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What Are Dermal Fillers?

By September 29, 2021August 4th, 2022Eyes, Skin

Definition, Benefits, and Side Effects

Dermal fillers help those who want to get rid of their facial wrinkles to restore their face’s volume and fullness.

While aging, our faces start losing their subcutaneous, which separates the facial muscles from the skin surface. When the fat is gone, the muscles work closer to the skin. Besides, the facial skin layer loses its proteins. That is why wrinkles such as crow’s feet wrinkles and smile lines start appearing.

In addition, as we age, the facial skin starts stretching, which increases facial volume loss and fullness.

Many other factors can play a role over time in developing facial wrinkles such as sun exposure, lifestyle, and genetics.

What Are Dermal Fillers?

Dermal fillers are one of the most popular facial aesthetic solutions for facial wrinkles, fine lines, and contours. They are injectable, gel-like substances and minimally invasive treatments for a wrinkle-free face.

According to The American Board of Cosmetic Surgery, more than 1 million people in the United States alone get their faces treated by dermal fillers every year. (1)

Injectable dermal fillers do not replace subcutaneous fat and proteins. However, they can mimic the original structure of the facial skin.

Also, they are different from Botox treatments, which depend on relaxing the facial muscles to decrease the appearance of wrinkles. Dermal fillers add more volume, increase facial fullness, make the skin smoother, and are known for their plumping-up effects.

Types of Dermal Fillers

Dermal fillers have many categories and each one works differently.

Hyaluronic Acid

Our skin naturally produces hyaluronic acid; that is why many cosmetics use it among their ingredients because they help in hydrating and plumping the skin.

Hyaluronic acid dermal filler is a soft, gel-like substance that usually lasts more than other dermal fillers but the effects are not permanent. It usually lasts between 6 and 12 months and it is more expensive than other treatments. (2, 3)

Calcium Hydroxylapatite

Calcium Hydroxylapatite is a mineral-like compound found in our bones. It is a soft, gel-like compound that can be used by vegans since no animal products are used to create it.

The effects of Calcium Hydroxylapatite dermal fillers usually last between 9 to 15 months, which makes it one of the longer-lasting types of dermal fillers. (4, 5, 6)

Collagen Stimulator

Poly-L-Lactic acid dermal filler takes about a day or two to work. It works by stimulating the natural production of collagen in the whole body, especially in the face instead of just staying underneath the facial skin like other dermal fillers.

Poly-L-Lactic acid is biodegradable, yet synthetic. It is the same substance used to speed up healing in dissolvable stitches after surgical procedures. (7, 8)

Polymethyl-Methacrylate (PMMA) Microspheres

PMMA microspheres are small, synthetic balls that can be injected underneath wrinkles and fine lines to restore the structure. It is the perfect solution for deep wrinkles and also for thin lips that need to be filled out.

PMMA microspheres last longer than polylactic acid and hyaluronic acid dermal fillers. Therefore, they require longer and more appointments so that the doctor can fill all the areas slowly using multiple, smaller injections. (9, 10, 11)

Autologous Fat Injections (Facial Fat Grafting)

This dermal filler material is extracted from each person’s body. Autologous fat injections depend on fat deposits from the person’s body such as the fat existing in the abdomen or buttocks.

A liposuction procedure is done to extract the fat that will be injected into another body part that needs more volume. Unlike the other dermal fillers, this one is natural and can last forever since it restores the subcutaneous fat and proteins in the skin. (12, 13, 14, 15)

Where Can Dermal Filler Be Used?

The type of dermal filler is recommended based on the targeted area of your body.

Deep Wrinkles

Almost all dermal fillers can be used to diminish deep wrinkles. However, most plastic surgeons recommended certain types of hyaluronic acids, PMMA, and polylactic acid.

Under-Eye Area

Certain types of hyaluronic acids, autologous fat injections, and polylactic acid can be used around and under the eyes.
Make sure to find the best cosmetic surgeon for this procedure because sometimes, it may not provide the correction you are looking for. Some procedures leave the under-eye area bumpy.

Besides, your doctor may advise you against dermal fillers in this area since the Food and Drug Administration (FDA) has not approved any dermal fillers for use around the eyes.

Nasolabial or Smile Lines

PMMA and nearly all hyaluronic acid types are approved by the FDA to be used for smile lines and folds surrounding the nasal area.

Forehead and Crow’s Feet Wrinkles

Polylactic acid, calcium hydroxylapatite, and PMMA dermal fillers are usually used for forehead and crow’s feet wrinkles. However, most doctors recommend against using injectables in this area because they may lead to serious complications. Besides, they are not approved by the FDA to be used in this area.


Polylactic acid and some types of hyaluronic acid dermal fillers can be used to plump and structure the cheeks.


Most hyaluronic acid dermal fillers are approved by the FDA for use in the lips. Other dermal fillers should not be used to avoid complications.


All dermal fillers can be used to add more volume and contour the chin area but calcium hydroxylapatite and hyaluronic acid are highly recommended.

Chest or Décolletage

Wrinkles on the chest and lower neck areas can be diminished with hyaluronic acid dermal fillers.

Figure 1 – Vectra images of a young, female patient before and after augmentation of a nasal dorsal hump, slight left septal deviation, and
drooping of her nasal tip with 1
cm3 of Restylane L. The patient also had 1 cm3 Restylane Lyft to the chin for chin augmentation.

The Benefits of Dermal Fillers

Dermal fillers have incredible benefits for your appearance in addition to many other aspects.

Immediate and Visible Results

Dermal fillers work immediately once injected in the target area, unlike more invasive procedures. In a matter of days, the filler will settle underneath the skin and add more volume and smooth out the wrinkles and fine lines.

Does Not Require Recovery Time

The recovery time depends on how many injections you get per appointment. The procedure does not take more than 10 to 15 minutes.

It is a non-invasive procedure, which means that it is not surgical. Therefore, no time is needed for recovery. There will be slight swelling, but once the filler settles under the skin, it will disappear.

Minimal Risk

Dermal fillers have some common risks including redness and swelling at injection sites, which disappear completely after a few days.

The major concern though is asymmetry, where a side of the face is different from the other. This risk can be minimized by choosing a skillful and experienced cosmetic surgeon to perform the injections.

Confidence Boost

After dermal fillers, your appearance will be improved significantly. Your skin will be smoother, face contours will be sharper, and definitely, your confidence will be higher. Most people who get filler say that they have younger-looking skin with fewer wrinkles, and a better bone appearance.

Therefore, if your aging signs are becoming more visible, dermal fillers may be the solution for you.

Figure 2 – A 58-year-old woman (a) before treatment; (b)
immediately after the injection of seven syringes of 2.5 mL fat
(patient shown with make-up). Injected sites: malar area, temples,
forehead, perioral area, nasolabial folds and chin.

The Side Effects of Dermal Fillers

All the common side effects of dermal fillers are minimal and manageable (16). The most common side effects reported include:

  • Redness.
  • Swelling at the injection site.
  • Bruising.
  • Itching.
  • Mild pain after treatment.

On the other hand, some people may experience rare side effects, especially with some types of hyaluronic acids and autologous fat injections including:

  • Filler migration, which refers to the existence of the filler material in a different area of the face other than the injection site.
  • Visible clumping caused by the filler material.
  • Mild to severe headaches.
  • Vision problems including blurred vision and even blindness in severe cases.
  • Allergic reaction.
  • Infections.
  • Skin discoloration.

How to Minimize the Risks of Dermal Fillers?

Certain steps can help to decrease the risk of dermal fillers’ side effects. (17)

  • Find a licensed, trusted healthcare provider who is highly recommended for dermal fillers.
  • Never purchase dermal filler materials online or try to inject them yourself.
  • Follow your doctor’s instructions typically before and after getting a dermal filler treatment.
  • You should avoid drinking alcohol the day before getting the treatment and 2 days after.
  • Ask your doctor about all the questions you have.
  • Silicone injections, butt fillers, and fillers for spaces are not approved by the FDA and are not safe to use for the face.
  • Use aloe vera or arnica gel if there is swelling and try to avoid excessive touching of the injection site to avoid introducing bacteria and subsequent infections.
  • Call your doctor immediately if the side effects are severe or last longer than expected.

FAQ About Dermal Fillers

  1. Who Should Avoid Dermal Fillers?

Pregnant and breastfeeding women should avoid dermal fillers since there is no research showing that they are safe for them. Also, if you are getting a teeth cleaning or any other dental treatment, you should avoid getting the filler around your dental appointment since they require a lot of pressure and stretching on the face, which may lead to misplacing the filler.
During the consultation, ask your doctor about when it is safe to get a dental procedure again.

  1. How Do I Know the Best Dermal Filler for Me?

Each case is unique and the good doctor is the one who develops the best treatment plan for each case and knows how to achieve the best and most natural results.

To achieve a natural look, you may need more than one type of filler. Each category has many different brands of fillers and the experienced doctor knows how to choose the right brands for each case.

For example, Restylane is one of the most popular hyaluronic acid dermal fillers and it has fine different lines. Each line has a purpose and concentration of the active ingredient. Restylane Lyft is one of Restylane lines that has larger particle sizes and can rebuild cheekbones while Restylane Silk is highly recommended for diminishing fine lines and wrinkles and plumping lips.

In Conclusion, choose a good doctor who knows the best way to get your face younger again.

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Dr Khaled Mahmoud

A medical researcher with more than 5 years of professional academic and medical writing experience. My main goal is to provide readers with evidence-based, data-driven, detail-oriented content to help them make the best choices.