Soft Tissue fillers are substances designed to help rejuvenate the aging face with a goal of restoring a more youthful appearance. They are used to fill lines and wrinkles, such as those found near the nose and mouth (nasolabial and marionette lines). Fillers can help enhance shape and definition to areas such as the lips and jaw line and are also used to restore fullness (volume) to cheeks, temporal areas and under the eyes. They are injected at varying depths into the skin and soft tissues and while the majority of fillers are used in the face, they can also help restore/rejuvenate other areas such as the hands and decollate.
There are a number of different types of soft tissue fillers available today and the most widely used are known as hyaluronic acid or HA fillers. Hyaluronic acid is a naturally occurring substance fund in many parts of the body with the greatest percentage found in the skin. Hyaluronic acid binds with water to give the skin a full, plumped appearance. It also protects and lubricates the skin. As one ages, the amount of hyaluronic acid decreases which can make the skin drier and less supple. There are a dozen different HA soft tissue fillers available in the US today. Some contain lidocaine which acts as an anesthetic making the injections more comfortable. Manufacturing processes differ among the HA products thus they have different FDA-approved indications. Manufacturing differences also impact the longevity of the HA fillers; some last as little as 6 months while others can last up to 24 months. One reason HA fillers have become so popular is that they are quickly reversible; if the results are not acceptable, the product can be removed by a tiny injection of a substance (hyaluronidase) that will almost immediately dissolve the filler.
There is another group of products available which are often referred to as collagen-stimulating fillers. These contain synthetic, biodegradable materials which stimulate the production of the body’s own collagen. These products can last from 12-24 months. Finally, there is one FDA-approved product classified as a permanent filler. The product contains tiny microspheres of a synthetic resin suspended in a bovine collagen, lidocaine mixture. This product lasts 5 years or more.
In the right hands, soft tissue fillers can help restore a more youthful appearance to your face. These products can fill lines, wrinkles and deeper facial folds or other depressions such as acne scars.
HA fillers can add volume and improve the shape of facial features such as the midface and chin. They can also enhance the fullness of the lips and define the lip border, or create a “Cupid’s bow.” They are often used to fill the hollow under the eyes and can be used to shape the brow and provide volume to the cheeks.
Treatment with collagen-stimulating products can add volume and improve the appearance of deeper facial folds or other depressions such as concave scars. They can also be used to add volume and improve the shape of facial features such as the cheeks, midface and chin.
Permanent fillers are more often used for deeper facial folds or lines.
U.S. FDA-Approved Soft Tissue Fillers
|Product Name||Year Approved||Notes|
|Zyderm||1981||Animal-based collagen – No longer available|
|Zyplast||1985||Animal-based collagen – No longer available|
|CosmoDerm/CosmoPlast||2003||Human-based collagen – No longer available|
|Evolence||2003||Animal-based collagen – No longer available|
|Hyaluronic Acid (HA) Fillers|
|Juvéderm Ultra and Ultra Plus||2006|
|PREVELLE Silk||2008||Contains lidocaine (anesthetic)|
|Hydrelle||2009||Contains lidocaine. Formerly known as Elevess, which was approved in 2007|
|Juvéderm Ultra XC/Ultra Plus XC||2010||Contain lidocaine (anesthetic)|
|Restylane-L and Perlane-L||2010||Contain lidocaine (anesthetic)|
|Juvéderm Voluma||2013||Contains lidocaine|
|Restylane Silk||2014||Contains lidocaine|
|Collagen Stimulating Fillers|
(Poly-L-lactic acid – PLLA)
|2004||Launched in 2004 with an indication for patients with lipoatrophy. Received aesthetic indication in 2009|
|Radiesse (Calcium hydroxylapatite – CaHA)||2006||Available and used prior to 2006; however this was the year Radiesse received a cosmetic indication from the FDA|
|ArteFill (Polymethylmethacrylate – PMMA)||2006||First and only permanent soft tissue filler available in the US|
- Your doctor may massage or manipulate the area where the filler has been placed
- The treated area may be cleansed again
- You may be given ice or cold packs to place on the treated area to minimize swelling and bruising
- The entire treatment process may take 20 to 30 minutes or more
After Your Injections
- You may experience mild swelling or bruising from any type of injection. Ice or cold packs can help to minimize swelling or discomfort
- You can generally apply make-up over the treated area immediately
- Hyaluronic acid fillers may result in 3 to 7 days of swelling, redness and post-injection bruising
- Collagen stimulating or permanent soft tissue fillers may result in 5 to 7 days of swelling, redness and post-injection bruising
- If you have received Sculptra treatment, your results will develop over the coming weeks. You may require 2 to 3 treatments spaced apart to gain the improvement you desire
Your results are visible immediately. However, due to swelling, you may look a little fuller than you might expect. This will improve rapidly over the next few days.
- The improvement from HA fillers can be variable since the concentration of hyaluronic acid in each product differs. Results with Restylane, Juvéderm Ultra and Ultra Plus, and Perlane typically last between 6-12 months while the results with Prevelle Silk may be slightly less. Juvéderm Voluma has been shown, in some cases, to last up to 24 months.
- Studies have shown that the improvement with some HA fillers can be enhanced if you get treated again between 6-9 months after your first treatment. Restylane has shown longevity to 18 months with re-treatment
- The improvement from Radiesse and Sculptra begins to disappear within 12-18 months after treatment
- Artefill is considered a permanent treatment thus results are still noticeable 5 years post-treatment
If you do not repeat treatment once your results have begun to diminish, or as directed by your doctor, your appearance will return to its pre-treatment state.
Commonly injected sites
Questions to Ask Your Doctor
- What is your board certification?
- How were you trained to do injectable treatments?
- Do you regularly provide soft tissue filler treatments?
- How many people have you treated with a condition similar to mine?
- Will you personally inject me? If not, what are the qualifications of the person who will?
- Exactly what name brand of injectable do you recommend for me?
- Is it U.S. FDA approved specifically for cosmetic purposes?
- May I see the packaging to verify the brand name?
- Did the product come from the manufacturer or did you get it elsewhere?
- Are there any precautions I should take before my injectable treatment?
- What type of anesthetic is available, and what is your preferred means of anesthesia?
- What can I expect to experience after my treatment?
- How do you treat any problems that may arise?
- What are the potential risks of treatment?
- How long will my results last?
- What if I am not satisfied with my results – what options do I have?