Dermal fillers are a solution for several cosmetic problems. Whether you have a loss of volume in the face simply because you are in your 50's or 60's or you want a better chin, fuller lips or to erase the dark shadows underneath your eyes, dermal fillers do the job and do it quite nicely.

It’s important to know the differences between dermal fillers so that you can make smart decisions after discussing them with your board-certified plastic surgeon.

What Dermal Fillers Do

Dermal fillers literally fill in the tissues of the face, giving them the plumpness and youthfulness that you desire in your look. They are categorized according to how long they last in the tissues.

Facial fillers can be temporary, lasting up to 12 months; semi-permanent, lasting up to a year or two; or permanent dermal fillers which last more than two years.

Temporary Fillers

Temporary fillers are often used in situations where someone wants to see what type of results they will get from fillers. Since they disappear within 12 months, the patient is not at any real loss from trying them.

Some examples of them include:

  • Zyderm 1, Zyderm 2 and Zyplast (all collagen-based bovine products - collagen injections)
  • Cosmoderm and Cosmoplast (collagen injections but human tissue-derived)
  • Hyaluronicacid-based fillers that include Resylane, Esthelis, Lipps, Vital, Touch, SubQ, Perlane, Fortelis, and Revanesse. Hyaluronic acid fillers plump the skin; hyaluronic acid is a natural component of the skin.

Here’s a chart on the different uses for the hyaluronic acid fillers:

Wrinkles Location

Resylane Mid-dermis

Touch Superficial dermis (fine lines)

Perlane Deep dermis (deep folds)

Esthelis Soft Superficial dermis (fine lines)

Esthelis Basic Superficial/mid dermis (medium to deep wrinkles)

Esthelis Fortelis Deep dermis

Revanesse Mid-dermis

Lips

Lipps

Volume Filler Location

SubQ Subcutis

Esthelis Basic Superficial to mid-dermis

Skin Rejuvenation

IAL system Dermis

Hydration

Vital Intradermal

Semi-Permanent and Permanent Fillers

Semi-permanent fillers degrade slowly in the skin. Because of this, side effects are more common than with temporary fillers. They are used primarily for volume enhancement and placed in the deep dermis. Some examples include Sculptra, Radiesse, and Biotin blue. (Read: The Versatile Touches of Sculptra: A Non-Surgical Boost to Your Body.)

Radiesse is a calcium hydroxylapatite filler which is a natural mineral complex normally found in bones whereas Sculptra is composed of poly-L-lactic acid, which stimulates the skin to make its own collagen. Biotin blue is polyvinyl alcohol.

Permanent fillers remain in the tissues the longest, and thus have the longest side effects if you end up having side effects from them. They are usually dermal fillers.

Two examples of polyacrylamide fillers (dermal fillers) for used for volume correction and deep folds are Aquamid and Amazingel.

Another, composed of polyalkylamide is called BioAlcamid. However, silicone injections may be used as well. One last type of permanent filler is called polymethyl-methacrylate microspheres or PMMM.

Costs vary from about $900 USD for PMMM to $800 USD for Sculptra, Radiesse for around $700 USD and hyaluronic acid fillers for about $650 USD for a syringe. Prices vary depending on how much filler is needed.

Botox Can Also be Considered an Injectable

“Botox” stands for Botulinum toxin. Its source is a bacteria that when used in small amounts corrects wrinkles such as around the eyes or between the eyebrows. Botox isn't quite in the category of dermal fillers. (Read: 7 Key Things to Watch Out for If You Are Considering Botox Injections.)

Botox is used for the upper face only; not the lower face. Botox works differently than other fillers. It blocks the nerve transmissions in the muscles wherever it is injected. Botox temporarily paralyzes the muscles thus not allowing them to contract and thus wrinkle. However, it does not do anything to plump up the skin or rejuvenate it in any other way.

Different brands of Botox include Botox Cosmetic, Xeomin and Dysport.

Newer Novel Therapeutic Agents That May Be Used as Fillers

There are a few novel therapeutic agents that are used as fillers:

Stem Cells

Stem cells obtained from belly fat liposuction in your own body provides an excellent source of your own stem cells. These are excellent for soft tissue regeneration or repair. This source provides about 5000 stem cells per gram of fat. Bone marrow only provides 100-1000 stem cells per milliliter.

Autologous Vein Transplantation

Autologous vein transplantation involves extracting varicose or other unsightly veins, soaking them in saline and then implanting the collagen, elastin and muscle into the skin defect for filling.

Filler Locations May Include More Than the Face

Dermal fillers and facial fillers are great for the above-mentioned uses in the face but they also may be used for other conditions that you may not be aware of:

  • Earlobes that have shrunken
  • Nasal depressions
  • Depressed scars
  • Skin disorders such as to fill acne pits
  • Neck
  • Decollete to rejuvenate
  • Hands to rejuvenate
  • Corns and calluses

Complications to fillers are not that common and if they do, it’s usually due to hypersensitivity reactions. Those who are most susceptible to complications include those with autoimmune disease or those who have the tendency to form keloids.

Technique Matters Most

The way the board-certified plastic surgeon does the filler injection is quite important. The medical literature states that for temporary fillers, the success is due to 90% technique and 10% substance, but for permanent fillers it’s 99% technique and 1% substance.

This emphasizes the seriousness of making sure that who you select for the procedure is qualified to give the injections, has the necessary background (board-certified plastic surgeons are best) and have given thousands of filler injections over the years and thus have plenty of practice.

Questionable ‘Practitioners’

On the dark side of fillers, there are those who are not qualified to give fillers that do it in sham operations such as a hotel room – and the fillers may be composed of questionable materials, not the prime, cosmetologic preparations that real plastic surgeons use.

This type of person usually has no background education in anatomy and their clients are at risk for nerve injury, infection or other serious problems. Although the dark side of fillers is more often seen in countries other than the U.S., one must always look for any red flags that give clues that the person offering the service is not qualified.

How the Filler Procedure Should Be Done

The actual procedure of performing the injection is quite specific:

  1. Question the patient for history of herpes cold sores on the lips if you are going to do lip injections. If the answer is yes, antiviral treatment should start a few days before the injection.
  2. Apply a topical anesthetic, regional nerve block or ice to the area.
  3. After the numbing has become evident, the injection takes place.
  4. The area may be iced afterwards.

Complications of the Filler Procedure

It is possible to have side effects or complications from the collagen injections, silicone injection or other injections (polyacrylamide fillers) even thought the track record of them is quite good. Millions of filler injection visits take place across the country each week, and severe complications are rare.

Here’s a list of them:

  • Hypersensitivity reactions
  • Bruising, which resolves on its own in a few days
  • Reactivation of herpes simplex
  • Infections
  • Swelling
  • Acne flare-up
  • Ability to feel the filler substance underneath the skin
  • Redness that may either go away or not
  • Skin necrosis (death of skin cells)
  • Embolism followed by blindness
  • The injection migrates
  • Small red veins appear
  • Granulomas
  • Fat in the area of the injection dissolves
  • Scarring such as keloids
  • Abscesses

Side Effects of Botox

The side effects of botox injectables are different than for fillers:

  • droopiness of the brow or eyelid near the injection site
  • muscle weakness or inability to move the muscle
  • rashes, itching or hives
  • pain at the site of the injection
  • bruising
  • swelling and/or redness at the injection site
  • flu-like symptoms
  • headache
  • difficulty in swallowing, breathing or speaking
  • vision disturbances
  • dry mouth
  • nausea

If you get any of these complications, be sure to contact your doctor immediately. They will then aggressively treat the complication to resolve it.

Be sure to do your homework about injectables before you schedule your appointment with your board-certified plastic surgeon. (Read: Black Market Plastic Surgery: Why So Many Are Choosing Deadly Injection Perfection.)

When you do and are knowledgeable about them, it makes your questions more likely to be foreseen and brings you closer to a smarter decision.