Dermal fillers

Dermal filler treatments add volume and shape to the soft tissues of the face. We use fine needles or cannulas, which are thin tubes, to place gels prepared for this purpose in the areas where we want to add volume. We select filler placement and properties according to facial anatomy, skin thickness, and overall facial proportions.

Properties of hyaluronic acid fillers

Hyaluronic acid is a molecule with water-binding properties that is also found in the body’s connective tissue. For filler treatments, it is prepared as a gel that can be placed in tissue. The gel’s structure allows it to create volume and support the tissue where it is injected. This mechanism differs from Botox treatment targeting a facial expression muscle.

Connections between molecules in filler gels affect the material’s consistency and ability to retain its shape. These connections are called cross-links. Hyaluronic acid preparations can vary in structure, so the ingredient name alone does not explain which area a filler suits. Different gel properties may be relevant in a mobile area such as the lips or for deep tissue support.

Lip movement during speaking and smiling makes flexibility a consideration in filler selection. At the chin, forward projection and the shape of the outer contour may be the targets. Gel softness and distribution within the tissue are considered together with the intended layer. During the examination, you can ask why a particular filler is being suggested for that area.

Treatment areas

With fillers, we can add lip volume and aim to define the cheekbones, chin, and jawline. The area around the lower eyelids, the nose, and certain wrinkles are also treatment areas. Small injections into the skin may be planned to address skin structure.

For nasal filler, we listen to what you would like to change about irregularities along the bridge, a slight hump, or the nasal tip. We may aim to conceal certain irregularities or a slight hump, or to lift the tip slightly. I consider nasal filler sufficient for only some of the conditions that call for a nasal procedure.

The outer contours of the cheeks and temples are formed by the bone structure and the fat compartments above it. An inward curve at the temple or a pronounced cheek hollow may indicate where volume is lacking. This distribution can differ between the right and left sides, so the treatment area is defined across both halves of the face. The transitions between forehead and temple, and between cheek and lower face, are part of the same examination.

The fold running from the side of the nose to the corner of the mouth is called the nasolabial fold. Skin folding, cheek tissue position, and volume distribution contribute to its prominence. Changes in the fold during smiling show the role of movement around the mouth as well. When filler is considered, examining the cheek support around the fold helps identify where volume is lacking.

Forward projection of the chin and the edges of the jawline are separate shaping targets. Around the lower eyelid, hollowness, excess skin, and protruding fat are distinguished. When describing an under-eye shadow, dark skin and a depressed surface may point to different findings. Filler is considered according to the volume-related component of the appearance.

Nasal filler shapes the nose by adding volume. It does not remove bone or cartilage and is not a method for reducing the nasal framework. Changing a transition along the bridge and reducing nasal width require different interventions. A breathing concern also requires a separate examination of the internal nasal structures.

Examination and filler selection

You can begin by pointing out the area you would like to change with filler. We examine its volume, skin thickness, and relationship to neighboring structures. The fullness you want in your lips or definition you want along your jawline is planned in the context of your whole face. We also select the filler’s properties according to the tissues in that area.

You are welcome to bring records of previous fillers and facial treatments. Knowing which material was placed where helps interpret the tissue felt and the volume seen today. Known illnesses and allergies are also discussed when assessing suitability for the material. If the previous injected substance is unknown, that uncertainty is addressed before deciding on new filler treatment.

We do not perform filler treatments during pregnancy or breastfeeding. In other patients, suitability depends on facial anatomy and examination findings. During the consultation, we explain how the change in shape you have in mind relates to the filler’s volume-adding mechanism.

A hollow visible when your face is at rest may change as the cheek moves during smiling. The front view shows volume distribution on the right and left, while the side view shows the positions of the nose, lips, and chin. Lines that become more pronounced with expression are called dynamic; those visible at rest are called static. This distinction helps separate the volume need targeted by filler from muscle movement.

Filler is not injected into an area with an active skin infection. Known allergies to ingredients, uncontrolled illnesses, and conditions affecting the immune system are considered alongside current treatments. A history of autoimmune disease does not lead to the same decision for everyone; the nature and activity of the disease matter. An unknown previous filler type is also information that needs to be clarified before a new procedure.

An area with thin overlying tissue and a support deficit beneath thick skin do not require the same injection plane. Tissue thickness, movement, and the structures felt underneath are considered during the examination. Volume loss may be concentrated in a small area or extend into neighboring facial regions. The boundaries of the filler plan follow this distribution of the visible hollow.

The teeth and jawbones support the lips from within. Changes in this support can affect the appearance of folds around the mouth or the lip corners. Findings related to the bite may call for a dental and jaw examination. The target of filler added to soft tissue is explained with the existing dental support in mind.

Cheekbone prominence and chin appearance are related in the facial profile. Adding volume in one area also changes its transition to neighboring areas. You can show the contour you would like in a photograph, although lighting and facial position can affect how a hollow appears. Different viewing angles during the examination help locate the volume deficit.

In a facial filler consultation, adding fullness to the entire face and supporting a particular contour are different requests. Someone wishing to emphasize the cheekbone prominence may be pointing to a different area from someone describing a hollow in the lower cheek. This detail guides the boundaries of the target area during the examination. Filler placement can then be explained through a specific tissue need rather than a general face-shape label.

The chin lies at the facial midline, while the jawline runs along the edge of the lower jaw. Desired changes at the chin may involve forward projection, height, or transitions to the sides. At the jaw angle, bone shape, the chewing muscle, and overlying soft tissue affect the appearance. Considering filler in these areas does not mean that filler can change the bite.

Under-eye darkness may be related to a shadow cast by a hollow. The skin’s own color and thinness also contribute. A filler examination considers the transition between eyelid and cheek, the thickness of the overlying tissue, and fat position. Treating every dark area as an empty space to fill confuses these different causes.

Describing a filler plan only by the amount of material does not explain where or in which layer it will be placed. Distribution along a narrow line and support around the cheekbone have different tissue targets. Distribution may also differ between the right and left cheeks in the same face. Asking which area would receive volume and what shape is intended helps clarify the plan.

How fillers are injected

We inject filler into the area where we want to increase volume using a fine needle or cannula. We clean the treatment area and establish sterile working conditions. The positions of facial tissues and blood vessels are anatomical features we consider when choosing injection points.

The tissue layer in which filler is placed depends on the treatment area and the properties of the filler. Filling a line close to the skin and adding volume to deeper facial tissues require different treatment plans.

The difference between a needle and a cannula

A needle enters tissue with a sharp tip. A cannula is a thin, blunt-tipped tube advanced through a prepared entry point. Reaching a specific point with a needle and distributing material along a tissue plane with a cannula are different injection approaches. The choice depends on the size of the target area, the tissue layer, and the anatomical structures.

With a cannula, the material’s properties and the intended tissue layer remain part of the plan. Shaping the lip border and supporting a broad cheek area may require different distributions. The choice of needle or cannula can be explained through that distribution. An instrument’s name alone does not determine one injection approach for the whole face.

The difference between biostimulators and fillers

With hyaluronic acid filler, we aim to add volume and shape to a specific area through a gel. With biostimulators, we focus on the tissue’s response in producing collagen. Poly-L-lactic acid (PLLA) and calcium hydroxylapatite are options associated with this second mechanism; the gel carrier in calcium hydroxylapatite also provides direct tissue support.

When there is pronounced excess skin, adding tissue volume and removing skin are different anatomical interventions. Cheek volume loss and an accumulation of tissue in the lower face may coexist. A filler plan addresses the location of the hollow, while a surgical plan addresses excess skin and displaced tissues. Collagen stimulation with a biostimulator is also explained in terms of its own tissue target.

Planning with other treatments

Botox, mesotherapy, which involves small injections into the skin, and biostimulator treatments may also be options within a filler plan. Facial volume and skin structure determine which treatments can be included together.

I use Botox to reduce the activity of the muscle that pulls the nasal tip downward. In my own practice, I usually combine this method with nasal filler.