How to Choose a Dermal Filler

Dermal fillers can be used to sculpt the face and restore a natural, youthful look. It is very important to find an injector with an artistic eye combined with skill and experience. Fillers are used to erase wrinkles, plump the lips, add volume to the face and to hide scars caused by acne, surgery and trauma. Fillers do not affect muscle motion or facial expression the way that botulinum toxins like Botox, Dysport, and Xeomin do. When fillers are injected properly by a skilled injector, they look very natural and undetectable.  

What Are the Different Types of Dermal Fillers?

How to Choose a Dermal Filler

Filler injections can be performed quickly and safely with minimal discomfort, and some also provide instant results. There are many types of fillers available on the market.

Hyaluronic Acid (HA)

Hyaluronic acid is a naturally-occurring sugar found in the skin that helps skin hold onto water. It is broken down by natural processes and has a positive long-term effect on the skin by coaxing skin cells to produce youthful substances such as collagen and more HA. Using HA injections in the skin may help to prevent some of the signs of skin aging. HA can be broken down within hours using an injection of hyaluronidase, a naturally occurring enzyme. Therefore, the results are completely reversible, making this my favorite type of dermal filler. There are three main families of HA fillers:

  • Restylane products: Restylane products are stiffer and more cohesive, meaning that they hold together better, than most of the other fillers. They are ideal for providing structural support to the face. Restylane products are divided into three formulas (based on density, texture and depth of application) and are chosen depending upon the area that needs structural support.
  • Restylane Silk is ideal for enhancing the outline of the lips, augmenting the volume of the lips and filling in the lines around the mouth. Results last from six to nine months.
  • Restylane is used for nasolabial folds (the parentheses lines between the nose and the mouth) and marionette lines (the lines from the corner of the mouth down to the sides of the chin). Results last from six to nine months.
  • Restylane Lyft is used to lift sagging facial skin, add volume to the midface and to define the chin and the jawline. It is a great product to give men a more chiseled or defined jaw appearance. Results last from 12 to 18 months.
  • Juvéderm products: Juvéderm products are softer and more moldable than most of the other fillers. They are ideal for adding volume to various areas of the face. Juvéderm products are also divided into three formulas that are chosen depending upon the area that needs increased volume.
  • Volbella is the newest of the dermal fillers. It is ideal for subtly plumping the lips and filling fine lines. Results last for up to a year.
  • Juvéderm is used for nasolabial folds and the marionette lines. Results last for up to a year.
  • Voluma is used to add soft, natural-looking volume to the midface. Results last for up to two years.
  • Belotero: Belotero is a very small HA-containing dermal filler that is best used for erasing tiny lines on the face, such as crow’s feet and forehead lines. Because it is placed very superficially, expect bruising for at least a week. Results last from nine to 12 months, depending on where it’s placed.


Radiesse is made from calcium hydroxylapatite, which has been safely used for many years for facial reconstruction. It is used as a structural filler to enhance the cheekbones and jawline, and to improve the appearance of facial folds. This filler can be seen in x-rays and is not comprised of natural components of the skin, and it cannot be reversed with hyaluronidase. Results last from one to one-and-a-half years.


Unlike other fillers, Sculptra is a “dermal stimulator.” This means it stimulates your skin to produce collagen on its own. Sculptra differs from the above mentioned dermal fillers because it does not offer instant gratification in the form of immediately visible results. Sculptra is injected once a month. For the first two months, you will see minimal to no improvement. After three months of injections, you will begin to see increased volume and improvement in the appearance of lines. Injections are performed every month until the desired outcome is achieved, which usually takes three to eight injections. Once the desired result is reached, results usually last from two to three years. Dermal stimulators can be combined with dermal fillers to achieve both immediate short-term improvement and delayed long-term correction.


This collagen-based injectable provides a long-lasting solution for acne scars. It delivers instant results as well as continued improvement over time, and results can last for up to five years. This filler usually is injected once a month for two to three months. After each injection, you will experience swelling and bruising, and acne scars may actually look worse for a few weeks until the swelling subsides. We wait four weeks between treatments to give the skin time to make collagen, which in turn fills in the scars. This treatment works best on rolling and boxcar acne scars and does not work well on ice pick scars. This treatment is not reversible.

What Are the Risks?

You should plan to not have any important social events for two weeks after dermal filler injections in the event of bruising or swelling. The risk of bruising can be increased by ibuprofen, aspirin, alcohol and omega-3 fatty acids, so avoid these for at least 10 days before your injections. If bruising occurs, it may take seven to 10 days to fade. Redness and swelling can occur for one to three days, or up to two weeks if more than four syringes are used. Sculptra injections can cause small lumps under the skin. Please see the package insert of each product for a complete list of unexpected risks. Patient labelling information is often available on product websites for consumer education.

How Long Will Results Last?

HA filler results generally last from six months to two years, depending on how many syringes are injected and the type of HA filler used. The more that is injected and the more frequently it is injected, the longer it lasts. Touch-up treatments are often needed sooner. We recommend getting treatments twice per year because it’s better to do a few syringes more frequently rather than more syringes once a year to maintain a consistent appearance. If you lose weight or your skin develops excess sagging due to smoking, sun exposure or improper skincare, you may need injections more often.

Who Cannot Get Dermal Fillers?

You should not get dermal filler injections if you are allergic to lidocaine or hyaluronic acid, are pregnant, breastfeeding, have a herpes blister in the area to be treated, or if you have a disorder that prevents blood from clotting. If you have a social event, we recommend that you schedule injections two weeks prior.

Pricing and Touch-Ups

The price is determined by the number of syringes required and the type of filler used. Studies show that doing “touch-ups” of fillers at two weeks may increase how long they last. For this reason, we often choose to layer fillers over two visits spaced two weeks apart.

The Bottom Line

If you go to a doctor with both ample experience and artistic skills, you will love the very natural-looking results that dermal fillers offer, and we hope that you will refer all of your friends to us to help improve their look, too! Our goal is to make you look fabulous and natural. To find a doctor in your area that I have trained on how to properly inject fillers, visit


Dr. Leslie Baumann, M.D. and her team at Baumann Cosmetic Dermatology believe in proof, not promises. World-recognized for both cosmetic and general dermatology, our treatment strategies rely exclusively on evidence-based, scientifically verified products and procedures that promote skin health and a natural appearance. We combine effective medical procedures with individualized instruction on proper skincare, nutrition, supplementation and lifestyle in order to maximize the health of the skin and body as a whole while minimizing the effects of aging. For more, visit Dr. Baumann’s blog for daily updates Monday through Friday, or inquire about an appointment through

January 13, 2017 Dermal Fillers