What is the Safest Dermal Filler?

As early as the turn of the 20th century, paraffin was used to provide volume to the face. To summarize the medical history, it was not a good idea to put wax in the face. In the 1940s and 50s silicone oil was used to augment the breasts. There were a lot of medical problems due to migration of silicone oil and laws were enacted that limited the practice. Yet silicone oil is still injected into the face and body today. In some cases, industrial silicone oil is injected by lay practitioners in non-medical settings in the United States and abroad.

In Southern California, I have seen a number of patients who were treated with silicone oil in Mexico or South America. Here in the United States, treatment with industrial grade silicone oil in the transgender community is known as “pumping.” The practice was recently in the news having caused the death of a 23-year old transgender male.

Medical grade silicone is available and is FDA approved for use in complex retinal detachment. A small number of physicians have elected to take this product and use it “off-label.” In small volumes, it is unlikely to be life threatening.

However, the material is unpredictable and impossible to remove. The scar tissue it stimulates tends to hang in the face while the surrounding untreated tissue sags around it creating bizarre and unfixable changes in the appearance. Enough said.

The safe dermal filler should be a filler called Hyaluronic Acid, also known as HA, is produced by imitating substances that are present in the body naturally to complement or replace collagen and hyaluronic, which are essential components of the skin structure that the body loses as we age.
Filler should be a medical instrument approved by the Food and Drug Administration from the United States or FDA as a highly safe natural extract and it is essential to provide doctors with specialized expertise. Know the correct injection techniques and accurately analyze the dosage and injection location and must be injected in a standard medical facility. Allowed because if injected with unwanted veins or other areas, it can be fatal.

In the hands of a board certified experienced dermatologist or plastic surgeon, fillers are an essential tool in rejuvination, and are, overall, a very safe treatment.  Temporary fillers have less risks than permanent fillers, and certain areas of the face are more risky to inject with fillers (such as in between the eyebrows).  The most important thing is to know what you're being injected with and who is injecting you. 

In terms of legal, FDA approved cosmetic dermal fillers, anything that's temporary is going to be safer than a permanent filler. Temporary fillers have temporary side effects. Naturally, permanent fillers can have permanent side effects.

In terms of the duration of the effects of temporary and semi-permanent fillers, this is a guideline:


collagen based fillers such as evolence - up to 1 year

hyaluronic acid fillers such as juvederm, restylane, perlane, juvederm ultraplus - up to 18 months

other fillers such as radiesse, sculptra - up to 2 years


The hyaluronic acid fillers (e.g. juvederm, restylane, perlane) are even safer because lumps and bumps can be smoothed out and the filler can be dissolved by injecting an enzyme to break it down.

I do not use permanent fillers such as aquamid and artecoll and definitely not silicone because permanent fillers can cause permanent problems.