermal Fillers Guide | ABCS (2022)

What are Injectable Dermal Fillers?

Dermalfillers are gel-like substances thatare injected beneath the skin to restore lost volume, smooth lines and soften creases, or enhance facial contours. More than 1 million men and women annually choose this popular facial rejuvenation treatment, which can be a cost-effective way to look younger without surgery or downtime.

  • How can dermal fillers enhance my appearance?
  • What are fillers made with?
    • Hyaluronic Acid (HA)
    • Calcium Hydroxylapatite (CaHA)
    • Poly-L-lactic Acid
    • Polymethylmethacrylate (PMMA)
    • Autologous fat injections
  • Choosing a provider
  • Which filler do I need?
  • What to expect during treatment
  • How long will results last?
  • Find a qualified dermal filler provider

How Can Dermal Fillers Enhance My Appearance?

While dermal fillers are casually known as “wrinkle fillers,” they can do much more than just smooth out wrinkles, although they are excellent at this too! Here are a few of the common issues dermal fillers can help address:

  • Smooth out lines around nose and mouth (a.k.a.marionette lines, smile lines, and parentheses)
  • Enhance & restore volume to sunken cheeks or temples
  • Diminish vertical lip lines
  • Plump & enhance the lips
  • Smooth out a chin crease
  • Improve symmetry among facial features

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What are Fillers Made With?

There are a variety of FDA approved filler products that cosmetic surgeonsuse. In general, fillers are categorized by the substance they are made from. A note for your safety: always make sure that you are receiving FDA approved, brand name fillers, which are only available through a licensed physician, such as a board certified cosmetic surgeon.

(Video) Injectors Anatomy: Depth of Filler Injections Around the Face

Hyaluronic Acid (HA)

Hyaluronic acid is a naturally occurring substance that is already found in your skin. It helps keep skin plump and hydrated. HA fillers are typically soft and gel-like. The resultsare temporary, lasting 6 to 12 months or longer before the bodygradually and naturally absorbs the particles. Most HA fillers are infused withlidocaine to help minimize discomfort during and after treatment. FDA approved HA fillers include:

  • Juvéderm products: Juvéderm XC, VOLUMA, VOLBELLA, VOLLURE
  • Restylane products: Restylane, Restylane Silk, Restylane Lyft, Restylane Refyne, Restylane Defyne, Restylane Kysse, Restylane Contour
  • Belotero Balance
  • Revanesse Versa
  • The RHA collection: RHA 2, RHA 3, and RHA 4

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Calcium Hydroxylapatite (CaHA)

Calcium hydroxylapatite is also a naturally occurring substance, found primarily in ourbones. When used in a filler, the calcium particles are nearly microscopic and suspended in a smooth gel. The consistency of a CaHAfiller is typically thicker than that of a hyaluronic acid filler and typically last longer as well, about 12 months for most patients. Calcium hydroxylapatite is also reported to help stimulate natural collagen production, and it is typically used for deeper lines and wrinkles. FDA approved CaHA fillers include Radiesse®.

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Poly-L-lactic Acid

Poly-L-lactic acid is a biocompatible (meaning it is safe to use in the body), biodegradable synthetic substance. It has beenused for many years in medical devices, such as dissolvable stitches.Poly-L-lactic acid products are technically classified as “collagen stimulators,” as their main mechanism to smooth fine lines is by helping your skin rebuild natural collagen—the filler gel itself dissipates a few days after treatment. Poly-L-lactic acid is typically used to treat deeper facial wrinkles, and results can last more than 2 years. FDA approvedPoly-L-lactic acid fillers include Sculptra® Aesthetic.

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Polymethylmethacrylate (PMMA)

Polymethylmethacrylate (PMMA) is a synthetic, biocompatible substance that has been used in medicine for much of the last century. In dermal fillers, PMMA takes the form of a “microsphere” or tiny ball,that remains beneath the skin indefinitely to provide continued support. PMMA fillers will also contain collagen, a naturally occurring substance in the skin that provides structure and firmness. FDA approved PMMA fillers include Bellafill® (formerly known as Artefill).

(Video) Injectors guide: Treating Neck Lines! Tutorial using dermal fillers

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Autologous fat injections (facial fat grafting)

Autologous fat injections are the only injectable filler treatment that requires surgery, but results can last for many years. Your own fat is harvested from another area (autologous means “from the same person”), typically using liposuction. Thefat is then purified and injected into the face to help restore volume to the cheeks, temples, lower eyelids, or other areas. Fat injections require specialized training to perform safely and achieve great results, and should only be performed byan experienced, board certified cosmetic surgeon.

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Choosing a Provider for Filler Treatments

When selecting a provider for injectable treatments, give your decision the same level of care and scrutiny that you would for a surgical procedure. Non-surgical filler treatment isstill amedical procedure that requires specific training, knowledge and skill to ensure safe treatment andnatural-looking results. Choose a provider with an extensive knowledge of facial anatomy, a well-developed aesthetic eye, and a surgeon’s skill and precision.

Whomever you choose, make sure your provider hasa proven background in cosmetic medicineas well as training and substantial experience performing filler injections.Ask to see before & after photos of apotentialprovider’s patients. If an R.N. or physician’s assistant will be performing your injections, that person should be working closelyunder the supervision of a qualified physician, preferably a board certified cosmetic surgeon.

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Which filler do I need?

With so many dermal filler products on the market, it can be difficult to know which option is best for you without an experienced cosmetic surgeon’s guidance. Each product is uniquely formulated to have a certain texture, density, and injection depth, which means that certain fillers work better for certain areas of concern. While yourprovider will determine what product is best for you, the following diagram illustrates in general where cosmetic surgeons tend to apply certain products:

(Video) The Perfect Cheek Augmentation

Click to enlarge

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What to Expect During Treatment

Dermal filler injections are non-surgical and typically completed during an office visit. Your initial treatment will begin with a consultation,during which you willmeet with your cosmetic surgeon todiscuss your concernsand goals.

Pre-treatment consultation

During your consultation, your cosmetic surgeonwill evaluate your area of concernand reviewyour medical history. While the risks associated with dermal fillers are minimal, you need to fully discloseyour medical history prior to treatment, as certain allergies, skin and neurological conditions, or medications can jeopardize your safety or results.For instance, you need to tell your cosmetic surgeon if you have been taking NSAIDs (e.g., aspirin, ibuprofen, naproxen) or blood thinners, as these increase the likelihood of bruising.

Your injectable filler treatment

Just before the actualtreatment, the area will be cleaned, and you may be given a topical anesthetic to numb the area prior to injection. Manyfiller products also containlidocaine, a mild anesthetic, which is intended to help minimize discomfort during and after your treatment. Your provider will then injecta precise amount of fillerstrategically beneath the skin.

(Video) Natural Looking and Beautiful Lips | Dermal Filler Training Masterclass

Depending on the product and the areas treated, you shouldbe able tonoticeresults immediately afterreceiving filler injections. Some patients experience mild bruising and swelling, but these are temporary and shouldsubside over the days following treatment.You will be able to go back to your normal activities right after treatment, but your cosmetic surgeon may ask you to take the day off from exercise or other strenuous activity.

If you are having fat injections…

Facial fat grafting is a surgical procedure and follows a different treatment protocol. Typically, fat grafting is performed as an outpatient procedure, using general anesthesia or local anesthesia with sedation. Up to 2 weeks of downtime may be required, depending on the extent of liposuction performed. Your cosmetic surgeon will go over what to expect with surgery and recovery during your consultation.

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How Long Do the Results Last?

How long the effects of dermal fillers will last depends on the product, the area of treatment, and the patient. Generally speaking, the denser the product is and the more deeply it is injected, the longer it will last, although this is not a hard and fast rule.To maintain your results,your cosmetic surgeon will simply repeat treatment, adjusting the amountand techniques as necessary to ensure optimal results.

Hyaluronic acid fillers tend to be the most temporary option, and therefore are often recommended for first-time filler patients. These will typically last from 6 to 18 months. Injections to the lips will wear out a little faster than those to the nasolabial folds. CertainHA fillers, such asVOLUMA,are formulated to last longer, but are usuallylimited to certain areas, such as the cheeks.

Synthetic fillers tend to last longer, as they are not absorbed by the body. They can be a great option for the right patient, but you’ll want to be ready to commit to results that will be there for several years—and choose an experienced, qualified provider whose aesthetic style you like.

Fat injections aremeantto last indefinitely; however, some of the injected fat is expectednot survive. Initially, your cosmetic surgeon may overfill the treatment area, resulting inan initially fuller look that will gradually settle into a more natural appearance.

(Video) Dermal Fillers Treatment - 1to1 Training Course - Practical Hands-ON Session

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Find a qualified dermal filler provider near you

With the help of an experienced, qualified provider, injectable fillers can providenatural-looking enhancements to help you feel more confident in your appearance. If you’re ready to learn more about your options, the next step is to meet with a board certified cosmetic surgeon for a consultation. You can useourABCS Find-a-Surgeon toolto locatea cosmetic surgeon near you.


Where should you not inject dermal fillers? ›

Top 5 Danger Injection Zones for Dermal Fillers
  • Between the eyebrows and just above the nose. It is recommended that you use a Low-G filler around this region using the serial puncture technique. ...
  • Temple area. ...
  • Lines between the corner of nose and the mouth. ...
  • Infraorbital region. ...
  • Nasal Augmentation.
17 Jul 2018

How deep should filler be injected? ›

Upper and lower lip filler injections should be less than 3 mm deep and within vermillion-cutaneous border or the dry vermillion. Commissure injections proceed in the superficial subcutaneous plane within a thumb breadth of the angle of the mouth.

Is 1 syringe of filler 1ml? ›

Most filler syringes contain 1.0 ml (milliliters or cc) of product. This includes products such as Restylane and Juvéderm–which also includes Voluma, Vollure, Ultra, and Volbella. Some fillers do come in larger (e.g., Radiesse-1.5 ml) or smaller sizes but let's discuss the vastly more commonly used 1.0 ml syringes.

How long does 1ml dermal filler last? ›

The generally accepted standard is to inject 1ml of lip filler every 6 months, however we recommend infrequent filling of the lips, and to use only small amounts with each session.

What happens if filler hits a vein? ›

A) If dermal filler is injected into an artery, it can either block the blood flow (thrombosis) at that site resulting in ischemia (reduction in oxygen to tissue) or tissue necrosis (cellular death), or it could travel to a more distant site (embolism) where it can cause ischemia or necrosis.

What happens if filler hits a nerve? ›

Most commonly, it results in neurapraxia, but injury to a nerve branch may cause localized anesthesia. Most common site for paresthesia is the infraorbital nerve when it gets compressed by tight filler injection in the vicinity, or from excessive molding into the foramen.

Do fillers look better over time? ›

Answer: Fillers improvement over time.

Once the fillers settle in, and your tissue heals from injections, your results can truly be seen as they are!

How many syringes of filler do most people need? ›

Regardless of which dermal filler you use, two or three syringes are almost always recommended in order to achieve the most gorgeous outcomes. The number of needed syringes should not be a determining factor when considering dermal fillers since they are similar across brands and filler types.

Do fillers expand after injection? ›

Answer: Yes, within the first few days. Yes Juvederm expands within the first few days. The hyaluronic acid is hygroscopic, meaning that it absorbs water from the surrounding tissue.

What happens when you stop getting fillers? ›

The effects of the fillers will wear off after months or years, but the treated area is likely to return to its original state. The benefits of both Botox and fillers will be gone and you'll notice that those lines and volume loss will come back.

Do fillers age you? ›

Fillers are a great option for patients seeking a softer, more youthful look. However, if used improperly or over used, fillers can have negative long term consequences. In fact, patients who do not properly use filler could actually speed up their skin's aging process, resulting in older looking skin.

Should you massage lumps after fillers? ›

While massage can sometimes improve mild symptoms such as moderate lumpiness or slight asymmetry, don't perform massage on your fillers unless instructed to do so by your plastic surgeon or injector.

How deep do you inject hyaluronic acid? ›

It is inserted into the dermis for the entire needle length (0.5 in.) with the skin fully stretched using fingers. Hyaluronic acid (HA) is introduced into the dermis while withdrawing the needle, creating a “strut” of 0.03–0.05 mL HA.

What layer of skin does filler go into? ›

Most commonly, one of these areas is the dermis, or middle layer of the skin. Then, to augment this initial injection, the filler will also be administered to the subdermal plane, which is a level directly below the skin.

Can I inject filler myself? ›

Please don't try to inject yourself with facial fillers - it is extremely dangerous! […] Without knowing the anatomy of face muscles, nerves and blood vessels you could cause irreversible facial paralysis, blindness and tissue necrosis.

What is the safest dermal filler? ›

There's only one FDA-approved dermal filler that is not absorbed by the body. It is made with polymethylmethacrylate (PMMA) beads suspended in a solution that contains bovine (cow) collagen. PMMA beads are tiny round, smooth, plastic beads.

How do I know if filler was injected into a blood vessel? ›

If filler is injected into or around a vessel and causes an occlusion of a vessel, the most immediate sign is a blanching or whitening of the tissue that the vessel supplies. This happens immediately or soon after injection. The next warning sign is pain that feels like a burning or stinging.

What are signs of necrosis after filler? ›

Answer: Skin necrosis is rare after injection of filler

Signs of skin necrosis include changes in skin color (a blue, dusky, or dark hue in that area), pain, and “breakdown” of the skin.

How common is blindness from fillers? ›

Indeed, dermal fillers have already led to 98 reported cases of blindness (Beleznay et al, 2015). Out of 98 cases of vision complications from dermal fillers, 65 led to unilateral vision loss, and only two cases of vision loss were reversible.

What happens if filler is injected too superficially? ›

If fillers are injected too superficially or in overly large volumes then light may be reflected through them, generating a bluish hue that is visible through the skin. The Tyndall effect is more likely to occur in areas where the skin is thin as light is more easily reflected in these areas.

What is blanching after filler? ›

Blanching™ is a common technique used largely abroad in Europe. At international medical conferences we attend, the technique is commonly discussed, but it is not yet well-known in the United States. The technique involves using specific smile line fillers to remove fine lines without appearing puffy from any angles.

Is 60 too old for fillers? ›

There are effective cosmetic treatments for individuals of any age who want to look younger. The aging process is inevitable for everyone, and injectable fillers are ideal for adults of any age who want a fresher, rejuvenated appearance.

Does drinking water help fillers? ›

Drinking plenty of water can keep your skin hydrated and enhance the effect of hyaluronic acid fillers. After your treatment, we can recommend skin care products that complement the effects of your filler type.

Which filler lasts the longest? ›

Juvederm and Restylane fillers last longer than other fillers. Juvederm and Restylane are currently the longest-lasting and most durable dermal fillers on the market. Juvederm and Restylane are families of hyaluronic acid fillers with numerous possible formulations.

How much is a full syringe of filler? ›

The average cost is between $500-800 per syringe. Restylane Lyft differs from original Restylane and Restylane-L both in the size of the particles in the product and the depth at which the product is administered, making it the better choice for those seeking to reduce particularly severe or deep wrinkles.

How much filler is needed for jowls? ›

We generally place a half to one ml per side in this area. Like the temples, this is a large area of volume loss that changes the shape of the face, elongating it and squaring it off, and causing jowls. We would usually place a ml on each side.

Is 2 syringes of filler too much? ›

Based on how thin your lips are and how enhanced you want them to be, most patients will do well with 1-2 syringes of dermal filler to get the long term aesthetic goal that they want. 1 syringe has 1.0 cc of dermal filler, so most patients will look great after 1-2 cc of dermal filler.

What to avoid after fillers? ›

Avoid topical products such as Tretinoin (Retin-A), Retinol, Retinoids, Glycolic Acid, or any “anti-aging” products. Avoid waxing, bleaching, tweezing, or using hair removal cream on the area to be treated. Do start taking Arnica two days prior to the procedure.

How long does it take for fillers to settle? ›

Fortunately, dermal fillers work very quickly, and you won't have to wait twelve months to see the full benefits of your injections. That said, these injectable treatments take some time to integrate into your tissues, and it's normal for your dermal filler to take up to two weeks to fully settle into your face.

Does massaging filler break it down? ›

Massage can encourage the filler to be broken up by the body more quickly. But in practice this still takes a long time (like weeks of daily vigorous massage) to improve the outcome.

What areas of the face can you use fillers? ›

Here are five areas of the face that can be improved with dermal fillers:
  • Lips. Plumping the lips might be one of the most common areas that dermal fillers are used these days. ...
  • Cheeks. ...
  • Forehead. ...
  • “Marionette Lines” and “Nasolabial Folds” ...
  • Reduce the Appearance of Scars.

What are Botox danger zones? ›

Any Botox injection sites on the lower part of the face require more caution. The lower part of the face is more sensitive when it comes to injections, since weakening the muscles around and on the lips can cause difficulty speaking or puckering.

Can filler be put in forehead? ›

If you want to improve the look of your forehead, fillers are a minimally invasive alternative to facelifts. Although well known in their use for plumping your pout, enhancing your cheekbones, and as an alternative to rhinoplasty, face fillers are also commonly used as an anti-ageing treatment on the forehead.

Can fillers be used on thighs? ›

For thighs dents

Fillers can be used to treat dimples and divots on the backs of the thighs, often caused by cellulite and aging skin. The filler can help lift the skin to improve the appearance of some superficial sagging and cellulite.

Can filler lift jowls? ›

A light sprinkling of filler in this area can help lift drooping mouth corners and sculpt the jawline, smoothing out any remaining signs of jowling. The procedure is not painful, does not require any significant downtime and is excellent for lifting and sculpting the skin, where volume needs to be replaced.

How can I plump up my face without fillers? ›

12 Ways to Get Plumper Skin
  1. Replenish Your Collagen & Elastin from Within. ...
  2. Eat Skin-Plumping Foods. ...
  3. Get More Hyaluronic Acid Into Your Dermis. ...
  4. Give Yourself a Facial Massage. ...
  5. Use a Retinol Serum. ...
  6. Use Skin-Plumping Sheet Masks. ...
  7. Don't Forget Antioxidants. ...
  8. Get Out & Exercise.

Can I use hyaluronic acid after fillers? ›

Unfortunately, these levels majorly decrease over time, which is why it's important to have hyaluronic acid in your skincare routine, especially after fillers! This product enhances the plumpness fillers give you all while providing long-lasting hydration.

What is the safest dermal filler? ›

There's only one FDA-approved dermal filler that is not absorbed by the body. It is made with polymethylmethacrylate (PMMA) beads suspended in a solution that contains bovine (cow) collagen. PMMA beads are tiny round, smooth, plastic beads.

What does Botox under the eyes do? ›

Those who had them in the lower eyelids and crow's feet area were more likely to report positive results than those who only received injections in their lower eyelids. These results suggest that Botox injections can make the lower eyelid appear fuller and plumper, helping to reduce wrinkles and bagginess.

How common is blindness from fillers? ›

Indeed, dermal fillers have already led to 98 reported cases of blindness (Beleznay et al, 2015). Out of 98 cases of vision complications from dermal fillers, 65 led to unilateral vision loss, and only two cases of vision loss were reversible.

Do fillers work on deep wrinkles? ›

Dermal fillers are gel-like substances that we inject just beneath your skin. They can reconstruct a more youthful look and smooth lines and deep wrinkles. The nice thing about dermal fillers is that they provide a dramatic change in your appearance without surgery or downtime.

What is the best filler for deep wrinkles? ›

Hyaluronic acid (Restylane, Juvederm, others).

This natural component of the skin's connective tissue is the most common filler used for wrinkles. The results typically last 6 to 12 months.

What is better for forehead wrinkles Botox or fillers? ›

Fillers typically last longer than BOTOX in most cases, but a filler may or may not give you the long-lasting results you would want for forehead lines. The lines can be smoothed with fillers, but in most cases, BOTOX is a superior choice for forehead lines.

Can fillers get rid of cellulite? ›

Do Sculptra injections work to minimize the appearance of cellulite? Yes, it does. Since Sculptra works to stimulate collagen production and boost skin volume and structure, the injectable helps fill and smooth out depressions and dimples in the skin.

Can you put filler in your arms? ›

Dermal filler tightens and thickens collagen to improves the appearance of loose skin in treated areas. Dermal filler can tighten the upper arms, and with regular injections Dermal filler leaves your arms looking healthy and contoured.

What are leg fillers? ›

Sculptra Leg Lift at ZO Skin Health Centre | Great Legs Over 50


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