Filler 101

While Botox (and similar neuromodulator) treatments have become fairly commonplace, the idea of injectable fillers may still be a bit of a mystery to some. People may be wary of filler and looking “done” with an image in their mind of an overfilled celebrity. The reality is that filler injections, when done by the right person, should deliver subtle enhancements and harmonization of facial features. 

Hyaluronic acid (HA) based fillers are most frequently used. Common brands include Juvederm, Restylane, etc. HA is a natural substance found in our skin. HA filler is a gel-like substance that can be injected into the area of concern at different depths to help soften a line or fold, lift tissues, or enhance a feature. Over time the filler will gradually be absorbed by your body. The results from filler can be seen immediately and generally last 6-18 months. There are a wide variety of HA filler options, with different thickness or viscosity, intended for different purposes. An advantage of HA fillers is that they can be dissolved with an enzyme called hyaluronidase if needed.

The range of different formulations of filler provides the injector with the ability to select the appropriate product to achieve a specific outcome. Fillers can be used to provide treatments ranging from general facial contouring to lip enhancement to filling under eye hollows to “liquid rhinoplasty.” There is even a class of fillers referred to as biostimulators, like Sculptra or Radiesse, where the injected product encourages the body to produce collagen.

Filler injections are generally quite safe but as with any procedure there are risks, and the risks with filler are greater than those with Botox. Bruising, redness and swelling may occur. Inadvertent injection of filler into a blood vessel can lead to more serious complications including loss of blood supply to the skin or eye. This is one reason why it is extremely important to see a qualified injector who understands facial anatomy as well as how to manage complications should they arise. With strategically placed filler, and when safety and natural looking outcomes are top of mind, we can have great results with filler treatments.

Can Filler Treatment Be Reversed?

I am often asked if injectable treatments can be reversed. For most fillers today, which are commonly hyaluronic acid (HA) based, the answer fortunately is yes. HA fillers, including Juvederm and Restylane, can be dissolved using an enzyme called hyaluronidase. Hyaluronidase is a naturally occurring substance in the body and it works by breaking up the bonds that hold the HA filler together and then the body can reabsorb it by a natural process.    

Hyaluronidase allows injectors to adjust HA fillers if the treatment needs to be modified to ensure satisfactory results. Some patients are worried about getting filler injections and looking unnatural or “what if something doesn’t look good.” Thanks to hyaluronidase we can reassure them that filler can be adjusted if needed. In addition, it is critical for patient safety. In the rare event that an HA filler has been injected into a blood vessel, hyaluronidase can be used to dissolve the filler! If you are an injector it is absolutely important that you are up to date with management of these complications and have access to a sufficient supply of hyaluronidase!

The photo below the progression of filler being dissolved immediately, 30 and 60 minutes after hyaluronidase.  

While it is helpful to understand how hyaluronidase can be used, it is also important to remember that when you are being treated by a highly trained injector HA fillers are not only very safe but can deliver a beautiful, natural result.