What Are Dermal Fillers?
Injectable implants used to add volume or alter contour. Materials and reversibility differ; accidental injection into a blood vessel can cause tissue death, stroke, or permanent blindness.
Overview
Dermal fillers are injectable implants used to add volume, smooth selected folds, or change facial contour. Products include hyaluronic acid (HA), calcium hydroxylapatite, poly-L-lactic acid, polymethylmethacrylate, and other materials. They differ in approved area, depth, duration, tissue response, and whether they can be dissolved.
HA is not the same as every filler
Hyaluronic-acid filler can often be broken down with hyaluronidase, although correction may require repeated treatment and does not guarantee recovery from vascular injury. Biostimulatory or permanent materials cannot be simply dissolved. Ask what happens if the result is poor or a delayed nodule develops.
Vascular occlusion is the critical emergency
Accidental intravascular injection can block blood flow and cause skin necrosis, stroke, or blindness. Visual loss may be permanent and has no reliably effective rescue. Severe or escalating pain, blanching, dusky or mottled skin, visual change, weakness, or speech trouble requires immediate action.
Long-term considerations
Fillers can persist longer than their advertised cosmetic effect and may migrate, form nodules, become infected, or complicate later treatment and imaging. Repeated sessions can create cumulative volume and cost. Keep a record of every product, location, amount, lot, and date.
Benefits
Can restore or alter volume without surgery
Offers products with different textures and durations
HA fillers may be adjustable or dissolvable
Results are visible relatively quickly for many products
Can be staged conservatively by area and goal
The Procedure
1
Assessment and product history
2
Verify product and emergency plan
3
Conservative injection
4
Observe and follow up
Preparation
Provide a complete history of fillers, implants, facial surgery, dental procedures, cold sores, infection, allergies, autoimmune disease, medications, pregnancy, and prior reactions. Do not stop anticoagulants without the prescriber.
Recovery & Aftercare
Swelling, tenderness, firmness, and bruising can last days and sometimes longer by product and area. Follow specific instructions. Any visual symptom, severe pain, blanching, mottling, fever, or rapidly worsening swelling needs immediate assessment.
Risks & Considerations
Bruising, swelling, pain, asymmetry, poor result, infection, reactivation of cold sores, nodules, granulomas, migration, delayed inflammation, tissue injury, and need for dissolution or surgery. Rare intravascular injection can cause necrosis, stroke, or permanent blindness. Some materials are difficult or impossible to remove.
Frequently Asked Questions
References
[1]
FDA. Dermal Filler Risks and Clinical/Regulatory Considerations.
https://www.fda.gov/media/188185/download[2]
American Society for Dermatologic Surgery. Injectables and Patient Safety.
https://www.asds.net/skin-experts/skin-treatments/injectables/dermal-fillers[3]
ASDS Guidelines of Care for Minimizing Risks of Filler-Associated Visual Compromise.
https://pubmed.ncbi.nlm.nih.gov/32503058/
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