The Complete Guide to Dermal Fillers

What Are Dermal Fillers?

Dermal fillers are injectable treatments that restore volume, smooth wrinkles, and enhance facial contours by placing a gel-like substance beneath the skin. They are one of the most popular non-surgical aesthetic treatments in the world — and for good reason. When performed by a skilled injector, fillers can produce natural-looking improvement that turns back the clock without surgery, incisions, or significant downtime.

Understanding how fillers work, what types are available, and how they are used is essential for making informed decisions about your treatment. This guide covers everything you need to know, from the science behind different filler types to what the injection experience is actually like, so you can approach your consultation with confidence.

Understanding Facial Aging and Volume Loss

To appreciate what fillers can do, it helps to understand why the face changes with age. Facial aging is not just about skin — it involves changes at every layer, from bone to fat to muscle to skin.

Bone resorption. The facial skeleton actually shrinks with age. The eye sockets widen, the cheekbone loses projection, and the jawbone recedes. These skeletal changes create the appearance of hollowing and sagging even before any skin changes occur.

Fat pad descent and deflation. The face contains distinct compartments of fat that provide youthful fullness and contour. Over time, these fat pads shrink (deflate) and shift downward (descend), causing volume loss in the cheeks and temples and contributing to jowling, nasolabial folds, and under-eye hollows.

Collagen and elastin loss. Beginning in your mid-20s, the skin produces less collagen and elastin each year — the structural proteins that keep skin firm and elastic. This gradual decline leads to thinner, less resilient skin that wrinkles more easily and does not "bounce back" the way it once did.

Skin thinning and laxity. The combination of structural protein loss, gravity, and repetitive facial movement leads to progressively thinner, looser skin that drapes differently over the changing framework beneath it.

Dermal fillers address these changes by restoring volume where it has been lost, supporting structures that have shifted, and smoothing the lines and folds that result from this multi-layered aging process.

Types of Dermal Fillers

Not all fillers are the same. Different filler types have different properties — consistency, duration, behavior in tissue, and mechanism of action — that make them suited to different purposes. Understanding these categories helps explain why your provider may recommend specific products for specific areas.

Hyaluronic Acid (HA) Fillers

Hyaluronic acid is a naturally occurring sugar molecule found throughout your body, with the highest concentrations in the skin, joints, and eyes. HA fillers are the most widely used category and include brand families like Juvederm, Restylane, and Belotero.

How they work: HA fillers add immediate volume by attracting and binding water molecules. The gel is injected beneath the skin, where it integrates with the tissue and provides structural support and hydration.

Key advantages:

• Reversible — HA fillers can be dissolved with hyaluronidase (an enzyme) if needed, providing a safety net that other filler types do not offer
• Predictable — Decades of clinical use have established well-understood behavior and safety profiles
• Versatile — Available in a wide range of formulations, from thin and fluid (for fine lines and lips) to firm and structured (for cheek augmentation and jawline contouring)
• Natural feel — HA integrates well with tissue and, when properly placed, feels soft and natural

Duration: 6 to 18 months depending on the specific product, treatment area, and individual metabolism. Products used in high-movement areas like the lips tend to break down faster, while those placed in deeper planes for structural support last longer.

Common brands and their specialties:

• Juvederm Voluma — Firm, cohesive gel for cheek augmentation and deep volume restoration
• Juvederm Ultra/Volbella — Softer formulations for lips, perioral lines, and delicate areas
• Restylane Lyft — Structured HA for midface volume and chin augmentation
• Restylane Silk/Kysse — Designed specifically for lip enhancement with natural movement
• Belotero Balance — Ultra-smooth formulation that integrates seamlessly for fine lines

Calcium Hydroxylapatite (CaHA) Fillers

Calcium hydroxylapatite is a mineral that naturally occurs in bone. The filler (brand name: Radiesse) consists of CaHA microspheres suspended in a water-based gel carrier.

How they work: Radiesse provides immediate volume from the gel carrier, then offers a second phase of improvement as the CaHA microspheres stimulate your body's own collagen production over the following months. As the gel carrier is absorbed, the newly produced collagen takes its place — meaning the improvement transitions from filler-derived to your own natural collagen.

Best for: Deep facial wrinkles, cheek augmentation, jawline contouring, hand rejuvenation, and areas where both volume and collagen stimulation are desired.

Duration: 12 to 18 months, often longer in areas with less movement.

Important note: CaHA fillers are not reversible with an enzyme, so precise placement by an experienced injector is essential.

Poly-L-Lactic Acid (PLLA) Fillers

PLLA (brand name: Sculptra) works differently from HA and CaHA fillers. Rather than adding immediate volume, PLLA stimulates your body's collagen production over time, producing a gradual, natural-looking improvement that develops over weeks to months.

How they work: PLLA microparticles are injected beneath the skin, where they trigger a controlled inflammatory response that stimulates fibroblasts (collagen-producing cells) to generate new collagen. The PLLA itself is gradually absorbed, leaving behind a matrix of your own collagen.

Best for: Global facial volume loss (temples, cheeks, lower face), patients who want subtle, gradual improvement that does not look "done," and those seeking long-lasting results without frequent touch-ups.

Duration: Up to 2 years or longer. Because the result is your own collagen, it tends to last significantly longer than HA fillers.

Treatment protocol: Sculptra typically requires 2 to 3 injection sessions spaced 4 to 6 weeks apart to achieve optimal results. The gradual onset means that results build progressively — most patients see the full effect at 3 to 6 months after their last session.

Polymethylmethacrylate (PMMA) Fillers

PMMA (brand name: Bellafill) is the only FDA-approved permanent filler. It contains tiny PMMA microspheres suspended in a collagen-based gel.

How they work: The collagen gel provides immediate volume, while the PMMA microspheres remain permanently in the tissue, serving as a scaffold for the body to build collagen around. Over time, the body's own collagen encapsulates the microspheres, creating lasting structural support.

Best for: Deep nasolabial folds and moderate to severe acne scars in patients who want permanent correction and have previously tolerated temporary fillers well.

Duration: Results are considered permanent, though some patients may desire periodic touch-ups for optimization.

Important considerations: Because PMMA is permanent, it requires an experienced injector, a thorough consultation, and typically a trial with temporary filler first to confirm the desired result before committing to a permanent solution.

Strategic Filler Placement: The Art of Facial Balancing

The most important development in filler technique over the past decade is the shift from treating individual lines to treating the face as a whole. This approach — often called facial balancing or the MD Codes system — recognizes that the most natural, effective results come from addressing the underlying structural causes of aging rather than simply filling in the surface-level symptoms.

The structural approach starts deep and works superficially. Rather than injecting filler directly into a nasolabial fold (which can produce an unnatural, overfilled look), a skilled injector may instead restore volume to the cheek — which lifts the fold from above, producing a more natural improvement.

Common treatment areas and strategies include:

Cheeks and midface — Restoring the "apple" of the cheek and the zygomatic arch creates a natural lifting effect that improves the entire lower face. This is often the foundation of a comprehensive filler treatment.

Temples — Temple hollowing is one of the earliest and most aging changes, yet it is frequently overlooked. Restoring temple volume creates a smoother transition from the forehead to the cheek and can make the eyes appear more youthful.

Under-eye area (tear troughs) — Hollowing beneath the eyes creates dark circles and a tired appearance. Carefully placed HA filler can smooth the transition between the lower eyelid and the cheek, reducing shadows and restoring a rested look. This is one of the most technically demanding injection areas and should only be performed by highly experienced injectors.

Lips — Modern lip augmentation focuses on proportion, symmetry, and natural movement rather than maximum volume. The goal is to enhance the lips in a way that looks balanced with the rest of the face — fuller and more defined, but still naturally "you."

Jawline and chin — Filler along the jawline can sharpen a soft or undefined jaw contour, while chin filler can improve facial balance by adding projection and length. These structural applications of filler can produce significant improvement in overall facial harmony.

Nasolabial folds and marionette lines — While these areas can be treated directly, the best results often come from a combination approach: structural support in the cheeks and midface to lift the folds, with a small amount of filler placed directly in the folds for residual smoothing.

What to Expect During Treatment

Before Your Appointment

Your filler experience begins with a consultation where your provider evaluates your facial anatomy, discusses your concerns and goals, and recommends a treatment plan. This is the time to ask questions, review before-and-after photos, and discuss what kind of results are realistic for your anatomy.

To prepare for injection, you may be advised to avoid blood-thinning medications and supplements (aspirin, ibuprofen, fish oil, vitamin E) for several days beforehand, as these can increase bruising risk. Alcohol should also be avoided for 24 hours before treatment.

During Treatment

The injection process typically takes 15 to 45 minutes depending on the number of areas treated.

Numbing. Most HA fillers contain lidocaine (a local anesthetic) within the gel, which numbs the area as the filler is injected. Additional topical numbing cream or nerve blocks may be applied for sensitive areas like the lips.

Injection technique. Your provider uses fine needles or blunt-tipped cannulas to place the filler at the correct depth and location. Cannulas — which enter through a single point and glide through tissue — can reduce bruising risk and are often preferred for larger areas. Needles provide greater precision and are used for detailed work.

During injection, you may feel pressure, mild pinching, or a dull ache. Most patients find the procedure very tolerable, especially with the built-in anesthetic. Your provider will pause periodically to assess symmetry, adjust placement, and confirm that the result is developing as planned.

Immediately After Treatment

You will be able to see immediate improvement, though some swelling is expected — particularly in the lips and under-eye area. Your provider may gently massage certain areas to ensure smooth distribution.

Common post-treatment effects include:

• Mild swelling (most pronounced for 24-48 hours)
• Possible bruising at injection sites (typically resolves within 5-10 days)
• Tenderness when pressing on treated areas
• Temporary firmness or lumpiness that smooths out as the filler settles

Most patients return to their normal activities immediately. You will be advised to avoid strenuous exercise, excessive heat (saunas, hot yoga), and alcohol for 24 hours, and to avoid pressing or massaging the treated areas for the first few days.

Results and Longevity

Filler results are visible immediately, though the final result becomes apparent once any swelling resolves — typically within 1 to 2 weeks. The treated areas will look refreshed, balanced, and natural when the work is done well.

How long your results last depends on the filler type, the treatment area, and your individual metabolism:

• Lips: 6-9 months (higher metabolism due to constant movement and blood flow)
• Nasolabial folds: 9-12 months
• Cheeks: 12-18 months (Voluma) or up to 2+ years (Sculptra)
• Jawline and chin: 12-18 months
• Tear troughs: 9-15 months

Maintenance treatments — often requiring less product than the initial session — can sustain your results over time. Many patients develop a maintenance schedule that keeps them looking consistently refreshed.

Safety Considerations

Dermal fillers have an excellent safety profile when performed by qualified, experienced providers. However, they are medical procedures that carry risks, and understanding these risks is part of making an informed decision.

Common side effects include temporary swelling, bruising, redness, and tenderness at injection sites. These are expected and resolve on their own within days.

Rare but serious complications include vascular occlusion — where filler inadvertently enters or compresses a blood vessel, potentially compromising blood flow to tissue. This is the most serious risk of filler injection and is why choosing an experienced provider with thorough knowledge of facial vascular anatomy is critical. Board-certified plastic surgeons and dermatologists have the most extensive training in facial anatomy of any providers.

The reversibility advantage of HA fillers is significant from a safety standpoint. If a vascular complication occurs with an HA filler, hyaluronidase can be injected immediately to dissolve the filler and restore blood flow — a treatment that is not available with other filler types.

Why Choose Allure MD for Dermal Fillers

Injectable treatments are only as good as the person performing them. The same filler, placed by two different providers, can produce dramatically different results. Factors that distinguish expert injectors include:

• Deep understanding of facial anatomy and the vascular structures that must be avoided
• An aesthetic eye for proportions, symmetry, and what looks natural on each individual face
• Technical skill with different injection techniques and the judgment to know when to use each one
• Conservative approach that prioritizes natural results over maximum volume

At Allure MD in Newport Beach, injectable treatments are performed under the direction of Dr. Rosing, a Stanford-trained, FACS-certified physician with over 14 years of experience. His surgical understanding of facial anatomy — gained through years of performing facelifts, rhinoplasties, and other structural procedures — informs every filler treatment, ensuring precise placement, natural results, and patient safety.

To learn more about dermal fillers or to schedule your consultation, contact Allure MD at (949) 706-7874.