All About Filler Injections

A filler is any injectable substance used to fill cutaneous defects and is referred to as a filler, such as hyaluronic acid gels, fat, liquid silicone, calcium hydroxyapatite, and poly-L-lactic acid. Here, by filler, we specifically mean injectable gels. The injected gel is composed of hyaluronic acid and has a volumizing property. Hyaluronic acid is used to fill skin defects, lines, and wrinkles caused by various factors such as excessive weight loss and aging, as well as to enhance certain areas like the cheeks and chin.

Background:

Before 2003, collagen derived from animal or human sources was used to restore volume to the face. Autologous fat injection (fat grafting) was also common and remains so today. However, animal-derived (bovine) or human-derived collagen had short durability and a high risk of allergic reactions. In 2003, following the understanding of the structure of hyaluronic acid and its introduction, a revolution occurred in the field of fillers. Hyaluronic acid is a polysaccharide (a type of carbohydrate) naturally present in connective tissues. Nowadays, hyaluronic acid is synthetically produced in laboratories, eliminating allergy risks associated with animal- or human-derived collagen. Furthermore, chemical modifications of the hyaluronic acid chain can increase its longevity in some products up to 3 years. This type of filler, also called a gel due to its appearance, is used for mild to moderate wrinkle correction and can be injected anywhere on the face.

Applications of Fillers:

Fillers are used to improve forehead wrinkles and frown lines, nasolabial folds (smile lines), enhance the cheeks, treat tear trough deformities, contour the face, augment the chin, improve nasal appearance, fill the dorsum of the hands, genital area, and areas of fat atrophy in the body.

• Forehead Wrinkles:If horizontal forehead lines are deep and not fully corrected by Botox, fillers can be used after Botox’s effect to fill these lines. Skill and expertise are crucial in this area to avoid serious complications.
• Frown Lines:Botox is usually effective for frown lines, but if deep lines persist after Botox, filler injections two weeks later can fill the deep folds by separating fibrous adhesions and compensating for volume loss. Regular annual Botox after this treatment usually prevents deep frown lines, providing a relatively permanent solution.
• Nasolabial Folds (Smile Lines):These lines run from the side of the nose to the corner of the mouth and deepen with age due to skin thinning and loss of cheek volume. Hyaluronic acid fillers are one of the best, easiest, fastest, and least invasive methods for correction. Proper filler selection and technique are important to avoid unnatural fullness.
• Marionette Lines (Sad Lines):Vertical lines running from the mouth corner to the jawline, caused by soft tissue loss around the chin and jaw, give a tired or sad appearance. Proper technique is essential to avoid unnatural protrusion or deepening of the lines.
• Lip Fillers:Contrary to the common misconception of overly large and unnatural lips, lip fillers are suitable for individuals with disproportionately small lips, age-related volume loss, or asymmetry caused by trauma or surgery. Careful assessment of which part of the lip needs enhancement—vermilion border, body, or both—is critical for natural and harmonious results. Lip filler injections can also trigger herpes simplex virus reactivation; therefore, patients with a history of cold sores should inform their physician for preventive treatment.
• Cheek Fillers:The cheekbone and overlying soft tissues create the youthful cheek contour. Aging leads to fat loss and sagging, diminishing cheek prominence. Fillers can restore cheek volume, improve skin laxity, and correct facial asymmetry caused by habitual facial movements or sleeping positions.
• Chin Fillers:While surgical chin implants are the gold standard for chin augmentation, fillers are a good alternative for those unwilling to undergo surgery, requiring minor augmentation, or seeking temporary results. Fillers are also useful in cases of previous inadequate implants or asymmetry concerns.
• Jawline Contouring:A strong, prominent jawline often provides a masculine appearance and is a common procedure for men. Previously, permanent implants were used; currently, fillers simplify the process. Fillers can also improve facial proportions in women with small or asymmetric jaws.
• Nose Fillers:Some patients have minor nasal irregularities such as a small dorsal hump, drooping tip, or broad nasal tip, or undesirable post-rhinoplasty changes. In these cases, minimal filler injection can correct external deformities without the need for surgery or anesthesia.
• Temporalis Area Fillers:Hollowing in the temple region can create a sunken and weak appearance in the upper face. While trauma, disease, or malignancy may cause fat loss here, natural aging is the most common cause. The temporalis region is bordered by the hairline laterally, eyebrow and lateral orbital rim medially, and the superior cheekbone inferiorly.
• Under-Eye Fillers:The tear trough can become hollow due to severe weight loss, sleep deprivation, aging, or genetics, leading to dark shadows. Injecting filler here can reduce these shadows and delay the need for surgical blepharoplasty in mild cases. Injection should be deep on the bone to avoid bruising and swelling.
• Skin Rejuvenation and Fine Wrinkle Improvement:Fine wrinkles around the mouth, cheeks, and eyes caused by aging and photodamage can be improved with filler injections, lasting up to one year.
• Dorsum of Hand Fillers:Despite a youthful face and body, aged hands with discoloration, fat loss, thinning skin, and prominent tendons can reveal true age. Fillers restore volume and improve hand appearance.

Patient Preparation:

Needle injections can be painful or uncomfortable; therefore, local anesthesia is recommended before treatment.

Pre- and Post-Treatment Care:

One day prior, patients should avoid medications, supplements, and foods that thin the blood (e.g., aspirin, vitamin E, green tea, celery). After injection, patients should avoid manipulating, massaging, or applying pressure to the treated area, refrain from exfoliants or scrubs for two days, and consult their physician if they experience pain, swelling, bruising, or discoloration.

Filler Longevity:

Hyaluronic acid fillers typically last 10 to 12 months, though this may vary from 6 to 8 months or up to 2 to 3 years depending on HA concentration, molecular size, and additives.

Complications:

Pain during injection, swelling, skin rash, infection, bruising (especially around the eyes), and herpes simplex virus reactivation in patients with prior cold sores. Appropriate antiviral prophylaxis is advised for such patients.