True Skin Experts Live: "Filler Injections: Improve Your Skin’s Appearance" With Drs. Sue Ellen Cox and Vince Bertucci


Dermal Fillers

What are dermal fillers?

Dermal fillers – Juvederm, Restylane, Belotero, and Voluma– contain some form of hyaluronic acid, a substance that naturally occurs throughout the body and skin, with the highest concentrations in the fluids of the eyes and joints. Radiesse is a calcium hydroxyapatite filler, while Sculptra contains L-poly-lactic acid. Fillers can be used to temporarily plump lips, raise depressed scars and level wrinkled skin.

Before (left) and after (right) Radiesse to hands.

Photo courtesy of Daniel P. Friedmann, MD - Austin, Texas

What should first be done before considering dermal fillers?

First, an ASDS dermatologist will review the patient’s medical history and examine the condition to be treated. Areas to be treated should be kept clean. If there is a skin infection, then treatment needs to be postponed until it resolves. Patients who take blood thinners (such as aspirin, ibuprofen, certain herbal medications) should stop them two weeks prior to injection with the approval of their prescribing doctor.

Gary Goldenberg, MD, discusses the benefits of dermal fillers.

What happens during the procedure?

First, the physician marks the areas to be injected. Topical or injection numbing medication may be used for added comfort. Then the fillers are injected by syringe using very fine needles. The effect typically lasts six months to two years. After that, additional injections are required to maintain the effect.

In this video, Heidi Waldorf, MD, discusses the use of soft-tissue fillers for recontouring purposes.

Who is not a candidate for dermal fillers?

Dermal fillers are not recommended for patients who have:

  • Current oral herpes or a similar infection
  • Uncontrolled diabetes
  • Blood-clotting problems
  • Lupus or other connective tissue disorders

Are dermal fillers painful?

Topical numbing agents or anesthetic injections are sometimes applied to ease discomfort. Before and following treatment, ice may be given to ease discomfort and swelling. Patients should avoid applying firm pressure on the treatment area.

When are dermal fillers appropriate?

Dermal fillers can be used to treat

Before (left) and nine months after (right) Radiesse.

Photo courtesy of Sabrina Fabi, MD —San Diego, California

Before (top) and after (bottom) Radiesse to temples, mid-cheek and madibular angle.

Photo courtesy of Kimberly J. Butterwick, MD —San Diego, California

Before (left) and after (right) Restylane to upper and lower lip.

Photo courtesy Cheryl Burgess, MD —Washington D.C.

Before (left) and after (right) - Sculptra to full face and Botox to masseters

Photo courtesy of Rebecca Fitzgerald, MD —Los Angeles, California

What can I expect after having had dermal fillers?

All hyaluronic acid soft-tissue fillers are temporary, lasting anywhere from six months to two years, depending on the filler and type of procedure. Some patients require maintenance treatments to achieve the best results. Expectations differ following treatment:

  • Lip therapy: Dermal fillers can improve the shape, structure and volume of the lips for up to six months. Following treatment, ice may be given to ease discomfort and swelling. Avoid applying firm pressure on the treatment area. Lipstick and other lip products should be avoided immediately following the procedure.
  • Scars and wrinkled skin: Bruising, which may last up to a week. Swelling. Redness. Following treatment, ice may be given to ease discomfort and swelling. Avoid applying firm pressure on the treatment area.

Possible Risks

Common side effect include:

  • Swelling
  • Bruising
  • Bleeding
  • Lumps and bumps

Uncommon side effects include:

  • Numbness
  • Allergic reactions
  • Infection
  • Blisters and cysts
  • Inflammatory reactions
  • Migration of filler material to another site