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.

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

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).

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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.

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

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

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.

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.

(Video) Botox vs Fillers: The Beginner’s Guide to Treating Wrinkles with Injectables

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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.

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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.

(Video) The Perfect Cheek Augmentation

FAQs

Is 1 ml enough for cheek fillers? ›

Cheek filler

They are ideal for replacing volume loss, enhancing cheek volume, and can improve the appearance of the lower eyelid by volumising the upper cheek area. We recommend using as little as 1ml per session for an enhanced appearance.

Is 1ml dermal filler enough? ›

Treating with 1ml at a time is certainly appropriate for some areas, such as volumising lips or having smaller tweakments into other areas of the face. Sometimes, however, more than 1ml may be required – in the cheeks, for example – as 1ml may not make a discernible difference.

How many syringes of dermal filler do I 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.

How many units of dermal filler do I need? ›

So based on this fact, most patients will need 1 syringe of filler per decade of age to restore their once youthful and plump appearance. Again, those numbers would be 3 syringes for a 30 year old, 4 syringes for a 40 year old, 5 syringes for 50 year (you see where we are going with this) for a full facial correction.

Can dermal fillers lift jowls? ›

Dermal fillers can be used to restore mid-face (cheek) volume and sculpt the jawline, in order to reduce the appearance of sagging jowls. The procedure is not painful, does not require any significant down-time and is excellent at lifting and sculpting the skin, where volume needs to be replaced.

Is 1ml of filler a lot? ›

1ml of dermal filler falls within the average amount. It still creates a natural increase. Everything over 1ml creates a more dramatic look, and this is something that should be taken into consideration by patients. 1ml of dermal filler can be used in the lower lip as well as the upper lip.

Is 1 syringe of Juvederm enough for cheeks? ›

One syringe may be enough for a mild bilateral cheek correction. However, if deep hollows or marked flattening of the cheeks are present, additional syringes may be required. I recommend patients new to JUVÉDERM VOLUMA® XC start with a minimal treatm ent of one syringe.

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.

Do fillers look better over time? ›

The Results Improve Over Time

Because these injections stimulate your body's production of collagen and elastin, the final results of treatment won't be seen for several weeks. Even as the hyaluronic acid is processed by your body, healthy collagen and elastin grow at a more significant rate.

What can 1 syringe of filler do? ›

How our faces age: What can one syringe of filler do? - YouTube

How many syringes of filler is too much? ›

Because of safety concerns related to compression caused by swelling and filler, you really want to stick to just 1 syringe per treatment session, and most patients only need 1 syringe in total to achieve their desired results.

How many cc are in 1 syringe of filler? ›

Fillers come in an average of 1.0cc aliquots delivered in syringes. Syringes should be used in a single setting to preserve their efficacy and sterility and not saved or "split" between patients.

Is 1cc of filler enough? ›

One cc of filler is typically sufficient for most clients, however, some will need more. It can be staged weeks or even months apart if cost is an issue.

Is 0.5 mL cheek filler enough? ›

X amount of mls in some individuals may make little to no difference, depending on area, age and desired look. We usually recommend at the very least 1ml each side as the minimum. Dermal filler begins to be broken down by the body a month after treatment.

How much filler can you get at once? ›

If it's something that bothers you, dermal filler can be used to treat the area, and, typically, a practitioner will use anywhere from 0.5ml to 2ml filler per side, depending on the individual and how deep the lines are.

Is 70 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.

What is the best filler for sagging jowls? ›

Cosmetic fillers like Restylane and Sculptra are often used for jawline contouring. Restylane Lyft – a hyaluronic acid filler – is also frequently recommended for reshaping the jawline as it is thicker than other fillers under the Restylane umbrella.

Where do you put the filler to lift jowls? ›

When the dermal filler is used as a jowl filler, it is injected along the jawline in the pre-jowl sulcus and the marionette lines to regain jawline definition. Treatment of jowls with jawline fillers often involves treating the chin area as well.

How long does it take filler 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.

How much filler is in each cheek? ›

The mid cheek is the area of the cheek directly under the eyes. It's a common area of volume loss and a little volume here can make a huge difference to a face. We generally place a half to one ml per side in this area.

How do you sleep after dermal fillers? ›

Sleeping on your back is the safest position after any cosmetic procedure. The first night after your treatment, sleep with your head elevated (propped up with an extra pillow) to help avoid/reduce swelling and to ensure that the newly-injected filler stays in place.

Can you use Juvederm under eyes? ›

Juvéderm Volbella XC, one of the most widely-used dermal fillers, has recently been approved by the FDA for injection into the under-eye area of the face.

Which filler is best for cheeks? ›

Best Fillers For My Cheeks
  • Juvéderm. Made from hyaluronic acid, Juvéderm is designed to add both volume and hydration. ...
  • Juvéderm Voluma. This is the first FDA-approved injectable gel that will instantly add volume to the cheek area. ...
  • Restylane. Among the most commonly used dermal fillers is Restylane. ...
  • Radiesse. ...
  • Sculptra.
6 Jan 2016

How much Juvederm does it take to lift cheeks? ›

In general, the amount of filler you will need for your treatment will depend on the severity of skin laxity in your cheeks and your aesthetic goals. Voluma syringes are typically one cc and many patients need between two and four syringes to complete the treatment, which can be one to two syringes per cheek.

Can filler move if you touch it? ›

Although extremely rare, dermal fillers are able to migrate within the skin if consistent and adequate pressure is applied to them. For this reason, we advise patients not to get a facial, massage (on the treated skin), or microdermabrasion for the first two weeks following their filler injections.

Can I get more filler after 2 weeks? ›

I recommend waiting 2 weeks after a filler injection before repeating filler in that same region. The swelling that normally occurs after an injection will usually have subsided by that time to give a more accurate view of whether or not additional filler is needed.

Will filler lumps go away? ›

The most common cause of lumps after a filler treatment is swelling and bruising from the injections themselves. These should naturally subside within the first week.

Is 60 too old for fillers? ›

Botox and fillers are generally considered safe for people of all ages, whether they are 30 years old, 60 years old, or 80 years old.

Does drinking water help fillers? ›

Keeping your skin healthy and moisturized can help maintain your treatment results as well. Drinking plenty of water can keep your skin hydrated and enhance the effect of hyaluronic acid fillers.

What fillers make you look younger? ›

Fillers like Juvéderm, Restylane®, and Belotero Balance® can help transform the eye area for a younger, rejuvenated look. Cheek volume is another popular area that clients want to target with fillers. With age, the cheeks can become hollow in appearance or look flat due to a decrease in collagen production.

How many filler injections do I need? ›

The number of syringes of filler administered during each treatment will depend on your age and what you are trying to accomplish. One or two syringes are usually all that's needed to treat a single area, but some dermal filler patients may require 3 or 4.

Do fillers sometimes not work? ›

There are also occasions where patients who get fillers frequently do not respond as well to the same filler since the injected tissues start to develop channels, swelling or firmness. For instance, Radiesse can form tissue tracks after as little as 3 serial treatments.

How much is a syringe of Juvederm? ›

Juvéderm is a dermal filler used for the treatment of facial wrinkles. It contains both water and hyaluronic acid to create a gel-like product that plumps up your skin. The national average cost for each syringe is around $620, according to the American Society for Aesthetic Plastic Surgery.

Can you get 2 syringes of Juvederm at once? ›

It is absolutely possible to do two syringes at the same treatment session.

Is 2 syringes of Juvederm a lot? ›

HOW MANY SYRINGES OF JUVEDERM DO I NEED? Most nasolabial folds will typically require two syringes to fully correct. One syringe of Juvederm is sometimes sufficient for mild nasolabial folds. For lip augmentation, one syringe will sculpt and enhance the lips.

Is 2 syringes of Juvederm too much? ›

One syringe would probably be enough to plump up your lips. If you inject too much, the results will look abnormal. If it's your first time, as well, you'll want to be a little conservative so you can see how it looks.

What is pillow face? ›

“Pillow face” is a direct play on the puffy, unattractive result of using too much facial filler or transferred fat. Another term often used to describe this overfilled look is “chipmunky.”

Is 1cc of Juvederm enough? ›

Answer: Yes, based upon the photos. Ideally would like to look at your entire face and not just lips, as everything has to be in proportion, HOWEVER based upon the photos, yes, 1 ml will get you there.

Is 1 cc a full syringe? ›

The majority of dermal fillers are made from Hyaluronic Acid and contain 1cc per syringe. Keep in mind that this means that there is only 1/5 of a teaspoon of filler in that 1cc syringe! This means that it takes FIVE full syringes to make a up a single teaspoon of filler.

How many syringes do you need for cheek fillers? ›

When doing filler injections for the cheeks, we typically recommend 2-6 syringes. Weight loss and illness can also negatively impact the fat pads in the cheeks, causing patients to need more filler to restore them to a youthful appearance.

How much is 1ml in filler? ›

Most fillers come in a syringe with 1mL of product. That is approximately 1/5th of a teaspoon. A small amount of product can go a long way, but many times optimal results require more than one syringe to obtain.

Is one syringe of Juvederm enough for cheeks? ›

One syringe may be enough for a mild bilateral cheek correction. However, if deep hollows or marked flattening of the cheeks are present, additional syringes may be required. I recommend patients new to JUVÉDERM VOLUMA® XC start with a minimal treatm ent of one syringe.

How much cheek filler is too much? ›

It's common to inject 1-2mls per procedure, in a gradual approach. However, some professionals will inject up to 10ml per procedure. Too much filler or filler injected incorrection can result in people looking strange or misshapen.

What can 1 syringe of filler do? ›

How our faces age: What can one syringe of filler do? - YouTube

Is 1cc of filler enough? ›

One cc of filler is typically sufficient for most clients, however, some will need more. It can be staged weeks or even months apart if cost is an issue.

How many cc are in 1 syringe of filler? ›

Fillers come in an average of 1.0cc aliquots delivered in syringes. Syringes should be used in a single setting to preserve their efficacy and sterility and not saved or "split" between patients.

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.

Is 4 ml of filler a lot? ›

Half a ml gives a very subtle and natural result. One ml will give a noticeable but still natural result. We like to “do natural” and not give someone fake looking lips. If you see some very large pronounced lips around town they have usually had 2-4mls of filler.

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.

What filler is best for jowls? ›

While there are a variety of injectable dermal fillers that can be useful in jawline contouring, one of the most popular and effective choices is Juvéderm® Voluma XC. This hyaluronic acid filler is FDA-approved for adding volume to the face.

Do fillers look better over time? ›

The Results Improve Over Time

Because these injections stimulate your body's production of collagen and elastin, the final results of treatment won't be seen for several weeks. Even as the hyaluronic acid is processed by your body, healthy collagen and elastin grow at a more significant rate.

Can you use Juvederm under eyes? ›

Juvéderm Volbella XC, one of the most widely-used dermal fillers, has recently been approved by the FDA for injection into the under-eye area of the face.

How can you tell if someone has fillers? ›

How to tell if someone has had lip filler injections? - YouTube

What is a pillow face victim? ›

What Is Pillow Face? It's a condition that occurs as a result of a person getting over-injected with dermal fillers in their face. This leads to an overstuffed look, which causes the checks and other areas of the face to puff out.

Is 0.5 ml cheek filler enough? ›

X amount of mls in some individuals may make little to no difference, depending on area, age and desired look. We usually recommend at the very least 1ml each side as the minimum. Dermal filler begins to be broken down by the body a month after treatment.

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