What are dermal fillers?

Dermal fillers help to diminish facial lines and restore volume and fullness in the face.

As we age, our faces naturally lose subcutaneous fat. The facial muscles are then working closer to the skin surface, so smile lines and crow’s feet become more apparent.

The facial skin also stretches a bit, adding to this loss of facial volume. Other factors that affect the facial skin include sun exposure, heredity and lifestyle.

What dermal fillers can do

• Plump thin lips
• Enhance shallow contours
• Soften facial creases and wrinkles
• Improve the appearance of recessed scars
• Reconstruct contour deformities in the face
• Decrease or remove the shadow of the lower lids

Dermal fillers can be very helpful in those with early signs of aging, or as a value-added part of facial rejuvenation surgery.

What dermal fillers can’t do

For some patients, surgery such as a facelift, brow lift or eye lift may be the best approach. Minimally invasive rejuvenation treatments, such as soft tissue fillers, cannot achieve the same results, but may help delay the time when consideration of a facelift becomes appropriate. It is important to remember that dermal fillers are temporary treatments for facial aging and that ongoing treatments will be needed for long-term results.

Who is a good candidate for dermal fillers?

You may be a good candidate for dermal fillers if you:

• Are physically healthy
• Don’t smoke
• Have a positive outlook and realistic goals in mind for the improvement of your appearance
• Are committed to maintaining good skin health

For some patients, surgery such as a facelift, brow lift or eye lift may be the best approach.

How much do dermal fillers cost?

The following is a list of the average cost of several popular types of dermal fillers, according to 2018 statistics from the American Society of Plastic Surgeons and are priced as a per syringe cost. Most patients need multiple syringes to achieve desired results.

• Calcium hydroxylapatite (e.g., Radiesse): $691
• Fat grafting: $2,126
• Hyaluronic acid (e.g., (Juvederm Ultra, Juvederm Ultra Plus, Perlane, Restylane, Belotero): $682
• Platelet-Rich Plasma (PRP): $683
• Polylactic acid (e.g., Sculptra): $915
• Polymethyl-methacrylate microspheres (e.g., Artefill): $889

Cost is always a consideration in elective procedure or treatment. The cost of dermal filler injections may vary based on the expertise and qualifications of the person performing the treatment, the type of procedure used, time and effort the procedure or treatment requires, as well as the geographic location of the office.

Your satisfaction involves more than a fee.

When choosing a plastic surgeon for dermal filler injections, remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the procedure.

Health insurance does not cover dermal fillers, but many plastic surgeons offer patient financing plans, so be sure to ask.

Choose a professional

Although tissue augmentation with dermal fillers is a quick, in-office procedure that can produce a marked improvement in restoring facial fullness and a more youthful appearance, effective and safe use requires a physician with specialized training and a thorough understanding of facial anatomy to recommend and inject an appropriate filler. Significant complications can occur with dermal fillers, as with any medical procedure, so being treated by a board-certified plastic surgeon is essential for your safety and good outcomes.

What should I expect during a consultation for dermal fillers?

During your dermal fillers consultation be prepared to discuss:

• Your goals
• Medical conditions, drug allergies, and medical treatments
• Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
• Any past treatment with soft tissue fillers, botulinum toxin therapy, laser or other minimally invasive facial procedures, as well as any prior facial surgery

Your surgeon may also:

• Evaluate your general health status and any pre-existing health conditions or risk factors
• Discuss your available options
• Examine and measure your face
• Take photographs
• Recommend a course of treatment
• Discuss likely outcomes of using soft tissue fillers and any risks or potential complications

Your plastic surgeon will carefully explain:

• Your course of treatment
• The type of filler recommended in your case and why
• Expected results
• The longevity of the result

Be sure to ask questions. To help, we have prepared a checklist of questions to ask during your dermal fillers consultation.

It’s important you understand all aspects of dermal fillers. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of pre-treatment stress. Don’t be shy about discussing these feelings with your plastic surgeon.

What questions should I ask my plastic surgeon about dermal fillers?

Use this checklist as a guide during your dermal fillers consultation:

• Are you certified by the American Board of Plastic Surgery?
• Are you a member of the American Society of Plastic Surgeons?
• Were you trained specifically in the field of plastic surgery?
• How many years of plastic surgery training have you had?
• Do you have hospital privileges to perform this procedure? If so, at which hospitals?
• Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
• Am I a good candidate for this procedure?
• What will be expected of me to get the best results?
• Where and how will you perform my procedure?
• How long of a recovery period can I expect and what kind of help will I need during my recovery?
• What are the risks and complications associated with dermal fillers?
• How are complications handled?
• How can I expect my skin to look overtime?
• What are my options if I am dissatisfied with the cosmetic outcome of my procedure?
• Do you have before-and-after photos I can look at for each procedure and what results are reasonable for me?

What types of dermal fillers are available?

There are several different types of dermal fillers. The most common types are:

Calcium hydroxylapatite

Brand names include: Radiesse

Calcium hydroxylapatite is found naturally in human bones and is a mineral-like compound. It’s often used to:

• Moderate-to-severe creases such as nasolabial folds, marionette lines and frown lines
• Enhance fullness of the cheeks and other facial contours
• Improve volume in areas of facial wasting such as can occur in HIV-positive people taking certain medications

Calcium hydroxylapatite is biosynthetically produced, which means that no animals or animal products are used. This lowers your risk of an allergic reaction and no skin testing is required. This type of dermal filler is known to produce a very natural result, doesn’t migrate and side effects are rare. This dermal filler was first used in dentistry and reconstructive surgery and has a long safety record.

Hyaluronic acid

Brand names include: Captique, Esthélis, Elevess, Hylaform, Juvederm, Perlane, Prevelle, Puragen, Restylane

Hyaluronic acid injections can be used to improve the skin’s contour and reduce depressions in the skin due to scars, injury or lines. You can see potentially dramatic improvements for:

• Acne scars
• Cheek depressions
• Crow’s feet at the corner of your eyes
• Deep smile lines that run from the side of the nose to corners of the mouth (also known as nasolabial furrows)
• Frown lines between the eyebrows
• Marionette lines at the corners of the mouth
• Redefining lip border
• Scars including burns, acne and those caused by wounds
• Smoker’s lines; vertical lines on the mouth
• Some facial scars
• Worry lines that run across your forehead

Hyaluronic acid is a natural substance found in your body. High concentrations are found in soft connective tissues and in the fluid surrounding your eyes. It’s also in some cartilage and joint fluids, as well as skin tissue. It is extracted and reformulated and now has become one of the most popular kinds of injectable fillers. If the term sounds familiar, it’s because the same substance is often injected into the aching joints of people with arthritis to ease pain and provide extra cushioning.

Polyalkylimide

Brand names include: Aquamid

Polyalkylimide is a semi-permanent dermal filler and is often used by plastic surgeons to:

• Treat deeper wrinkles such as nasolabial folds or depressed scars
• Plump thin lips
• Enhance cheekbones and the jawline, and to replace facial volume lost due to age
• Treat facial wasting from HIV medications

Polyalkylimide has very little reaction with human tissue, meaning it’s biocompatible, and no allergy test is required. It is radio transparent, meaning it won’t interfere with x-rays.

After the injection, a thin layer of collagen slowly forms around it over the course of about a month. The gel is eventually completely surrounded. A single procedure can inject large volume. This product, which is thought to be quite stable over time, can even be removed if necessary.

Polylactic acid

Brand names include: Sculptra

Polylactic acid is a synthetic dermal filler that is injected into your face, causing your body’s own production of collagen. This type of dermal filler is known as a stimulator. This non-toxic, biodegradable substance has been used for more than 40 years as suture material.

Polylactic acid is known to work particularly well in the lower half of your face, and is used to:

• Fill the lines caused by laughing
• Plump thin lips
• Treat deep nasolabial folds

This substance is unlike other dermal fillers because it doesn’t produce immediate results. Instead, it stimulates your own body’s collagen production, so results appear gradually over a period of a few months.

You will likely need about three monthly treatments to achieve your desired results. With each treatment, there is re-stimulation of your own collagen. Then it can take four to six weeks to see the full effect. While this type of dermal filler is considered semi-permanent, you may still need occasional touch-ups.

Polymethyl-methacrylate microspheres (PMMA)

Brand names include: Bellafill

PMMA is considered a semi-permanent filler and is most often used to treat medium-to-deep wrinkles, folds and furrows, particularly nasolabial folds. It can also be used to fill out pitted scars and to augment thin lips.

When a more permanent solution to facial wrinkles is desired, PMMA is often used instead of collagen replacement therapy or hyaluronic therapy. PMMA has been used for many years in permanent surgical implants. Because of this, your surgeon will likely under-fill on the first treatment, adding more later if needed.

One of the downsides of PMMA is that a number of injections are needed to create volume and it can take up to three months to realize the full effects. It may also be visible under the skin. To avoid any unwanted results, it’s key that your plastic surgeon is familiar with the proper technique, which involves injection at the dermal subcutaneous junction using threading or tunneling methods.

Summary

Dermal fillers differ in chemical makeup, longevity and have varying degrees of softness. Softer fillers are used in the lips, for example, while sturdier fillers might be desired to enhance cheekbones.

Your surgeon will determine with you the best type and volume of filler needed for your particular areas of concern.

For many people, the use of “off-the-shelf” fillers can be a simple office-based procedure that can nicely enhance their appearance. These dermal fillers are very predictable and have relatively minimal risks and side effects. These fillers are often injected in the surgeon’s office or medical spa.

How can fat injections be used as dermal fillers?

Some patients may want to consider fat injections, which use fat harvested from the patient’s own body which can then be re-injected to enhance facial fullness, fill creases or build up shallow contours.

How fat injections are administered

Fat injection requires a more extensive procedure than “off-the-shelf” soft tissue fillers.

A “donor area” must be determined (such as the abdomen or buttocks) and liposuction is used to extract the fat. The suctioned fat can then be transferred to the face, as a graft.

The grafted fat then has to redevelop a blood supply in order to survive. About 50% of the fat injected will survive, and the surviving fat will last forever.

Fat injection results

In the face, most of the transferred fat usually survives, but the results can be a bit less predictable. Typically, multiple fat transfer procedures will be needed to achieve desired results.

The use of fat transfer involves additional discomfort in the donor area. This is a minor surgical procedure that can be performed in the surgeon’s treatment room or in an operating room.

What are the risks of dermal fillers?

The decision to use fillers is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks and potential complications of dermal fillers are acceptable.

Your plastic surgeon and/or staff will explain, in detail, any risks.

You will be asked to sign consent forms to ensure that you fully understand the procedure, as well as the risks and potential complications.

Severe complications from dermal fillers are uncommon. Potential risks vary depending on the specific filler used and the relative permanence of the filler substance and include:

• Acne-like skin eruptions
• Asymmetry
• Bruising, bleeding from the injection site, swelling
• Damage to the skin that results in a wound and possible scarring
• Infection at the injection site
• Lumps
• Palpability of the filler under the surface of the skin
• Skin rash with itching
• Skin redness
• Under- or over-correction of wrinkles
• Blindness
• Skin necrosis (ulceration or loss of skin from disruption of blood flow)

These risks and others will be fully discussed prior to your consent.

It is important that you address all your questions directly with your plastic surgeon. Although good results are expected from your procedure, there is no guarantee that you will be satisfied with your results. Because significant complications can occur from dermal filler injections, it is important to be in the care of a board certified plastic surgeon who understands the risks and is trained and prepared to deal with any complications that may occur.

In some situations, it may not be possible to achieve optimal results with a single procedure. Most fillers do dissipate over time. To maintain your correction, you will need to consider repeating the injection process at intervals.

What are the steps of a dermal fillers procedure?

A dermal fillers procedure includes the following steps:

Step 1 –

Facial assessment & mapping

If you choose to utilize packaged soft tissue fillers, the plastic surgeon, or his specially-trained nurse, will evaluate your facial appearance and skin tone and examine the areas of your face to be augmented.

Strategic points on your face may be marked as the appropriate injection sites for the filler. Photographs may be taken of the areas to be treated.

Step 2 – Cleansing & anesthetizing

The injection sites will be cleansed with an antibacterial agent.

Pain at the injection site may be ameliorated by use of a very cold instrument to chill the skin, anesthetic ointment to numb the skin or injection of local anesthesia.

While not painless, the injections are usually easily tolerated.

Step 3 – The injection

Injection usually takes only a few moments per site. The process of injecting, massaging, and evaluating the result is performed, and additional filler added as needed.

Depending on the number of areas to be treated, the whole process may be as short as 15 minutes, or as long as an hour.

Step 4 – Clean up & recovery

Once the results are deemed satisfactory, any markings will be cleansed off.

You may be offered an ice pack to reduce swelling and alleviate discomfort. Although the area may feel a bit tender for a day or two, it is usually not painful enough to require any medication.

What should I expect during my dermal fillers recovery?

Recovery time varies for each patient and for each type of filler injected. You can resume most activities right away, but it is generally recommended that you avoid intense physical activity for the first 24-48 hours to minimize swelling and bruising. Be sure to discuss your specific recovery plan with your physician prior to scheduling your injections.

Your initial appearance after treatment with any dermal filler may include:

• An “overfilled” appearance to treated areas
• Swelling or bruising ranging from mild to severe
• Temporary numbness or redness
• Palpable lumps or hard areas at the injection sites
• Hypersensitivity reaction that can seem like an allergic reaction with hives and swelling

Most conditions can be alleviated with topical icing and massage and will improve within a matter of hours or just a few days. Some reactions may require more aggressive treatment with medications or injections. Be sure to discuss your recovery and treatment plan with your physician.

When your own fat is the injected filler, the healing process is longer and may take a few weeks. Get more information about fat injections.

What results should I expect after dermal fillers?

The results of soft tissue augmentation using dermal fillers are apparent immediately and will last from several months to several years depending on the filler used and the patient injected. Maintaining good overall health and maintaining healthy and strong skin with appropriate products and skin treatments will improve the results and longevity.

Dermal Fillers Before & After Photos

View before and after photos of dermal filler procedures performed by members of the American Society of Plastic Surgeons.

How do I choose a plastic surgeon for dermal fillers?

The decision to get dermal fillers involves many choices. The first and most important is selecting a board-certified plastic surgeon you can trust who is a member of the American Society of Plastic Surgeons (ASPS).

ASPS member surgeons meet rigorous standards:

• Board certification by the American Board of Plastic Surgery^® (ABPS) or in Canada by the Royal College of Physicians and Surgeons of Canada^®
• Complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training
• Pass comprehensive oral and written exams
• Graduate from an accredited medical school
• Complete continuing medical education, including patient safety, each year
• Perform surgery in accredited, state-licensed, or Medicare-certified surgical facilities

Do not be confused by other official-sounding boards and certifications.

The ABPS is recognized by the American Board of Medical Specialties (ABMS), which has approved medical specialty boards since 1934. There is no ABMS recognized certifying board with “cosmetic surgery” in its name.

By choosing a member of the American Society of Plastic Surgeons, you can be assured that you are choosing a qualified, highly-trained plastic surgeon who is board-certified by the ABPS or the Royal College of Physicians and Surgeons of Canada.