Dermal Fillers: Definition, Types, Approved Uses & Side Effects

Many people seek dermal fillers for smooth, plump, and youthful-looking skin. As we age, we naturally lose subcutaneous fat, especially on the face. This results in visible signs of aging, like crow’s feet near the eyes, smile lines, and saggy cheeks. There are many types of fillers, each intended to address particular issues and regions. Before choosing fillers, it’s important to speak with a proficient practitioner to find the best type and treatment plan for your specific needs.

What are dermal fillers?

Dermal filler injections consist of gel-like substances that are injected beneath the skin. They make the appearance of the skin smoother, fuller, or both. They aid in reducing wrinkles and gaining a youthful appearance with minimal recovery time and fast-appearing results.

The longevity of dermal fillers may last from months to many years, depending on the type and location of the fillers. Their effects are temporary because they are made from absorbable materials that the body can break down easily, so you may need to repeat the injection to maintain the desired results. One kind, however, consists of polymethylmethacrylate (PMMA) plastic beads suspended in bovine collagen. PMMA is a non-absorbable, permanent filler that the body does not break down.

What are the types of fillers?

Various types of fillers are available, ranging from those that use your own fat, extracted from one area and injected into another in a procedure called “autologous fat grafting,” to “off-the-shelf” fillers containing synthetic materials naturally present in the body.

Hyaluronic acid (HA) dermal fillers

Your skin, connective tissues, and joint fluids naturally contain HA, which maintains hydration and volume but diminishes with age, leading to volume loss and wrinkles. HA-based dermal filler injections, such as the common type Restylane®, restore skin fullness, smooth fine lines, and improve scars. Results last from 6 to 12 months. With different formulations for varying wrinkle depths, HA fillers are a safe and popular choice for minimally invasive solutions for rejuvenation and contouring.

Calcium hydroxylapatite (CaHA) dermal fillers

CaHA, found naturally in human bones, is a mineral-like compound used to treat deeper wrinkles, enhance cheek volume, and contour the jawline. A brand name like Radiesse® offers results that last up to 3 years for wrinkle filling and about a year for contouring. It gives natural-looking results, demonstrates good stability without migration, has rare side effects, minimal allergic reactions, and a proven safety record from its use in dentistry and reconstructive surgery.

Poly-L-lactic acid (PLLA) dermal fillers

PLLA is a biodegradable synthetic dermal filler that stimulates collagen production to smooth deep wrinkles and plump areas like thin lips, lines caused by laughing, and deep nasolabial folds. It was originally developed to treat extensive facial wasting in HIV infection. Results can last up to two years as the skin gradually improves over several months. Types of PLLA fillers include Sculptra® for optimum effect used for three monthly treatments. A long-lasting solution for facial rejuvenation is provided by PLLA.

Polymethylmethacrylate (PMMA) dermal fillers

PMMA dermal fillers, like Bellafill®, combine the collagen-based gel with tiny microspheres suspended in it,  providing lasting volume and structure support to give smoother and firmer skin. It is used for medium to deep wrinkles, pitted scars, lip enhancement, and nasolabial folds. PMMA offers a semi-permanent solution often preferred over other fillers for long-term results because it is non-absorbable or permanent. Although it necessitates several injections and takes around three months to show full results, its resilience is highly valued, making it ideal for those seeking long-lasting facial rejuvenation.

Human fat

The autologous fat grafting procedure involves removing fat from your body by liposuction, purifying the fat, and reinjecting it into the face. It restores lost volume, smooths deep creases, and improves contours. Despite being more complicated than off-the-shelf fillers, it’s effective but requires a recovery time of up to two weeks. The outcomes depend on the patient and injection site. Fat grafting provides lasting benefits, but it is important to carefully evaluate and consult with a qualified healthcare professional before proceeding.

FDA approved fillers and applications

All types of fillers we mentioned earlier are FDA approved fillers, such as hyaluronic acid, calcium hydroxylapatite,….etc. These fillers are approved for use in adults over 21 years old for certain applications, such as:

• The FDA approves temporary fillers such as hyaluronic acid, calcium hydroxylapatite, and poly-L-lactic acid for treating moderate to severe wrinkles and folds on the face, including perioral lines around the lips and mouth, and nasolabial folds that extend from the sides of the nose to the corners of the mouth.
• Dermal fillers are approved for augmentation ( adding more volume) in many body sites, such as lips filler, chin augmentation filler, and cheeks filler.
• The FDA approves permanent or non-absorbable fillers, like Polymethylmethacrylate (PMMA), solely for treating acne scars in the cheeks and nasolabial folds.
• Facial wasting in HIV infection to restore lost volume due to facial fat loss known as lipoatrophy.
• Resolving deficiencies in contours like wrinkles and acne scars.

FDA unapproved dermal fillers 

The FDA does not approve injectable silicone or fillers used for body contouring or enhancement. It also advises against using filler injections in areas like the breasts, buttocks, or between muscles. Injectable fillers can cause major harm, such as permanent scarring or deformity, and may cause persistent harm to the skin, lips, or eyes, chronic pain, and infection, and may even cause death when used for large-scale or extensive body contouring or enlargement.

Needle-free devices for dermal filler injections are not FDA approved. These devices use injectors that produce high pressure making it difficult to regulate the filler’s placement leading to serious injuries and potentially may lead to persistent harm to the skin, lips, or eyes.

Lip or facial fillers that are sold directly to the public may contain harmful chemicals and infectious organisms and the FDA warned against them. Approved dermal fillers are provided only with a prescription and injected by a licensed healthcare provider using a syringe with a needle or cannula, not needle-free devices.

Dermal fillers side effects or complications

Dermal fillers may cause temporary, permanent, or both types of side effects. Most of these occur after injection and may improve in a few days to weeks. Fortunately, serious side effects are rare, but when they occur, they last up to a year. However, every cosmetic surgery carries risks, which may include:

• Bruises, discomfort, redness, and swelling.
• Appearance asymmetry.
• Scarring due to skin damage.
• Infection that, in extreme circumstances may result in necrosis (death of affected skin).
• Lumps or pimples beneath the skin.
• Numbness, swelling, allergy, itching, and rash.
  

If you decide to have dermal fillers for lips, eyes, jawline, wrinkles, or even facial wasting you must choose a professional practitioner to ensure the proper choice of filler type and technique and get the optimum results. Take into consideration the FDA approved dermal fillers and discuss with your provider how long dermal fillers last and the possible side effects. Some of these fillers may be difficult or impossible to remove so make sure of your choice before proceeding.

Resources 

https://www.fda.gov/consumers/consumer-updates/dermal-filler-dos-and-donts-wrinkles-lips-and-more
https://my.clevelandclinic.org/health/treatments/22667-dermal-fillers
https://www.plasticsurgery.org/cosmetic-procedures/dermal-fillers/types
https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers
https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/fda-approved-dermal-fillers 
https://www.fda.gov/consumers/consumer-updates/dermal-filler-dos-and-donts-wrinkles-lips-and-more