What Are Facial Filler and How Do They Work?

Fillers are often made of naturally occurring substances in the skin that are lost over time. Hyaluronic acid (HA) is the most common type of filler, and it is also what makes up the base substance of our skin. Babies, for instance, have a ton of HA, which is why they have nice, round cheeks. As we age, we lose volume^[1] in our faces, which can cause lower face laxity and wrinkles. It’s like your face is a balloon being deflated, and injectable fillers can help to "re-inflate" it. There are many different fillers for achieving different goals. Each filler is specifically engineered to be used in specific areas of your face, such as your cheeks, tear troughs, temples, nasolabial folds, lips, lip lines, etc. The type of dermal filler utilized should be catered to each individual patient.

What are the Different Types of Fillers and How Long Do They Last?

Think of your skin like a tablecloth draped over a table. As we age, the table underneath starts to collapse, and the tablecloth starts to droop. As we age, we lose bone and subcutaneous tissue, and our faces transform from round shapes with full cheeks and rounded cheekbones to thin shapes with hollowed cheeks and temples and flattened cheekbones. Longer-lasting, thicker fillers help restore your skin by giving it the underlying structural support that is lacking, while shorter-term fillers are best for smoothing and softening, rather than restructuring. 

The length of time a filler lasts depends on the properties of that filler, and all fillers are different. Some are made to be injected deep into the skin, while some are engineered to be injected more superficially. Some fillers are thick and firm, and some are softer and thinner. For example, to restore structural volume loss in the upper and mid-face and “lift” the sagging skin below, a more robust, deeper filler is used. Alternately, to promote a soft plumping of the lips or fill a fine line around the lips, a thinner, more superficial filler will be used. These filler effects will vary in longevity depending on their unique purpose.

Some fillers last 6-12 months while some last two years. Most commonly, HA fillers are used for treating nasolabial folds (the parenthesis lines that extend from your nose to the corners of your mouth), lip augmentation, and lip wrinkles. These fillers typically last 6-12 months; however, this timeframe will vary from patient to patient. Fillers used to address the mid-face, on the other hand, typically last two years. The good news is, there have been some recent advances in filler technology to make them last longer.

Like HA fillers, calcium hydroxyapatite fillers also typically last 6-12 months and are used to restore volume on the mid- and lower-face, fill in wrinkles, and rejuvenate aging hands. Poly L lactic acid is another filler used to restore volume to the mid-face and temples to give your face a more youthful shape and lift any sagging skin.  Depending on the molecular structure of the product, you will see terms like “G prime” or  “cohesivability,” which describe how firm or soft the filler is. Ultimately, while it’s good to know your options, your doctor will help you choose the right filler based on your individual needs.

What Can You Expect After Filler Injections?

Immediately after filler injections, there may some short-lived redness and tenderness at the injection sites. Over the next 24 hours, localized swelling can occur and may feel like little “balls” under the skin. This goes away and is purely inflammation, not “clumped” or “lumpy” filler. That said, DO NOT squeeze or push on these inflamed areas within the first 48 hours, as doing so can make the swelling worse and may push the filler out of the inflamed area. Your practitioner may gently massage the area treated immediately after to ensure a smooth, even distribution of the product; however, do not try the same at home unless your doctor tells you to!

The most common adverse effect of fillers is bruising, which can last for two weeks. As with any injectable, avoiding things like ibuprofen, fish oil, blood-thinning medication, aspirin, and flaxseed will decrease this risk. If you have been prescribed blood-thinning medications, you should not stop them. Usually the risk of stopping necessary medications prescribed by your doctor outweighs the risk of bruising, so it is not advised that you stop these agents. However, avoidance of any non-essential blood thinning supplements is advised for ten days prior. Taking arnica, a supplement derived from pineapple, in an oral or topical form might help to minimize bruising, although the research on this is still unclear.^[2] Bruises range in severity. Some are easily covered with makeup, while others may be darker, larger or more severe (typically a side effect of blood thinning agents). Bruising from fillers can also be easily treated with a pulsed dye laser, which dramatically expedites the removal of the bruise, but must be performed within a window of 48 hours after the filler injection.  

All in all, fillers can be a fantastic solution for those looking to “lift” their facial skin without undergoing a facelift, or smooth and soften lines and creases. Just make sure you speak with your doctor about filler duration, bruising, and any other concerns you may have prior to receiving fillers for an optimal cosmetic experience!