Fillers are a class of injectable medication designed to soften and sometimes flatten folds, depressions and wrinkles of the skin. They are produced predominantly by US companies and are sold as syringes containing one cc. of clear gel product that is sterile and ready for immediate use. In the US, patients are only treated with fillers by physicians and nurses. These materials were first used to treat facial wrinkles and skin folds around the mouth but their use has expanded to include augmenting the bony surfaces of the face such as the cheekbone, chin and jaw line. Recently, fillers have found use in nonsurgical rhinoplasty (nose job) and treating surface changes after rhinoplasty surgery. Fillers are also currently used to fill areas of muscle loss due to the aging process and other causes. The most common area for this muscle loss treatment is in the temple areas on the side of the face.

The filler substances currently in use are composed of a chemical called hyaluronic acid, also known as “HA”. The HA that is used for cosmetic purposes is completely man-made but hyaluronic acid is a significant component of human skin. HA is found in all layers of the skin but especially under the uppermost layer of skin called epidermis. Within skin, hyaluronic acid is important in skin support and is a key component of skin healing. Hyaluronic acid is a small chemical but can be synthesized into a polymer of many of the same units. Longer polymers can last longer under the skin and therefore fewer treatments are required. The chemical polymers can also be modified to change their consistency and feel as well as other properties.

There are currently about twenty fillers on the market and the most common fillers for wrinkles and skin folds are the juvederm line of products and the perlane/restylane group of products. The most often currently used product for enhancing bony prominences is Voluma. The FDA currently approves all facial fillers and the approval not only clears these products for use but for use in specific areas of the face. Physicians and “nurse injectors” are instructed by the FDA to use these specific for specific areas but injectors often also use product in areas not mentioned by the FDA. These areas are referred to as “off label” locations. Off-label use can be safe and effective but should be discussed with the treating physician.

Fillers are commonly confused with Botox treatment. The rule is that fillers fill and Botox paralyzes muscles to lessen wrinkles. Botox is most commonly used for wrinkles that occur between the eyebrows, over the forehead and within the Crow’s foot area outside the eyes near the temple. There are some parts of the face where both Botox and fillers can be of use. For example, the corrugator muscle folds the skin between the eyebrows. When patients are younger, muscle overactivity leads only to folding in this area and Botox is a great fix. But with the aging process, permanent wrinkles can be seen even when the patient is not flexing these muscles. It is at this point where fillers can be used effectively to soften and flatten wrinkles and folds.

Facial filler side effects most commonly encountered include irregularities that can occur under the skin, pain bruising, itching and rash. The types of dermal fillers used can all have these side effects and some of the side effects are related to the experience of the injector.