Dermal Fillers

Woman receiving facial filler injection.
Dermal fillers are less invasive than plastic surgery, but their effects don't last nearly as long. See more getting beautiful skin pictures.
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Understandably, many people find the idea of having plastic surgery quite scary. But these days, there are many other ways you can rejuvenate your skin without actually going under the knife. Dermal fillers are one of the most popular, nonsurgical options for solving aging skin problems.

Dermal fillers, also known as "injectables" or "soft-tissue fillers," do just what their name suggests -- they fill in the area under the skin. Some fillers are natural and some are synthetic, but they all work to improve the appearance of aging skin in the following ways:


  • filling in wrinkles, fine lines and deep creases
  • improving other imperfections like scars
  • filling out thin or wrinkled lips
  • plumping up cheeks
  • contouring the jaw line and other areas of the face [source: American Academy of Dermatology]

Dermal filler procedures are generally performed in a doctor's office on an outpatient basis. Depending on the type of filler you choose, your dermatologist may need to give you a skin test before the procedure, often to find out if you are allergic to the filler [source: American Academy of Dermatology]. During the actual procedure, the physician will give you a series of skin injections, the number and depth of which will depend on what you're trying to accomplish. Afterward, you can usually return to your regular routine right away, but your doctor may recommend that you stay out of the sun and avoid strenuous activities for at least a day [source: Plastic].

Before using a dermal filler, check on whether or not the product is FDA-approved. Anti-aging researchers churn out new products all the time, but the latest craze isn't always the best thing for you. In November 2008, the FDA posted an extensive list of approved dermal fillers -- along with their benefits and side effects -- on its Web site [source: FDA].

With all the different kinds of dermal fillers out there, choosing the right one can be overwhelming. Read on for some guidelines.


Types of Dermal Fillers

Which dermal filler you choose really depends on what you want to accomplish. Start by telling your doctor what you want to improve and how long you'd like the filler to last, so that he or she can help you narrow down your choices. Also, do a little research on possible side effects. In November 2008, the FDA recommended that dermal fillers should carry stronger warnings, so patients would be more aware of potentially serious side effects. Dermatologists will most likely be using FDA-approved products -- and are trained to administer them -- which should minimize your potential for bad reactions [source: Doheny].

Dermal fillers typically fall into specific categories: synthetic or natural, absorbable or non-absorbable. The FDA has approved several synthetic fillers that have proven to be effective. Artefill, for example, is a non-absorbable synthetic filler made of microbeads floating in bovine collagen. Because your body can't absorb or metabolize it, Artefill -- formerly known as Artecoll -- lasts longer than collagen or fat injections. Experts refer to it as a "permanent" filler for its enduring results [source: Miller]. The FDA has approved Artefill for use in improving smile lines.


On the other hand, Radiesse -- an absorbable, synthetic filler -- is considered semi-permanent because its effects last only one to two years. How it works is simple: collagen, a protein that gives skin its structure, forms around the microspheres in Radiesse upon injection and firms the skin. The FDA approved this filler for treating wrinkles and folds that are moderate to severe [source: American Society of Plastic Surgeons]. In July 2009, the FDA also approved the use of a combination of Radiesse and the anesthetic lidocaine. This mixture has been shown to provide greater comfort for patients receiving fillers [source: Reuters].

Like Radiesse, Sculptra is a semi-permanent filler that causes the body to form collagen around microspheres [source: American Society of Plastic Surgeons]. However, the FDA has only approved Sculptra for treatment of fat loss in people with HIV [source: FDA].

Read on to find out how the effects of natural fillers differ from those of synthetics.


Natural Dermal Fillers

If you have sensitive skin or often experience allergic reactions, you may want to consider natural dermal fillers instead of synthetics. These fillers use ingredients already found in your body, or very similar to those already inside of you, so they are less likely to react with your skin. FDA-approved natural fillers have either hyaluronic acid or collagen as the major active ingredient [source: FDA].

The protein collagen is found naturally in the human body and helps keep your skin firm, strong and flexible [source: Bernstein]. Collagen loss is a natural part of the aging process, and collagen dermal fillers use human, bovine or porcine collagen to help replace what you've lost. Since collagen fillers are absorbable and only last from two to six months, you'll need repeated injections to maintain these dermal fillers' effects. Some FDA-approved collagen fillers include Zyderm/Zyplast (bovine collagen), Cosmoderm/Cosmoplast (human collagen) and Evolence (porcine collagen) [source: FDA].


Hyaluronic acid also appears naturally in the body. In addition to filling in wrinkles, hyaluronic acid also promotes new collagen growth. These fillers are also absorbable, but last from six months to a year or more [source: American Society of Plastic Surgeons]. Some FDA-approved hyaluronic acid fillers include Restylane, Perlane, Hylaform and Juvederm [source: FDA].

Although the FDA doesn't regulate them, there are other treatments available that use elements produced by your own body as fillers. Plasmagel uses a mix of your blood and Vitamin C [source: American Society of Plastic Surgeons]. Autologen uses collagen that's taken from your body, processed and injected into your face [source: Cleveland Clinic]. You can also have fat harvested from certain areas of your body, like your thighs, and then injected into your face as a filler. One advantage to using fillers from your own body is that you won't have an allergic reaction, but since your body will eventually reabsorb its own blood, collagen and fat, the results may fade over time.

Dermal fillers give you many options to improve facial imperfections without surgery. No matter what kind of dermal filler interests you, make sure you talk to your doctor and thoroughly understand the benefits, side effects and longevity of the treatment you choose.

For more information on dermal fillers, check out the links on the next page.


Lots More Information

Related HowStuffWorks Articles


  • American Academy of Dermatology. "Soft Tissue Fillers." (Accessed 7/23/09)
  • The American Society for Aesthetic Plastic Surgery. "Injectable Anti-Aging Treatments." (Accessed 7/23/09)
  • American Society of Plastic Surgeons. "Injectables At-A-Glance." May 2009. (Accessed 7/23/09)
  • Bader, Robert S., MD; Johnson, Doreen L., PA-C, MPH. "Dermal Fillers." October 23, 2008. (Accessed 7/23/09)
  • Bernstein, Eric. "What Is Collagen?" The Patient's Guide: Collagen. (Accessed 7/30/2009)
  • Blakeley, Kiri. "The Latest Options in Dermal Fillers." May 26, 2009. (Accessed 7/23/09)
  • Cleveland Clinic. "Lip Augmentation." (Accessed 7/23/09)
  • Consumer Guide to Plastic Surgery. "Artefill." June 2008. (Accessed 7/30/2009)
  • Doheny, Kathleen. "Panel: Toughen Dermal Filler Warnings." WebMD. November 18, 2008. (Accessed 7/23/09)
  • FDA. "Executive Summary: Dermal Filler Devices." November 18, 2008. (Accessed 7/23/09)
  • Mayo Clinic. "Skin Care: Top 5 Habits for Healthy Skin." (Accessed 7/23/09)
  • Miller, Scott R., MD, FACS (reviewer). "Injectable Fillers Overview." Consumer Guide to Plastic Surgery. (Accessed 7/23/09)
  • "Facial Fillers." (Accessed 7/23/09)
  • Reuters. "Update 1-FDA Oks mixing BioForm's dermal filler with anesthetic." July 16, 2009. (Accessed 7/23/09)
  • Wang, Frank, MD; Garza, Luis, A. , MD, PhD; Kang, Sewon, MD; Varani, James, PhD; Orringer, Jeffrey S., MD; Fishser, Gary J., MD; Voorhees, John J., MD.. "In Vivo Stimulation of De Novo Collagen Production Caused by Cross-linked Hyaluronic Acid Dermal Filler Injections in Photodamaged Human Skin." Arch Dermatol 2007; 043: 155-163. DermNews. (Accessed 7/23/09)