Dermal Fillers

    Dermal Fillers

    Dermal filler are medical products that are injected into the skin to add volume where needed to correct aesthetic issues. They are usually used to correct deep lines and wrinkles as well as “off-label” uses. The goal of filler treatment is to leave the patient with a more youthful, rested, healthier appearance while maintaining a natural look.

    Hyaluronic Acid Fillers

    The most common fillers used today are in the group known as hyaluronic acid, or HA products. In 1934, medical researchers Karl Meyer and John Palmer, scientists at Columbia University, found that one of the chief functions of hyaluronic acid is maintaining skin volume and hydration, along with other body maintenance functions and tasks. Hyaluronic acid later found uses in the baking and food industry in the 1940s and, by the 1990s, found its way into the medical field for use in joint pain, treating wounds, ye surgery and, finally, in 1996, for facial tissue augmentation in Europe.

    Duration of Fillers Effect

    Duration of all the above fillers depends on factors such as the individual’s skin type, medical condition, lifestyle, age and product used. The effects of the HA’s and Radiesse are visible immediately whereas Sculptra, Selphyl and Artefill vary from weeks to months. After the initial treatment with HAs, follow-up sessions are normally recommended approximately every 6 to 12 months depending on the individual and

    Pre-Treatment Info

    Although there is no specific pretreatment required for fillers (other than skin testing with Artefill and rarely used collagen products)) the following precautions should be taken. Patients should discuss their medications and supplements with their injector. Aspirin, ibuprofen products and some vitamins and some herbal supplements should be discontinued to limit bleeding and bruising. Your physician will direct you as to which, if any medication should be discontinued and for how long.

    The Procedure

    Every injector has their own unique way of injecting but the basics are the same for all. The area that has been determined to be the treatment site must be cleansed with a topical antiseptic agent including the removal of all lotions and cosmetics. The injector will then inject the pre-determined product into the area. The products are injected as per the injector’s choice and product recommendations. This includes the depth of the injection, the injection technique, the amount to inject and the type and size of the needle to be used.

    Potential risks and side effects

    The usual expected side effects include temporary redness, pain and tenderness. Patients can expect some swelling and bruising at the injection sites. These are self- limited and the typical patient has no significant visible effects of the treatment after 24 hours if performed by a skilled injector. There have, in rare cases, been reports of skin infection.

    Off Label Uses

    With only few exceptions the dermal fillers that have been approved by the FDA for use in the US were studied for use in the nasolabial folds (commonly known as smile lines, connecting the outer nostril with the corner of the mouth), and are approved only for use in that location. That being said most injectors will use the product in other areas which are referred to as “off label” use. An FDA consumer report is available at This is a common and very well accepted practice.

    Novel Uses

    Novel uses are various unusual or uncommon uses of the products. These are uses that are “off label” and usually performed by experienced injectors that have mastered the standard common uses. An example of novel use for filler is correction of nasal deformity (a liquid nose job). See the photo section of novel uses to see examples.


    The cost of the procedure is very variable based on many factors; the product(s) being used, the amount of the product to be used, the skill and reputation of the injector and the location of the office. In general highly skilled injectors may command higher fees based on their expertise. Various regions also command higher price with large cities such as New York and Los Angeles being at the upper price range. For some ballpark averages of pricing the HAs can be between $550 and $650, Radiesse is generally $50 to $100 more. The products with greater staying ability such as Sculptra, Selphyl and Artefill are generally higher and usually require multiple sessions to complete treatment.

    The Consent

    Although facial fillers as well as neuromodulators are very safe medical products when used by highly trained and experienced injectors an informed consent must be signed for both the protection of the patient and the injector. The consent will include a description of the procedure, alternate available treatments (if any), precautions, risks, possible adverse reactions and complications. An “informed consent” is required to be signed before any medical procedure. Feel free to ask your injector for a copy of the consent if you wish.


    Being that BTX products are injected with an extremely fine needle in most cases anesthesia is not necessary. Some injectors may offer a topical anesthetic or ice packs.


    Your injector will give you their specific post-treatment routine. In general you must keep the area clean and dry for 12 hours. There should be no manipulation of the treated area (like facials). You can expect redness, and swelling to be present to some degree when leaving the office. If bruising develops it may last from 24 hours to a week depending on how you heal. You may wish to purchase a supplement called Arnica Montana with bromelin to help limit bruising. If bruising does develop you may wish to gently apply ice to the area.