Injectables & Fillers

The use of injectable facial fillers is one of the fastest growing areas in the field of cosmetic surgery. Many advances in have been made in the last 5 years that have led to safer, more predictable and longer lasting fillers.

As one ages, the face loses volume. This creates more prominent wrinkles and skin folds while features become less distinct. Dynamic wrinkles caused by facial movement such as smiling and frowning appear. Injectables were designed to subtly reduce these signs of aging.

Injectables include two basic classes: fillers, to restore lost volume, and botulinum toxin injections, to lessen the appearance of wrinkles with smiling, frowning, concentrating and looking surprised. Most fillers work by filling the lip or wrinkle with volume and are gradually digested by the body. While botulinum toxin injections work by weaken the underlying muscles to decrease their overlying dynamic movement.

FDA approved injectable fillers include Collagen, Hyaluronic Acid Fillers, Fillers with microscopic beads and Poly Lactic Acid.

For those wishing to avoid the injection of any foreign material, lipotransfer, the harvesting and reinjection of your own fat, may be an option.

Collagen Fillers:

These were the first FDA approved fillers. They had the disadvantage of requiring a skin test prior to injection with a one month wait prior to treatment. As new injectables were approved by the FDA, these declined in popularity.

Evolence is a filler that is made from porcine collagen (derived from pig tissue) and has the consistency of a paste. Allergy testing is not required, permitting injection immediately following consultation.

Hyaluronic Acid Fillers:

These were the first of the new fillers to be FDA approved. Hyaluronic acid is a naturally occurring carbohydrate which occurs in skin. It is a clear gel with a thick consistency. Since skin testing is not required, injections may be done on the same day as the initial consultation. Manufacturers have manipulated particle size (thickness) and crosslinked molecules to offer both normal and longer duration products.

Restylane and Juviderm are examples of normal duration products that are injected in more superficial lines and have easier flow characteristics. Perlane and Juviderm Ultra Plus are examples of longer duration products are usually injected into deeper lines and folds.

The newest advance has been the addition of local anesthetic, Lidocaine, to the filler to reduce discomfort upon injection. Prevelle silk is an example of this advance.

Elvess and Prevelle Silk are hyaluronic acid filler that contains the local anesthetic dilute lidocaine. By combining a local anesthetic with the filler, the injection process is more comfortable for the patient, although most surgeons use local anesthetic injection routinely before filler administration.

Fillers With Microscopic Beads:

This class includes Radiesse and Artefill. Radiesse contains calcium based microspheres suspended in a water based gel. Since skin testing is not required treatment may be received on the same day as consultation. Artefil contains polymethyl methacrylate (PMMA) synthetic microspheres suspended in a bovine collagen gel and lidocaine. A skin test is required and must wait at least one month following the skin test for injection. The advantage is its longer duration of effect since the body does not reabsorb the synthetic PMMA microspheres.

Poly Lactic Acid Fillers:

Sculptra is substance known as L-Poly Lactic Acid which is similar to the material used to make a type of suture that is used to close lacerations. This material does not require allergy testing. Following injection the body produces new collagen in the area injected. The reaction is not immediate but increases over the next 3-4 weeks after injection.

Who is a Candidate

  • Facial fillers are administered over a wide age range.
  • Younger patients seeking fuller, plumper lips
  • Older patients seeking wrinkle reduction and fuller lips.
  • Men who wish reduction of folds around the mouth to look younger.

Intended Results

  • Fuller and plumper lips.
  • Softening of superficial and deep wrinkles.
  • Softening of wrinkles which appear during facial movement (smiling, frowning, concentrating and looking surprised).

Procedure Description

  • This procedure is usually performed in the office.
  • Most surgeons use a topical anesthetic cream and also administer local anesthetic injections prior to injecting fillers.
  • Ice may be applied before and after injection.
  • Immediate swelling may create the appearance of over treatment – his swelling generally resolves in several hours.

Recuperation and healing

  • For most patients, fillers can be injected in the lips or wrinkles and they can return to work the next day.
  • Occasionally a patient swells dramatically, especially in the lips. A first time patient may want to schedule the initial injection on a Friday.
  • Bruising may occur but can usually be covered with makeup. It is a good idea not to schedule filler injection right before an important social function.

Other options

  • Lipotransfer: the use of your own fat taken from one area and reinjected into facial lines and wrinkles after preparation.
  • Volume restoration through cheek or chin implants.
  • Forehead and facelift.
  • Eyelid surgery (blepharoplasty).
  • Chemical peel.
  • Laser resurfacing.


The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation with your cosmetic surgeon. Minor complications that do not affect the outcome occur occasionally. Major complications are rare.