What Are Facial Fillers?

Soft tissue fillers, also called dermal fillers, facial fillers, or “fillers”, are injectable products used to fill up defects in the soft tissues, typically wrinkles, folds and dents in the face such as in the cheekbone or the chin. Facial fillers are used to restore volume, smooth wrinkles, and enhance facial features such as lips and cheeks. They can be used to address age-related volume loss or to achieve specific aesthetic goals.

The results depend on the type of filler used, the treatment area, the amount injected and the individual's facial anatomy and goals.

There are many products on the market. The most important distinction is between non-permanent fillers, which disappear spontaneously after a while, and the permanent fillers, which stay embedded in the tissues forever.

It is advisable to demand fillers that are generally accepted, or FDA approved, such the ones based on hyaluronic acid, collagen, and calcium hydroxyapatite microspheres. Please consult your qualified aesthetic plastic surgeon regarding this. Non-permanent fillers are most used and gradually dissolve over time.

*ISAPS does not endorse any named company or product.

Types of Facial Fillers

There are different types of fillers, including:

• Hyaluronic acid (HA) fillers (a substance naturally found in the body): These attract and hold water, helping to restore volume and improve the appearance of the skin. Some HA fillers can be dissolved using an enzyme called hyaluronidase.
• Biostimulators such as Poly-L-lactic acid and calcium hydroxylapatite, which stimulate collagen production. Results may develop gradually rather than appearing immediately.

Non-permanent fillers are commonly used because they generally offer a more established safety profile than permanent fillers. One advantage of hyaluronic acid fillers is that they can be dissolved using an enzyme called hyaluronidase if needed. However, this does not eliminate all risks or guarantee that every complication can be reversed.

Permanent fillers: These are designed to remain in the body for a long time. They may be associated with long-term complications that can be difficult to manage or reverse. These are less commonly used and are banned in some countries due to a higher risk of complications.

The most appropriate filler depends on the treatment area, the desired result, the patient's medical history and the clinician's assessment.

How Are Facial Fillers Administered?

Facial fillers are injected into selected areas using a fine needle or, in some cases, a blunt-tipped cannula for a reduced vascular injury risk. The method used depends on the treatment area, the filler and the practitioner's assessment.

A cannula has a rounded tip and may be used to distribute filler through an area with fewer entry points. However, both needles and cannulas carry risks, including the rare but serious risk of injecting filler into a blood vessel.

The face contains blood vessels that supply the skin and other important structures. If filler blocks a blood vessel, it can cause tissue damage and, in rare cases, vision loss or stroke. A detailed understanding of facial anatomy and appropriate injection techniques is therefore essential.

• Fewer injection points and broader coverage: A single-entry point may allow a cannula to reach different parts of the treatment area, reducing the need for multiple separate injection points.
• Less bruising and tissue trauma: The blunt tip separates tissues rather than cutting through them, cannula use may cause less bruising and tissue damage, potentially making recovery more comfortable.
• More even, controlled placement. A cannula can help the surgeon place filler within the intended tissue layer, supporting a smoother and more even distribution of the product.

It is important to understand that using a cannula reduces certain risks but does not eliminate them. Blood vessel injury and blockage can still occur. The injector's training, knowledge of facial anatomy and careful injection technique remain essential, regardless of whether a cannula or needle is used.

Mechanism of Action

Different fillers work in different ways.

Hyaluronic acid (HA) attracts and holds water, helping to add volume soon after injection. The way the product is formulated affects its thickness, how it holds its shape and how long the results last.

Biostimulators work differently. Calcium hydroxylapatite (CaHA) provides immediate volume and supports the body's production of new collagen, a protein that helps give the skin structure and support. Poly-L-lactic acid (PLLA) stimulates the body's natural collagen-producing processes, so improvements in volume develop gradually over time rather than appearing immediately.

Contraindications

Facial filler treatment may not be suitable for everyone. Treatment should generally be avoided if there is an active infection at or near the injection site, or a known allergy to the filler or one of its ingredients.

Fillers are generally not recommended during pregnancy or breastfeeding because there is insufficient safety information. Certain autoimmune conditions or inflammatory skin conditions affecting the treatment area may also require additional assessment.

Medicines that affect blood clotting, including anticoagulants and antiplatelet medicines, may increase bruising. Patients should discuss all their medicines and supplements with their surgeon and should not stop prescribed medication unless advised doing so by an appropriate healthcare professional.

Complication Management

The injector must be prepared to recognise and manage complications promptly.

If a blood vessel becomes blocked, urgent assessment and treatment are needed to protect the affected tissue. Hyaluronidase, an enzyme that dissolves hyaluronic acid filler, may be used when appropriate. Patients can ask whether their injector has the necessary emergency supplies and protocols available. Hyaluronidase does not dissolve every type of filler.

If lumps or inflammatory reactions develop, treatment depends on the cause and may include dissolving the filler where appropriate, prescription treatments or antibiotics if an infection is suspected. Surgical removal may occasionally be necessary for persistent or difficult-to-treat lumps.

Severe allergic reactions, including anaphylaxis, are rare but can occur with injectable treatments. They require immediate emergency treatment by a trained healthcare professional.

Who is this for?  

Facial fillers may be suitable for patients who wish to:

• Reshape the three-dimensional contours of the face or want to restore volume within facial features
• Soften facial wrinkles that have developed with aging
• Enhance the shape of the lips, cheekbones or facial features without surgery

Please note: Permanent fillers are not to be recommended lightly as they can induce adverse reactions which are very difficult to treat without surgery. Suitability will depend on overall patient health and expectations.

A consultation with a qualified plastic surgeon can help determine whether fillers are an appropriate option.

Preparation

Before surgery, patients typically undergo:

• Facial assessment and consultation to assess patient wishes about treatment areas and goals
• Review of medical history, medications and allergies
• Advice on avoiding blood-thinning medications or supplements if appropriate (plastic surgeon will evaluate every patient individually and give detailed information)