Dermal Fillers

What is a dermal filler?

Dermal filler is a biological gel, which is injected under the skin to fill the deficit of tissue volume.Modern fillers are completely biodegradable (it means that they dissolve in tissues in a natural way). They contain biological polymers, which do not cause any allergic or immunological reactions. The tissues take biogels as a natural component of the body and do not reject them.

  1. In 72% of cases, dermal fillers are used when signs of skin aging appear, such as wrinkles, sagging skin, etc.
  2. In 20% of cases, fillers are used to correct the shape of the face, e.g. correcting the shape of the nose, changing the shape of the cheekbones, etc.
  3. In 8% of cases, the gel is administered to correct cosmetic defects, such as scars.

Particular attention should be given to the lip correction treatment with the help of dermal fillers. According to the official data of the American Society for Aesthetic Plastic Surgery (ASAPS), the popularity of this procedure has grown by about 300% over the past 15 years.

Women use dermal fillers actively to enhance the lips volume and achieve the desired shape. The development of this area of aesthetic cosmetology was possible due to the creation of hyaluronic acid fillers of various density.

Dermal fillers help correct the imbalance of the proportions between the lower and upper lips and improve their volume with natural fading.

The history of dermal fillers

The modern history of dermal fillers began in 1981. The FDA first approved dermal filler for aesthetic medicine under the trade name “Zyderm”. It was a drug based on collagen of animal origin.Scientists realized that this protein can be used to increase the volume of soft tissues for the signs of aging and cosmetic defects.

The FDA created a precedent in the field of aesthetic medicine, so many pharmaceutical companies began exploring the possibilities of human fat, collagen, and alloplastic materials. Each company wanted to create their product with unique properties.

Despite various developments, purified collagen of animal origin remained the only effective filler. It had many advantages over other drugs, yet it was not perfect.

The question of this substance tolerability remained open, though. Often, people manifested allergic reactions to the animal origin components. Thoroughly purified forms of collagen were only available at a very high price.

In the early 2000s, a revolution occurred on the market. The FDA has approved a completely new hyaluronic acid dermal filler. It was a product made by Medicis Pharmaceutical Corporation, registered under the trade name Restylane.

The FDA experts have confirmed that hyaluronic acid fillers show better performance, compared to collagen. Thus, they:

  • have a more stable and sustainable action
  • are less likely to cause allergic reactions
  • do not require prior testing before the introduction
  • are more flexible and easy to use.

Since 2003, the aesthetic medicine industry has been actively adopting hyaluronic acid. Over the past 15 years, many HA fillers of different density have appeared on the market. Patients note a good tolerability of these gels and a lasting effect. Doctors and aesthetic practitioners say that hyaluronic acid is very pleasant to work with, since the final result is always predictable.

Thanks to the innovative developments over the last 5-7 years, new generation products have appeared on the market. They stimulate the biological response to the injected filler. Doctors can activate the internal capabilities of the body to thicken the skin and restore regeneration processes. This made the fillers act longer and perform much more functions.

Dermal Fillers Effect

  1. Smoothing wrinkles on the face, neck, décolleté
  2. Elimination of nasolabial folds
  3. Tightening the skin under the eyes, on the chin, in the corners of the mouth
  4. Face contour correction, incl. correction of the shape of the cheekbones, cheeks, chin
  5. Facial asymmetry correction
  6. Correction of the shape of the nose without surgery
  7. Skin recovery after acne treatment, i.e. scar correction
  8. Lip shape and volume correction

These are just the basic features of modern dermal fillers. With proper use of fillers, you can drastically change a person's face and make it visually younger. To do this, use gels of different densities with different fillers, depending on the purpose of the treatment and the injection area.

How long does the effect last?

Dermal fillers contain different active ingredients. Each component has individual pharmacological properties. They determine not only the result of the procedure, but also the duration of the effect.The first dermal fillers worked no more than 3 months. The effect passed very quickly, because the fillers had a low density and were disintegrating quickly.With the advent of hyaluronic acid, dermal fillers began to work longer: 8-12 months. The effect duration depends on the density of the gel and the injection area.

  1. When the product is injected in an area with increased mobility (forehead, lips), the effect lasts about 8-10 months.
  2. When the product is introduced in an area with low mobility, the effect lasts 10 to 16 months.

Why does it happen like that?

Once the gel gets under the skin, the molecules of hyaluronic acid combine into a single chain. They create a dense substance, which fills the bumps or creates the “lifting” effect.This dense substance breaks down in a natural way and the gel dissolves completely under the skin. Yet this process is rather a slow one.The aggressive influence over the gel provokes the destruction of the HA chains. The substance loses its density fast, and the effect lasts less.

For example:

  • hot or cold food accelerates the destruction of the gel in the lips
  • excessive activity of the facial muscles accelerates the destruction of the HA chains in the forehead
  • facial massage reduces the density of the gel in the cheek area

Therefore, the duration of the dermal filler results depends not only on the quality of the gel or its composition. It largely depends on the conditions that the person creates.

For a long time, it was believed that the HA provides a relatively short-lasting results. But thanks to innovative developments, more lasting results were achieved.

PLLA and PMMA fillers are specially developed in laboratories as an alternative to hyaluronic acid. Their results last for up to 24 months.

Which kinds of dermal fillers are out there?

The correct classification of fillers begins with their division into:

  • biodegradable
  • permanent

We already know about the first group - these are fillers, which eventually dissolve under the skin.

The second group is fillers that do not dissolve under the skin. Fortunately, the era of such fillers is long gone. They are practically not used in aesthetic medicine (only for medical reasons).

Biodegradable fillers can be categorized by their composition. Each filler has its pros and cons, and we advise you to keep reading, if you want to know what these are.

Collagen dermal fillers

The active ingredient is a protein, made of the connective tissue of cattle (most often, xenogenic bovine collagen). Human connective tissue cells are used less commonly.These fillers are used to correct wrinkles, change the contour of the face, and correct post-acne defects.The most famous collagen fillers are: Zyplast and Zyderm. They have been used for over 30 years. These are the most well-studied biological fillers, which are used in aesthetic medicine.


  • instant effect
  • no rehabilitation period


  • the effect lasts 3-6 months
  • intolerance to animal ingredients is possible

HA Dermal Fillers

The active substance is hyaluronic acid of non-animal origin. This substance is tolerated very well. It can be used in all areas of the face and for any purpose.It is an absolutely natural ingredient, which is used for:

  • wrinkle filling
  • adding volume and correcting contours
  • skin tightening
  • post-acne treatment
  • correction of the facial proportions

Fillers with hyaluronic acid are rather inexpensive, and you can buy them all over the world.

The most popular brands Juvederm and Restylane offer a wide range of fillers with different properties.


  • injection results are visible in 15 minutes after injection
  • maximum safety and lack of allergic reactions
  • 100% solubility in tissues
  • effect lasts up to 18 months.


  • the ultimate result is visible in a week after the treatment
  • with improper filler administration, side effects are possible, such as gel buildup in one place, uneven filler distribution, bruises, edema.

CaHA dermal fillers

Calcium hydroxylapatite is a mineral substance, the main inorganic component of bone tissue. It is synthesized in laboratories in the form of micronized powder, and the gel is made using a solvent before the procedure.This type of filler is used for volumetric contouring of the forehead, nose, and cheeks. This is the heaviest and rather dense gel, as it contains plenty mineral components.Recently, cosmetologists are actively using these dermal fillers to rejuvenate the outside of the palm.

You can find CaHA dermal fillers under the trade name Radiesse.


  • are biocompatible with the human body
  • results last 12 to 18 months
  • provide a pronounced volume in the injection area


  • nodules can form when injected, and gel can accumulate into lumps
  • not suitable for sensitive areas due to high density

PPLA dermal fillers

The active component of the filler is Poly-L-lactic acid. It is a polymer synthesized in laboratories, which has a 100% biodegradable substance. Technically, it is one of the most powerful collagen stimulants.Poly-L-lactic acid has no therapeutic activity. It only causes the body to produce collagen in large quantities in order to correct the aesthetic defect on the skin.

  • This type of dermal fillers is used to:
  • treat scars after the acne treatment,
  • correct scars and defects on the skin,
  • repair deep wrinkles

Beauticians prefer to use Poly-L-lactic acid filler under the trade name Sculptra. It has been approved by the FDA, has a good reputation and an optimal price.


  • effect lasts up to 24 months
  • the drug is completely excreted several months after the injection
  • no allergic reactions in the patient


  • The effect occurs with a delay: 2-4 weeks
  • It is difficult to determine the final result, which sometimes requires additional correction
  • there is a chance of developing granulomas with improper administration of the drug

PMMA dermal fillers

The active substance is Polymethylmethacrylate - a synthetic component containing collagen of animal origin.This type of filler has been used for the last 10 years of the twentieth century. Its peculiarity is that the solution is suspended in a gel-like solution right before the injection treatment. When the gel is introduced under the skin, it takes the form of a tiny ball, which fills all the irregularities of the skin from the inside.

These balls are so tiny that they are not visible from the side (with the right introduction) and are not even felt when you touch the skin.

They focus only in the injection zone. In fact, it’s like hundreds of small air mattresses around skin cells, which prevent it from sagging and aging.

PMMA dermal fillers are used to correct deep wrinkles and nazolabial folds. One of the most popular drugs that has been approved by the FDA is Bellafill.


  • the gel stays under the skin indefinitely and can last for several years
  • it helps smooth out the deepest and most numerous wrinkles


  • to get the effect, you need several sessions
  • effect is visible after about 2-3 months
  • there is a risk of an allergic reaction to the animal collagen
  • if the gel is used improperly, it may be visible under the skin

Autologous fat injections

Own fat cells from other areas are introduced into the facial tissue, such as the abdomen, buttocks, and thighs. They are pre-filtered, washed, processed in a centrifuge. Purified fat cells are perfect for the facial area. They have an average density and maintain their effect for a long time.Such fillers can be used to increase the volume of the cheeks, cheekbones, and temporal region.Advantages:

  • the most natural filler, which does not cause adverse reactions
  • the treatment can be done an unlimited number of times
  • the effect lasts 1 to 10 years


  • it is impossible to predict how long the effect lasts. It is different even in one and the same person.
  • it is not suitable for spot wrinkle correction or contouring
  • the injections require a highly skilled specialist and should only be performed by an experienced cosmetic surgeon

If you’re not sure which to choose, dermal fillers or fat transfer, give preference to dermal fillers. The effect lasts less, yet they can be used locally to correct small imperfections. And the treatment itself is much simpler, safer and less discomforting.

Fat transfer is only suitable in the most severe cases, where dermal fillers effects are insufficient.

Still, it is impossible to say which drug is best for you. Your dermatologist/aesthetic practitioner is the one to determine this.

It happens so that the beautician chooses a perfect dermal filler for your skin type. During the procedure, though, unexpected reactions manifest. Or your skin requires a deeper impact with other products.

Therefore, we recommend that you discuss all existing dermal fillers with your doctor. Thus, you will understand better, which of them is best for your purposes.

Dermal fillers safety

All modern dermal fillers are FDA approved and have a high degree of pharmacological safety. Despite this, you must understand that an unpredictable reaction is still possible.Your dermatologist/aesthetic practitioner should inform you about all the risks before he begins the treatment. Please note that each filler has a different safety degree.

It is believed that hyaluronic acid fillers are the safest. They really are. They have less potential for side effects.

Collagen dermal fillers can cause an allergic reaction. Therefore, dermatologists make a fast test in the forearm area before the treatment session. If a reaction manifests in 15 minutes, another filler should be chosen.

If the test shows that you don’t have any allergic reaction to this filler, the treatment with this collagen dermal filler is absolutely safe.

It all depends on the qualifications of your doctor. Ask him if he has already worked with your filler, how many sessions he did, and what are the side effects.

If you need a collagen injection, look for the appropriate specialist. If your cosmetologist works with HA, and uses collagen rarely, it means that he doesn’t have a sufficient experience in this area. And low experience usually affects the result in a negative way.

On forums, we often see questions from users: “Are dermal fillers safe?” or “are HA injections safe?”. These questions should be asked to a qualified dermatologist. He is the only one, who can tell how safe this or that drug is namely for you.

Our experience suggests that every FDA-approved dermal filler is highly safe. It is very important to choose the right doctor and buy the original drug.

When using original dermal fillers, severe complications are almost impossible. The most dangerous mistakes made by your doctor are those, which can lead to:

  • bruising, edema, hematoma
  • asymmetry of facial contours
  • skin infection
  • wounds and subsequent scarring on the skin
  • impaired blood flow in the injection area

These risks do not depend on any specific dermal filler. They are conditioned by the fact that the skin of the face has very sensitive tissues, many vessels and nerve endings. If the injection is unsuccessful, important areas may be affected. And this will cause the above side effects.

Dermal fillers or Botox: what are the main differences?

Dermal fillers are often confused with Botox injections. Both procedures are used for facial rejuvenation, yet the aesthetic effect differs.Botulinum toxin is a natural protein, used to eliminate deep facial wrinkles. This substance relaxes the facial muscles, involved in facial expressions. The active movement of these muscles leads to the appearance of wrinkles, mainly in the forehead area.In the area of botulinum toxin injection, the facial muscles lose mobility. This allows reducing the formation of new facial wrinkles and smooth out the skin adjacent to the injection area.

Dermal fillers have a different mechanism of action. They fill the missing amount of tissue with the biological gel. It gets fixed in the tissues of the dermis and fills in all the irregularities.

As a rule, the gel contains beneficial substances: hyaluronic acid or collagen. These substances eliminate dry skin, improve tissue regeneration and increase its elasticity. Botulinum toxin does not possess such properties.

Dermal fillers do not block the nerve impulses in the facial muscles and do not interfere with their motor activity. Therefore, after the gel injection, the correction area retains its natural appearance and mobility.

If you have injected botulinum toxin in the forehead, it will be noticeable. Even with strong eyebrow raising, the forehead area remains completely immobile. This creates a small aesthetic inconvenience.

Botulinum toxin is mainly used to eliminate deep wrinkles in the following areas:

  • forehead (vertical and horizontal wrinkles)
  • between the eyebrows
  • corners of the eyes ("crow's feet")

Dermal filler injections are made in any area of the face. Each filler has a different density, which allows controlling the final result. With deep facial wrinkles, a dense gel is used, which does not break down with a high activity of the facial muscles. For fine wrinkles around the eyes, the corners of the mouth and nasolabial fold, you can use a less dense gel.

This is where dermal fillers surpass botulinum toxin. They are more flexible to use and provide a natural effect.

In addition, dermal fillers maintain their effect for 8–16 months. The action of botulinum toxin rarely persists for more than 6 months.

Which filler to choose

You can choose a suitable dermal filler only after consulting a specialist. Your doctor will have a visual inspection, ask several professional questions, understand your goals and objectives. After he understands your problem and desired results, he will offer you the most suitable product.A certain set of fillers is used for each area of the face:

  1. Dermal fillers for smoothing the under-eye area: Juvederm, Restylane, fat Injections;
  2. Dermal fillers for lifting and enhancing cheeks: Resultant lyft, Voluma;
  3. Dermal fillers for smoothing out the marionette lines: Belotero, Juvederm, Restylane Refyne \ Defyne;
  4. Dermal fillers for lip augmentation: Juvederm Ultra, Volbella, Fat injection;
  5. Dermal fillers for softening the nasolabial folds: Juvederm, Belotero, Restylane, Radiesse, Sculptra;
  6. Dermal fillers for smoothing out the vertical lip lines: Volbella, Belotero, Restylane Silk;
  7. Dermal fillers for chin wrinkles: Belotero, Radiesse, Juvederm, Restylane;
  8. Dermal fillers for filling the acne scars: Bellafill, Juvederm, Radiesse;
  9. Dermal fillers for hands rejuvenation: Radiesse, fat injections.

The cost of dermal fillers is different. Therefore, we offer several products for each zone.

Check with your doctor about which filler is best for you and choose the cheapest and most effective dermal filler.

You have to understand that the more technologies are used to create active components, the greater is the cost of dermal fillers. Therefore, many doctors recommend using hyaluronic acid products. They are inexpensive and quite effective.

Micronized fillers with complex chemical compositions will always be more expensive than the hyaluronic acid fillers.

When injecting dermal fillers, you should have a clear goal. Do not expect to get a “magic” effect. After the treatment, you should not forget about regular skin care.

Each dermal filler has its own duration. The effect gradually passes. If you do nothing to maintain the condition of your skin, the duration of the fillers action will be rather short.

Here are some important recommendations:

  1. Do not forget to moisturize the skin before bedtime
  2. Under extreme conditions (heat or cold), moisturize the skin 2 times a day (before going out and before going to bed)
  3. Take hyaluronic acid capsules. Only 1 capsule per day will ensure a good effect. Your skin will regain a healthy color, and become more elastic and moisturized.
  4. Every 3 months, change the face cream
  5. Drink clean water every day (at least 2 liters)
  6. Visit an aesthetic practitioner at least once a year. Even if you do not have acne, a visit to a beautician is recommended for both men and women. A light chemical peel or ultrasonic cleaning will help remove dead cells from the skin and speed up the regeneration processes.

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