Question 1

What are dermal fillers?

Accepted Answer

Dermal fillers (aka soft tissue fillers) are more than mere wrinkle fillers: they can plump lips, smooth creases and folds, and fill in the under-eye hollows known as tear troughs.

Fillers can also add volume to cheeks and temples, reduce the appearance of pitted acne scars, sculpt the jawline, and add projection to a weak chin. Some people even choose to get a nonsurgical nose job using injectable fillers.

For patients who are seeing the early stages of age-related volume loss, a "liquid facelift" that combines injectable fillers with a neuromodulator like Botox can restore a more youthful appearance, possibly delaying the need for more invasive plastic surgery procedures like facial fat transfer.

That said, dermal fillers will not provide the same level of facial rejuvenation as a cosmetic surgery like a facelift. Results are far more subtle and temporary.

Hyaluronic acid is the most popular FDA-approved facial filler ingredient because it's so easy to dissolve in the event of a complication or change of heart. Fillers can also be made of calcium hydroxylapatite (Radiesse), poly-L-lactic acid (Sculptra), or nonabsorbable polymethyl methacrylate microspheres (PMMA or Bellafill).

Related: A Plastic Surgeon Answers Your Top 5 Questions About Dermal Fillers

Question 2

What are the pros and cons of dermal fillers?

Accepted Answer

Pros

This injectable cosmetic procedure is quick, relatively painless, and safe when it’s performed by an experienced, licensed healthcare provider.
Hyaluronic acid fillers are nearly identical to the chemical that's naturally produced in our bodies. They're metabolized (broken down) over time and come with little risk of an allergic reaction. They can also be easily reversed with hyaluronidase, an enzyme that breaks down HA, if you don’t like your results.
Results are immediate.
The procedure usually involves no downtime, aside from some bruising and swelling.
All injectable fillers have been shown to stimulate collagen production (with products like Sculptra and Radiesse generating more than HAs).
RealSelf members give dermal fillers a type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el Worth It Rating, with many saying that they look more rested from under-eye fillers, finally got the lips they want, or like their new facial contour.

Cons

Results from dermal filler procedures are temporary. You’ll need touch-ups to maintain them over time, which can get expensive.
Filler injections can pose serious risks in unskilled hands.
They also come with potential side effects (outlined below). Some side effects, like migration and nodules, can last as long as your filler does without medical treatment, which is why so many providers recommend hyaluronic acid-based fillers that can be dissolved with hyaluronidase.
Bruising is common when injecting fillers in the face, and can last up to three weeks. Here's how to handle injectable bruises.
Results can be too subtle or overly dramatic, so be sure to clearly explain to your provider your aesthetic concerns and desired result (using photos), to help them deliver the kind of enhancement you're looking for.

Related: Nasolabial Fold Filler Is a Popular Ask. So Why Are Doctors So Reluctant to Inject?

Question 3

How much do dermal fillers cost?

Accepted Answer

The price you pay will depend on the type of filler and how many injections (expensed either by syringe or vial) you get, the experience level of your doctor, their practice location, and several other factors.

You can finance your treatment with CareCredit.

Learn more about the cost of dermal fillers

Question 4

Dermal fillers before and after pictures

Accepted Answer

The dermal filler photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 5

Hyaluronic acid-based fillers

Accepted Answer

Hyaluronic acid is the most popular filler ingredient, so you have lots of choices.

Juvéderm filler formulations each have a different viscosity and level of “liftability,” for different areas of the face.

Juvéderm XC smooths smile lines around your nose and mouth (nasolabial folds, smile lines, and marionette lines), lasting up to a year, according to the company.
Juvéderm Ultra XC plumps lips for about a year.
Juvéderm Volbella XC adds subtle volume to lips and smooths vertical lip lines for up to a year. It can also be used to fill under-eye hollows.
Juvéderm Voluma XC contours the cheeks and augments the chin for up to two years.
Juvéderm Vollure XC softens nasolabial folds and lasts up to 18 months.
Juvéderm Volux is FDA approved HA filler for improving lost definition for up to a year.

Restylane also offers a range of HA fillers that target specific areas.

Restylane Silk volumizes lips and smooths fine lines around the mouth and lasts up to one year.
Restylane Refyne softens nasolabial folds and marionette lines and can last up to a year.
Restylane Defyne fills deep wrinkles and folds, and enhances the chin, lasting up to a year.
Restylane Lyft, formerly called Perlane, is used for cheeks and hands. Off-label, it can be used for a nonsurgical nose job. Results can last at least 10–18 months.
Restylane Kysse adds volume to the lips and smooths lip lines for up to one year.
Restylane Contour, which is more robust than Lyft, corrects midface contour deficiencies, restoring cheek volume and shapeliness.
Restylane Eyelight is FDA approved to treat the dark circles and hollows in the under-eye area, with reportedly less swelling than other formulas. Results last up to 18 months.

The RHA Collection (called Teosyal in Europe) is a relatively new line of hyaluronic acid fillers, designed to more closely mimic natural hyaluronic acid than traditional fillers and provide an exceptionally natural appearance.

RHA fillers can last 15 months or more.

RHA 2 is FDA approved for correcting the appearance of moderate folds. It’s also a good choice for lip augmentation and lip lines.
RHA 3 is a firmer formula, for treating moderate to severe facial folds like the nasolabial folds (smile lines).
RHA 4, the firmest type, is injected into the deep dermis, to address deep wrinkles and severe folds, including marionette lines. It can also build the chin and jawline.
Redensity, the newest RHA filler to earn FDA approval, is indicated for fine lip lines (aka smoker’s lines or barcode lines) and proven to last 52 weeks.

Belotero (or Belotero Balance) is a thinner hyaluronic acid–based filler commonly used for delicate areas, like under the eyes.

It can also fill in fine lines throughout the face and neck, including lip lines, cheek lines, and horizontal neck lines. Results last for about six months.

Question 6

Other types of fillers

Accepted Answer

Bellafill

This bovine (cow-derived) collagen and PMMAmicrosphere combination smooths lines and fills acne scars.
Bellafill lasts for about five years, and it cannot be dissolved early. In fact, the FDA considers PMMA to be a permanent filler material.
It’s not recommended for lips or tear troughs.
Bellafill can cause allergic reactions in some patients. Skin testing is required prior to injection treatments in order to predict any possible adverse events.

Radiesse

Made of calcium-based microspheres, Radiesse works well on facial wrinkles, along bony prominences, and in the backs of hands.
It also stimulates natural collagen and elastin production and lasts about a year.
This formula has the highest “liftability” of all the fillers, so it’s frequently used to augment cheekbones and jawlines.

Sculptra Aesthetic

Made of poly-L-lactic acid, this collagen-stimulating injectable gradually addresses facial volume loss that’s been caused by weight loss or aging.
It’s not recommended for use in the lips or under eyes.
Sculptra can last two to three years.
Some providers offer a Sculptra Butt Lift, a nonsurgical option for butt augmentation. This is an off-label use, and it can be very expensive due to the volume of filler required.

Facial Fat Transfer

Also called fat grafting, fat injections, or lipofilling, this is actually a surgical procedure that uses fat from your hips, thighs, or stomach to add volume to cheeks and lips or to fill in nasolabial folds or under-eye tear troughs.
It’s even recommended for use on pitted facial scars.
The two-step procedure—liposuction plus fat grafting—takes at least two hours, and the downtime is a week to 10 days.
Unlike other fillers, which are routinely injected by not only doctors but also nurses and physician associates (PAs), fat injections are typically performed in dermatology and plastic surgery practices by a board-certified physician.

Related: 10 Celebrities Who've Opened Up About Getting Fillers

Question 7

What should you expect during a dermal filler treatment?

Accepted Answer

First, you and your injector will discuss your desired result and the best type of filler to create it, as well as potential risks.

This is a great time to ask how much filler you'll need and get a personalized cost estimate, to avoid sticker shock when you go pay your bill.

Once you’ve worked out these details, here's what you can expect:

Your injector will clean the treatment area and apply a topical anesthetic, if needed (though most fillers contain lidocaine).
Then they'll slowly inject the filler with a needle or blunt-tipped cannula, gently massaging the area with their fingers to distribute it before continuing with more injections, for even distribution.
If it's your first time getting filler (particularly lip or cheek filler), your injector may be conservative about how much filler to use and suggest that you return once the swelling has gone down, to assess your result and see if you want more volume. If you're getting Sculptra, you can expect to need a series of multiple treatments over a few months, as new collagen develops.
While each individual injection takes only a few moments, the entire cosmetic procedure can take an hour or more if your provider is treating multiple areas.
You’ll see more volume or smoother skin immediately.
When they're done, they may give you a small, light ice pack to hold against your skin to alleviate discomfort, tenderness, or immediate swelling or bruising. Just don't apply too much pressure.
With Sculptra, your injector will instruct you to massage treatment areas according to the rule of fives—fives times a day, for five minutes at a time, for five days—to help distribute the product and prevent nodule formation.

RealSelf Tip: Laws that govern who can perform dermal filler injections vary from state to state in the U.S. While some require a doctor to administer the injections, other states allow other medical professionals (nurses and PAs) to work under a doctor’s supervision. Look for a provider with proven experience who meets the medical requirements for your location.

Related: 9 Ways to Get Over Your Fear of Needles

Question 8

How much downtime will you need?

Accepted Answer

You won't need any actual recovery time. That said, it's very common to have bruising and swelling at the injection site, so you may want to take some social downtime. It can take a few days to a few weeks for these side effects to resolve.

Bruises can usually be hidden with makeup, but it's still not recommended to get fillers too close to a big event.

Avoid sun, heat, workouts, and alcohol for at least 24 hours after treatment, to avoid making the swelling worse. Some doctors on RealSelf also recommend arnica gel or cream, to reduce pain and swelling.

Question 9

How long do dermal fillers last?

Accepted Answer

Fillers can last anywhere from six months to several years, depending on which one you get, how much your doctor uses, and how quickly your body metabolizes it. Some HA fillers can last up to 18 months, while Bellafill typically lasts for five years (and possibly longer).

“If you have a fast metabolism, you may notice that the filler goes away sooner,” says Beverly Hills, California, plastic surgeon Dr. Nima Shemirani in his medical review forJuvéderm. “On the bright side, after two to three rounds of injections, you will notice it will last longer and longer.”

Filler longevity is proving to be more complex than originally thought, however. In recent years, imaging studies have revealed that HA fillers can last much longer than advertised, with gels being visible on MRI and ultrasound up to a decade or more after being placed. Certain parts of the face, like the under eyes, seem to retain old filler longer than others.

Related: Why Your Lip Filler May Not Last as Long as You Expected

Question 10

What are the long-term effects of dermal fillers?

Accepted Answer

Facial fillers that are properly injected don’t permanently alter the face or carry lasting consequences. However, when fillers are overdone—generally in a misguided attempt to “lift” a face—they can cause a host of problems.

While long-term effects of dermal fillers are rare, excessive HA fillers can distort the face, giving a cartoonish or alien appearance. They can attract and bind a lot of water, making the face look swollen, doughy, and otherwise unnatural.

Globs of cheek filler or lip filler can upset muscle mechanics, changing the shape of the eyes (especially when smiling), making the mouth move in an odd fashion, and even interfering with clear speech. Too much filler around the eyes can block lymphatic channels, causing persistent puffiness and bags.

Related: Do Fillers “Ruin” Your Face? Doctors Explain.

To avoid the issues associated with overfilling, choose an injector who takes a conservative approach and does not subscribe to the notion that fillers need to be topped off according to some prescribed schedule, as unnecessary touch-ups are a leading cause of pillow face.

Again, HA fillers have been shown to last longer than manufacturers claim—and you want to avoid layering new filler over old, time and again.

Question 11

What are the risks and side effects of dermal fillers?

Accepted Answer

Dermal filler treatments are considered safe when performed by an experienced injector, but they all come with risks and side effects.

The most common side effects of fillers include redness at the injection site, bruising, asymmetry, lumps and bumps. Avoid aspirin, some supplements (high-dose vitamin E, ginkgo biloba, and garlic) or other blood-thinning medications for a week or two prior to your appointment, to minimize bruising.
Hyaluronic acid fillers are known to migrate, or move from their intended location. Longer-lasting fillers and large-bolus injections are most prone to migration. Dermal fillers should be injected slowly, at the correct depth, and in small droplets (not large boluses) to ensure they stay put over time.
Allergic reactions (especially with fillers derived from bovine collagen), delayed inflammatory reactions (occurring months to years post-injection), and granulomas (hard lumps under the skin) are possible side effects of fillers, too.
Unintentionally injecting filler into a blood vessel, technically called vascular occlusion, can lead to serious complications, including tissue death, blindness, and stroke, if the filler isn't quickly dissolved. If considering getting hyaluronic acid fillers, find an experienced injector who knows facial anatomy (like a board-certified dermatologist or facial plastic surgeon) and stocks a sufficient supply of hyaluronidase for emergencies.
Do not get fillers if you have any infection on the face or close to the injection site—it can spread or cause complications.
Some providers offer permanent fillers via silicone injections, using a microdroplet technique to layer tiny drops of silicone oil. Learn why silicone injections are so risky.
Perception drift—unwittingly drifting farther and farther from your normal baseline with each injection—is a psychological risk of facial filler, which can lead to an overfilled, unnatural appearance over time.

Related: Filler Gone Wrong: The Most Common Filler Mistakes Doctors See—and How to Avoid Them

Question 12

Are dermal fillers better than Botox?

Accepted Answer

A lot of people think injectable botulinum toxins like Botox and Dysport are fillers, but while both are cosmetic injections, they work in an entirely different way: while fillers add volume, neurotoxins like Botox relax muscles to smooth lines, wrinkles, and creases (and prevent more from forming).

Botox is FDA-approved to treat crow’s feet, frown lines, and forehead lines, and can be paired with fillers during the same appointment for optimal facial rejuvenation results. During your consult, discuss your aesthetic goals with your provider to see which treatment is a better option.

RealSelf Tip: A growing number of providers are microdosing patients with Botox and fillers by microneedling them into the superficial layers of skin via treatments like Aquagold. Learn the benefits of this treatment technique.

Related: Can Botox Lip Flips Be a Better Option Than Filler?

Question 13

DERMAL FILLERS

Nima Shemirani, MD

Jolene Edgar

ALASTIN Inhance
Post-Injection Serum

Ice Pack
with Strap

Skinceuticals Hyaluronic Acid
Intensifier Multi-Glycan

Nima Shemirani, MD

Jolene Edgar

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	Juvéderm nonsurgical	Restylane nonsurgical	RHA Collection Fillers nonsurgical	Belotero nonsurgical
Worth It Rating	92%	86%	87%	67%
Average Cost	$950	$1168	$920	$879
Downtime	No downtime	No downtime	No downtime	No downtime
Anesthesia	Topical anesthesia	Topical anesthesia	Topical numbing cream	No anesthesia

	Bellafill nonsurgical	Radiesse nonsurgical	Sculptra nonsurgical	Facial Fat Transfer surgical
Worth It Rating	50%	64%	83%	90%
Average Cost	$3235	$1371	$1744	$7413
Downtime	No downtime	Minimal downtime	Minimal downtime	1 week of downtime
Anesthesia	No anesthesia	Topical anesthesia	Topical anesthesia	Local anesthesia

Nima Shemirani, MD

Jolene Edgar

Nima Shemirani, MD

Jolene Edgar

DERMAL FILLERS REVIEWS

Natural Results, Precision & Safety

Great Forehead Filler

PDGF Undereye Filler

DERMAL FILLERS QUESTIONS

In my 50's and ready to address under eye concerns - what procedure would be the most beneficial? (Photos)

27 year old male with skin folds around mouth and mid cheek area - Surgery or filler?

Should I get a second opinion before filler? Linear Scleroderma (En Coup De Sabre) Concerns (Photos)

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