Injectable filler

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Injectable filler (injectable cosmetic filler, injectable facial filler) is a soft tissue filler injected into the skin at different depths to help fill in facial wrinkles, provide facial volume, and augment facial features: restoring a smoother appearance. Most of these wrinkle fillers are temporary because they are eventually absorbed by the body. Most dermal fillers today consist of hyaluronic acid, a naturally occurring polysaccharide that is present in skin and cartilage. Some people may need more than one injection to achieve the wrinkle-smoothing effect. The effect lasts for about six months or longer. Successful results depend on health of the skin, skill of the health care provider, and type of filler used. Regardless of material (whether synthetic or organic) filler duration is highly dependent on amount of activity in the region where it is injected. Exercise and high intensity activities such as manual labor can stimulate blood flow and shorten the lifespan of fillers.[1]

In the US, fillers are approved as medical devices by the Food and Drug Administration (FDA) and the injection is prescribed and performed by a provider. What defines a qualified dermal injection provider varies by country and is a point of debate between board-certified doctors and injectors who operate under cosmetic or aesthetician licenses. Fillers are not to be confused with Neurotoxins such as Botox. Fillers are not approved for certain parts of the body where they can be unsafe, including the penis.[2] Injectable fillers may be used in these regions - forehead, temples, under eye zone, cheekbones, nose, midface (nasolabial folds), around the mouth, lips, chin, and jawline. Except for those areas, dermal fillers are also effective for treatments in the neck, décolleté, and hands zones.[3] In Europe and the UK, fillers are non-prescription medical devices that can be injected by anyone licensed to do so by the respective medical authorities. They require a CE mark, which regulates adherence to production standards, but does not require any demonstration of medical efficacy. As a result, there are over 140 injectable fillers in the UK/European market and only six approved for use in the US.[4] In China, the market of cosmetic surgery increase in recent 10 years, NMPA (formerly CFDA) also has issued several guidance to regulate injectable filler.[5]

Medical uses

Dermal fillers, also known as "injectables" or "soft-tissue fillers," fill in the area under the skin, and have some non-cosmetic uses, such as:

  • non-surgical cleft repair/modification
  • treating fat loss secondary to HIV.[6] Fillers were found to give a temporary acceptable therapeutic effect in HIV‐infected patients with severe facial lipodystrophy which is caused by the highly active antiretroviral therapy.[7][8] A systemic review concluded that the injectable fillers resulted in high satisfaction, however, further research is needed to determine the safety of its use.[9][10]
  • Hand rejuvenation. Dermal fillers can be used to add volume to the hands, which can help to reduce the appearance of veins and tendons.[11]


Risks of an improperly performed dermal filler procedure commonly include bruising, redness, pain, or itching. Less commonly, there may be infections or allergic reactions, which may cause scarring and lumps that may require surgical correction.[12] More rarely, serious adverse effects such as blindness due to retrograde (opposite the direction of normal blood flow) embolization into the ophthalmic and retinal arteries can occur.[13] Delayed skin necrosis can also occur as a complication of embolization.[14] Embolic complications are more frequently seen when autologous fat is used as a filler, followed by hyaluronic acid. Though rare, when vision loss does occur, it is usually permanent.[15]

Materials used

Fillers are made of polysacchides (such as hyaluronic acids),[16] collagens (which may come from pigs, cows, cadavers, or may be generated in a laboratory),[17] the person's own transplanted fat, and/or biosynthetic polymers. Examples of the latter include calcium hydroxylapatite, polycaprolactone, polymethylmethacrylate, and polylactic acid.[18] In 2012, "Artiste Assisted Injection System" was launched in the US market to assist in the delivery of dermal fillers. A study in 2013 concluded that the injecting device can achieve reductions in patient discomfort and adverse events by controlling the rate of flow of injection of the filler the practitioner is using to fill in the lips and frown lines.[19]

Hyaluronic Acid

Hyaluronan (Hyaluronic acid) is a common ingredient in injectable fillers. Hyaluronic acid fillers have become popular for soft tissue filling in recent years.[20][21]

  • Restylane: produced by Galderma, originally invented by Q-Med. Restylane is a dermal filler that can be used to restore volume and fullness to the skin, significantly reducing the appearance of fine lines and wrinkles. Restylane can be applied around the nose, lips, and wrinkles.[22]
  • Juvéderm: produced by Allergan. Juvederm is an injectable filler approved by the Food and Drug Administration. It is produced by Allergan.[23] Juvederm fillers are used in lips, nasolabial folds, marionette lines, cheeks, and tear troughs.[24]
  • Xspurt/Rejeunesse: produced by Forest Hills Lab Aesthetics (FHL Aesthetics), They are a non-animal based, crosslinked dermal filler using BDDE for linking agent made in South Korea[25].
  • Perfectha: produced by Sinclair Pharmaceuticals. Perfectha is an injectable filler of non-animal origin hyaluronic acid made in France.
  • Neuramis®: Produced by Medytox Inc., it is an injectable dermal filler based on hyaluronic acid approved by KFDA (Korean Food Drug Administration).
  • Artecoll
  • Yvoire


Collagen is the main structural component of the skin. Injectable collagen can come from xenotransplantation (pigs, cows), allografts (human donors), or it can be generated in a laboratory.

  • Zyderm 1&2, Zyplast (bovine)
  • Evolence (porcine)
  • Alloderm, Cymetra. Transplant tissue is processed to convert it into an acellular dermal matrix. This is achieved by removing the epidermis and dermal cells, and then converting the obtained dermal matrix into micronized particles.
  • Cosmoderm 1 & 2, Cosmoplast (laboratory cultivation)

Biosynthetic Polymers

They are authorized as facial fillers, in doses of 1 to 3 milliliters, and are administered by specialists in aesthetic medicine or plastic surgery.

  • Radiesse (calcium hydroxyapatite) is composed of microparticles of calcium hydroxyapatite (CaHA) suspended in an aqueous gel. Over time, the body gradually absorbs the gel.
  • Artefill (a mixture of polymethylmethacrylate, collagen, and lidocaine) is a synthetic polymer.
  • Sculptra (poly-L-lactic acid) is a absorbable filler, but long-lasting. It contains microspheres of Poly-L-Lactic Acid in gel form.

How It Works

Dermal fillers, also known as "injectables" or "soft tissue fillers," do exactly what their name suggests: they fill the area under the skin. Some fillers are natural and some are synthetic, but they all work to improve the appearance of the skin in the following ways:[27]

  • Filling in wrinkles, expression lines, and deep wrinkles
  • Improving imperfections such as scars
  • Plumping thin and wrinkled lips
  • Filling in cheeks
  • Changing the contour of the jaw and other areas of the face

In the case of hyaluronic acid, the filling effect is achieved through its properties, this compound is a viscous polysaccharide with high water retention capacity, so when injected, it accumulates liquid and fills the applied area.

See also


  1. ^ "Consumer Updates - Filling in Wrinkles Safely". Food and Drug Administration.
  2. ^ "Dermal Fillers (Soft Tissue Fillers)". Center for Devices and Radiological Health. Archived from the original on 2018-09-08. Retrieved 2018-03-14.
  3. ^ "How Long Do Dermal Fillers Last?". FillerSupplies. 2022-08-08. Retrieved 2023-05-02.
  4. ^ Bray, Dominic; Hopkins, Claire; Roberts, David N. (2010). "A review of dermal fillers in facial plastic surgery". Current Opinion in Otolaryngology & Head and Neck Surgery. 18 (4): 295–302. doi:10.1097/MOO.0b013e32833b5162. ISSN 1531-6998. PMID 20543696. S2CID 205831647.
  5. ^ "The Overview of Requirement for High Risk Cosmetic Devices in Different Countries". 2019.
  6. ^ Gooderham, Melinda; Solish, Nowell (2006-03-21). "Use of Hyaluronic Acid for Soft Tissue Augmentation of HIV-Associated Facial Lipodystrophy". Dermatologic Surgery. 31 (1): 104–108. doi:10.1111/j.1524-4725.2005.31020. ISSN 1076-0512. PMID 15720106. S2CID 22820504.
  7. ^ Moyle, GJ; Lysakova, L.; Brown, S.; Sibtain, N.; Healy, J.; Priest, C.; Mandalia, S.; Barton, SE (2004). "A randomized open-label study of immediate versus delayed polylactic acid injections for the cosmetic management of facial lipoatrophy in persons with HIV infection". HIV Medicine. 5 (2): 82–87. doi:10.1111/j.1468-1293.2004.00190.x. PMID 15012646.
  8. ^ Jagdeo, Jared; Ho, Derek; Lo, Alex; Carruthers, Alastair (2015-12-01). "A systematic review of filler agents for aesthetic treatment of HIV facial lipoatrophy (FLA)". Journal of the American Academy of Dermatology. 73 (6): 1040–1054.e14. doi:10.1016/j.jaad.2015.08.040. ISSN 0190-9622. PMID 26481056.
  9. ^ Sturm, Lana P.; Cooter, Rodney D.; Mutimer, Keith L.; Graham, John C.; Maddern, Guy J. (September 2009). "A systematic review of permanent and semipermanent dermal fillers for HIV-associated facial lipoatrophy". AIDS Patient Care and STDs. 23 (9): 699–714. doi:10.1089/apc.2008.0230. ISSN 1557-7449. PMID 19673594.
  10. ^ Sturm, Lana P.; Cooter, Rodney D.; Mutimer, Keith L.; Graham, John C.; Maddern, Guy J. (September 2009). "A Systematic Review of Permanent and Semipermanent Dermal Fillers for HIV-Associated Facial Lipoatrophy". AIDS Patient Care and STDs. 23 (9): 699–714. doi:10.1089/apc.2008.0230. ISSN 1087-2914. PMID 19673594.
  11. ^ | Fillercloud | Botox & Dermal Fillers Wholesale
  12. ^ Health, Center for Devices and Radiological. "Dermal Fillers" (WebContent). Food and Drug Administration. Retrieved 2015-03-07.
  13. ^ Ferneini, EM; Ferneini, AM (August 2016). "An Overview of Vascular Adverse Events Associated With Facial Soft Tissue Fillers: Recognition, Prevention, and Treatment". Journal of Oral and Maxillofacial Surgery. 74 (8): 1630–6. doi:10.1016/j.joms.2016.03.009. PMID 27067061.
  14. ^ Souza Felix Bravo, B; Klotz De Almeida Balassiano, L; Roos Mariano Da Rocha, C; Barbosa De Sousa Padilha, C; Martinezt Torrado, C; Teixeira Da Silva, R; Carlos Regazzi Avelleira, J (December 2015). "Delayed-type Necrosis after Soft-tissue Augmentation with Hyaluronic Acid". The Journal of Clinical and Aesthetic Dermatology. 8 (12): 42–7. PMC 4689510. PMID 26705447.
  15. ^ Beleznay, K; Carruthers, JD; Humphrey, S; Jones, D (October 2015). "Avoiding and Treating Blindness From Fillers: A Review of the World Literature". Dermatologic Surgery. 41 (10): 1097–117. doi:10.1097/dss.0000000000000486. PMID 26356847. S2CID 205583192.
  16. ^ Gold MH (2007). "Use of hyaluronic acid fillers for the treatment of the aging face". Clin Interv Aging. 2 (3): 369–76. doi:10.2147/cia.s1244. PMC 2685277. PMID 18044187.
  17. ^ Bray, Dominic; Hopkins, Claire; Roberts, David N. (2010). "A review of dermal fillers in facial plastic surgery". Current Opinion in Otolaryngology & Head and Neck Surgery. 18 (4): 295–302. doi:10.1097/MOO.0b013e32833b5162. ISSN 1531-6998. PMID 20543696. S2CID 205831647.
  18. ^ Liu, Michael H.; Beynet, David P.; Gharavi, Nima M. (June 2019). "Overview of Deep Dermal Fillers". Facial Plastic Surgery. 35 (3): 224–229. doi:10.1055/s-0039-1688843. ISSN 0736-6825. PMID 31189194. S2CID 189816072.
  19. ^ Lorenc, Z. Paul; Bruce, Suzanne; Werschler, William Philip (July 2013). "Safety and efficacy of a continuous-flow, injection-assisted device in delivery of dermal fillers". Aesthetic Surgery Journal. 33 (5): 705–712. doi:10.1177/1090820X13487372. ISSN 1527-330X. PMID 23671210.
  20. ^ "Use of hyaluronic acid fillers for the treatment of the aging face". 2007.
  21. ^ Usos Cosméticos del Ácido Hialurónico
  22. ^ "24-7 Press release, Restylane Effective at Reducing Signs of Aging". 28 July 2012.
  23. ^ "Medical news today, Allergan, Inc. Announces FDA Approval Of JUVEDERM(R) XC Dermal Filler Formulated With Lidocaine". 3 February 2010.
  24. ^ "Juvederm Dermal Fillers at Fillercloud".
  25. ^
  26. ^, ed. (30 June 2014). "Doctor Mek filler injections". EEUU: U.S. National Institutes of Health. Retrieved 5 April 2016.
  27. ^ Discovery Health. "How Dermal Fillers Work".


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