Dermal Fillers

Why Injectable Fillers?

The visible signs of facial aging occur over time as a result of sun exposure, heredity and life style.

One of the earliest signs of aging is a loss of facial fullness and the development of wrinkles. Softening of these facial lines and the restoration of volume and fullness in the face often can be achieved non-surgically with injectable fillers.

If you would like to restore facial contours, or reduce the appearance of lines and creases, injection therapy with soft tissue fillers may be right for you.

Injectable fillers can:

  • Plump thin lips
  • Enhance shallow contours
  • Soften facial creases and wrinkles
  • Improve the appearance of recessed scars
What It Won't Do

Soft tissue augmentation does not stop the aging process. If you wish to change the elements of your face, surgery such as a facelift, brow lift or eye lift may be the answer.

Non-surgical rejuvenation treatments such as injectable fillers cannot achieve the same results, but may help delay the time at which a facelift becomes appropriate.

Is It Right For Me?

While not as involved as surgical cosmetic procedures, soft tissue augmentation is a medical procedure. You should do it for yourself, not to fulfill someone else's desires or to try to fit any sort of ideal image. Tissue fillers are a good option for you if:

  • You are physically healthy
  • You don't smoke
  • You have a positive outlook and specific, but realistic goals in mind for the improvement of your appearance

What are the different types of fillers?

Hyaluronic Acid is a natural substance found in our bodies. It is well suited to plump thin lips and fill facial creases such as nasolabial folds. It may also be appropriate for some surface wrinkles and concave scars. The results may last 6-9 months or longer. Products such as Juvederm® and Restylane® are hyaluronic acid fillers.

Hydroxylapatite is a mineral-like compound found naturally in human bones, suspended in a gel-like formulation. It is the heaviest of facial fillers and is recommended to fill deeper creases such as nasolabial folds, marionette lines and frown lines, as well as to enhance fullness of the cheeks and other facial contours. These products such as Radiesse® may last up to a 12 months.

Human fat, harvested from your own body, can be reinjected to enhance facial fullness, fill deep creases and to build up shallow contours. Fat injection requires a more extensive procedure than other injectable fillers because it uses liposuction techniques to extract the fat prior to injection. Treatment results last up to a year or more in some cases and are highly variable. Some of the transferred fatty tissue may dissolve, however what remains provides the potential for longterm filling of the defect.

A note about the FDA and injectable fillers

The U.S. Food and Drug Administration reviews and approves pharmaceutical fillers in the same manner as medical devices. However, some fillers may be used on an off-label basis, meaning they are approved medical treatments but not directly reviewed for a specific application. The options discussed in this section are among the current fillers preferred by plastic surgeons.

Procedural Steps

What happens during soft tissue augmentation?

Step 1

Your plastic surgeon will carefully evaluate your facial appearance and skin tone, and examine the areas of your face to be augmented with injectable fillers.

Step 2

Strategic points on your face may be marked as guides to the appropriate injection sites for the filler.

Step 3

A topical numbing agent may be offered to make more sensitive patients comfortable. In most cases, the filler itself will contain an anesthetic agent and once the injections begin local numbing takes effect.

Step 4

Injection takes only a few moments per site and usually only 15-20 minutes for a course of treatment.

Step 5

Following injection, any markings will be cleansed and icing may be offered to alleviate any temporary, minor discomfort. Makeup may be carefully re-applied so long as care is taken not to apply pressure to the treatment area.

Line Filling

Filling wrinkles or recessed scars involves multiple injections. Common sites for deeper tissue fillers are the nasolabial folds and marionette lines, or to enhance fullness in the cheeks.

Lip Augmentation

Soft tissue augmentation of the lips requires multiple injections to distribute the filler for enhanced lip fullness and to raise or define a cupid's bow or vermillion border.

Nasolabial Folds

An improved appearance is visible almost immediately, although minor swelling or bruising may appear at the injection sites.

With some fillers, a slightly "over-filled" appearance may be initially present. These conditions will resolve within a few hours, or at most a few days. Gentle massage at the site will help to soften the appearance. The duration may be as long as a few weeks with injection of one's own harvested fat.


Important facts about the safety and risks of tissue fillers

The decision to have soft tissue augmentation is extremely personal and you'll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable.

Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications.

Complications from fillers are uncommon.

The risks vary depending on the specific filler used and the relative permanence of the filler substance and include:

  • Infection at the injection site
  • Acne-like skin eruptions
  • Antibodies to filler material may reduce the effectiveness of future injections
  • Asymmetry
  • Bleeding, bruising and swelling (will be less if aspirin and anti-inflammatory medications are stopped ten days prior to treatment)
  • Skin might die (skin necrosis)
  • Skin rash, itching and swelling
  • Skin redness
  • Skin sensitivity
  • Under or over correction of wrinkles

Choose a professional. Although tissue augmentation is a quick, in-office procedure that can produce a marked improvement in restoring facial fullness and a more youthful appearance, effective and safe use requires a physician with specialized training and a thorough understanding of facial anatomy to recommend and inject an appropriate filler.

Choosing a plastic surgeon to treat your face with injectable fillers means that your treatment will be performed by someone who not only has training in injection therapy, but in all types of non-surgical and surgical facial rejuvenation.

Be sure to ask questions.

 It's very important to ask your plastic surgeon questions about your tissue filler procedure. It's natural to feel some anxiety, whether it's excitement for your anticipated new look or a bit of preoperative stress. Don't be shy about discussing these feelings with your plastic surgeon.

My Recovery

The results of soft tissue augmentation using injectable fillers are apparent immediately. Your initial appearance after treatment with any filler may include:

  • Mild swelling or bruising
  • Temporary numbness or redness
  • An "over-filled" appearance to treated areas

These conditions can be alleviated with topical icing and will improve within a matter of hours or just a few days.

Where fat is the injected filler, these conditions may persist for a few weeks.

Results and Outlook

The results of soft tissue augmentation with injectable fillers are not permanent, even though a filler substance may be considered permanent. The continued aging of your face and variables in the absorption of fillers will affect how long your results last.

Should you choose not to repeat treatment, your appearance will return to its original condition. Plumped lips will lose volume and improved wrinkles, creases and scars will visibly recess and fully reappear in time.

The results of permanent fillers (for example, fat) can change over time; as you age naturally, these fillers may shift or clump.

Surgical removal may be necessary to correct these conditions and could result in visible changes in appearance and noticeable changes in the texture of soft tissue.

Your initial treatment will include a complete consultation. Subsequent follow-up procedures may take only a few minutes, as the full process of consultation is not necessary to repeat, although consent is required at each visit.

How much will soft tissue augmentation cost?

Cost is always a consideration in elective cosmetic treatments. Prices for injectable fillers can vary widely. Often multiple units of product are required to adequately treat your concerns. Multi unit discounts may be available.

Many plastic surgeons offer patient financing plans, so be sure to ask.


Your satisfaction involves more than a fee.

When choosing a plastic surgeon for soft tissue augmentation, remember that the surgeon's experience and your comfort with him or her are just as important as the final cost of the surgery.

Most health insurance does not cover cosmetic surgery or its complications.

Words to Know

  • Cupid's bow: The middle portion of the lip which has the upturn.
  • Human fat: Fat harvested from your own body and used as an injectable filler for soft tissue augmentation.
  • Hyaluronic acid: A natural substance found in the body used as a filler.
  • Hydroxylapatite: A mineral-like compound found naturally in human bone used as a filler.
  • Injectable fillers: Substances used to restore volume and a more youthful appearance.
  • Liposuction: Also called lipoplasty or suction lipectomy, a procedure that vacuums out fat from beneath the skin's surface to reduce fullness.
  • Local anesthesia: A drug injected directly to the site of an incision during an operation to relieve pain.
  • Soft tissue augmentation: The use of injectable fillers to restore volume and your youthful appearance.
  • Vermillion: The red pigment of your lips.

View Before And After Photos

Click the above button to view actual patient before and after photographs from surgeons who are ASPS members and certified by The American Board of Plastic Surgery.

These photographs represent typical results, but not everyone who undergoes plastic surgery will achieve the same.

  •  Hyaluronic Acid was injected. After photos for this patient were taken 7 weeks postoperatively.
  • Type of Filler: Hyaluronic Acid
  • Weeks between operation and 'after' photos: 7
  • This patient is 56 years old and is 5'2'' tall. Hyaluronic Acid was injected in the following locations: Nasolabial Folds (1.5 cc's), Corners of Mouth (0.5 cc's). After photos for this patient were taken 1 month postoperatively.
  • Age: 56
  • Height Feet: 5
  • Height Inches: 2
  • Type of Filler: Hyaluronic Acid
  • Filler Location (1): Nasolabial Folds
  • Filler Location (2): Corners of Mouth
  • Filler Amount (1): 1.5
  • Filler Amount (2): 0.5
  • Months between operation and 'after' photos: 1