Injectable fillers are substances that are injected through small needles into the skin to fill or plump wrinkles, depressed scars or restore facial volume. Areas that can be treated with fillers include lips, wrinkles running from the nose to the corner of mouth (nasolabial folds), folds beneath the corners of the mouth (marionette lines), lines between the eyes, grooves under the eyes, fine lines on the cheeks or around the mouth, and central cheek depressions. Fillers may also be used to treat larger areas of facial volume loss seen with conditions such as extreme weight loss and AIDS.
For many years, bovine collagen (derived from cows) was the only available injectable filler in the U.S. Recently, many newer forms of fillers, including human collagen, have become available. The most versatile and commonly injected filler today is hyaluronic acid, which is a natural component of all living tissue. Longer-lasting fillers that are most appropriate for deeper and larger areas of volume loss may include polyl-L-lactic acid, calcium hydroxylapatite and liquid injectable silicone. Different fillers are used depending on the condition being treated. Your dermatologic surgeon is the most qualified person to decide which filler is best for your particular need.
Corrections achieved with collagen fillers last about three months, while corrections achieved with hyaluronic acids fillers, used in optimum amounts, often persist for at least six months. Corrections achieved with poly-L-lactic acid and calcium hydroxylapetite may persist for 1-2 years or longer. Currently, liquid silicone is the only true permanent filler available in the United States. Its use is “off label,” meaning that it is specifically FDA-approved for use other than tissue augmentation, but as such may be legally used as an injectable filler for certain unique indications. Currently, investigational study with liquid silicone shows great promise for HIV facial fat loss and acne scarring.
Generally, your dermatologic surgeon will cleanse and treat the area to be injected with a topical anesthetic cream or injectable anesthesia prior to the filler injection. You may experience slight to moderate discomfort upon injection of the filler, but most patients find the treatment very tolerable. After the treatment, mild redness, swelling and tenderness may develop and persist for a few hours to 1-2 days. Occasional bruising may develop, which usually resolves after a few days. Bruising can usually be avoided by refraining from aspirin, anti-inflammatory medications (ibuprofen, naprosyn) and supplements such as vitamin E, gingko biloba, garlic, ginseng, omega 3 fatty acids and St. John’s Wort for at least one week prior to the procedure.
Rarely, bruising, overcorrection, persistent lumpiness or inflammation around the injection site may develop and persist for weeks after a procedure. Occasionally a superficial infection requiring antibiotics may occur. If a persistent irregularity should occur with hyaluronic acid, hyaluronidase may be injected to dissolve the filler and alleviate the problem. Allergic reactions to the older bovine collagen were common (about three percent). With the newer forms of fillers, allergic reactions are very rare (one in 5000 for hyaluronic acid). Rarely, injection of fillers may compromise blood flow to the skin, causing scab formation and possible development of a scar. This problem is very rare with the newer injectable fillers.
Yes, these modalities often compliment one another and recent studies support the safety and effectiveness of a combined approach to facial rejuvenation.
For more information on skin conditions and treatments, along with a list of ASDS members in your state, visit the Find a Dermatologic Surgeon search page.
Microlipoinjection information
Before and after photos: Injectable fillers for the forehead and cheek area
Before and after photos: Injectable fillers around the mouth area