The 411 on Dermal Fillers: Get Your Facts Straight

There are now many different dermal fillers which are FDA approved. Clients are now seeking out non-invasive medical spa treatments such as dermal filler injections to treat wrinkles and slow the signs of aging. The cost of dermal filler greatly depends on the time it lasts, if a dermal filler treatments with long lasting results (such as Radiesse and Sculptra) are most expensive ($1,000 or more a treatment) and those which are shorter-lasting effect are the least expensive (about $350).

As an aesthetician or clinician in a medical spa setting, it is important to know the facts about dermal fillers. First, let's list the most common FDA approved dermal fillers:

Human collagen based dermal filler such as CosmoDerm and CosmoPlast.
Bovine collagen based dermal filler such as Zyderm and Zyplast.
Hyaluronic acid based dermal filler such as Restylane, Juvederm and Hylaform.
Calcium hydroxy- lapatite microspheres dermal filler such as Radiesse.
Synthetic polylactic acid in microspheres dermal filler such as Sculptra.
Polymethyl- methacrylate microspheres suspended in bovine collagen dermal filler such as Artefill.

Dermal Filler FAQs

Are dermal fillers safe?

When prescribed by a properly qualified and trained doctor and injected in an appropriate medical setting, U.S. FDA-approved temporary dermal fillers are extremely safe.

What are the potential risks associated with dermal fillers?

Risks include hematoma or blood pooling beneath the skin, and although rare, infection and necrosis or skin loss is possible. An unsatisfactory outcome is also a risk. The greatest risk occurs when dermal fillers are injected by someone who is not properly qualified to perform injections. Semi-permanent and permanent fillers may carry a risk of clumping (the particles form a granuloma or lump that can be felt or seen beneath the skin). Particles may also migrate or displace from the injection site. Injection of an anti-inflammatory may help to improve minor clumps or swelling. More significant conditions of clumping or granuloma may require surgery.

Can I be allergic to a dermal filler?

Only dermal fillers derived from animal sources have a risk of allergy. This is something your doctor should explicitly cover during your consultation and the informed consent process. If necessary, a patch or allergy test can be performed on your inner arm. Injections will be scheduled several weeks later, after the risk of allergy has been evaluated. Zyderm, Zyplast and ArteFill are derived from bovine (cow) sources.

What if I don't like my results?

One advantage of most injectable treatments is that they are temporary. If you don't like the results they will diminish in time. A hyaluronic acid based filler like Restylane, Juvederm or Perlane can be more rapidly diminished (in weeks rather than months) with the injection of a substance called hyaluronodase in the treatment region.

Are dermal fillers only used on the face?

Dermal fillers should not be used to rejuvenate the hands, injected into the breasts or injected into any part of the body other than the face. In select cases, a scar, cellulite dimple or other limited depression can be treated with a U.S. FDA-approved dermal filler for temporary improvement.

Is there an age limit for dermal fillers?

Dermal fillers for cosmetic purposes should not be administered to anyone under 18 years of age.

Can dermal fillers be used on skin of color?

Hyaluronic acid fillers, like Restylane and Juvederm, are appropriate for skin of color as these are colorless gels that should not be visible under the skin or alter the skin color.

Will I be able to feel the filler once injected into my skin?

In the first few days after injection, the treated area may feel a little firm; however, this should rapidly improve. In general, a dermal filler should not be felt under the skin. However, there is the risk with semi-permanent or permanent fillers of particles clumping together and forming a granuloma that may be felt or seen under the skin. This risk is increased if a dermal filler was not properly injected.

Are there other forms of dermal fillers?

Your own fat can also be used as a dermal filler. Substances that are not specifically approved as dermal fillers for cosmetic purposes and substances that are not properly branded, named and defined as dermal fillers approved by the FDA risk your health and your beauty.

Are there cheaper alternatives to brand name dermal fillers?

No. While additional brands of injectables may be approved by the U.S. FDA, if you are offered a "generic" or "cheaper" solution to any U.S. FDA-approved dermal filler, you should refuse. There are no less costly alternatives proven safe or effective.

General Injectable FAQs

What defines board certification of injectors?

There is no recognized medical board that specifically defines injectors. Certification by a member board of the American Board of Medical Specialties refers to a doctor who has taken an accredited residency and fellowship in a defined medical specialty, and has been tested through written and oral exams for competency in that specialty. The following Boards are recognized by the American Board of Medical Specialties:

American Board of Plastic Surgery
American Board of Dermatology
American Board of Otolaryngology (Facial Plastic Surgery)
American Board of Ophthalmology (Ophthalmic Plastic and Reconstructive Surgery)

Is it safe for nurses to perform injectable treatments?

A licensed Registered Nurse (RN) or a licensed Physician’s Assistant (PA) can be an appropriate provider of injectables depending on your state's regulations. The following conditions should be met:

The nurse or PA is under the supervision of a qualified doctor who has prescribed the injectable treatment appropriate for you.
The nurse or PA can demonstrate appropriate medical education and training specific to the delivery of injectable beauty treatments.
The nurse or PA follows all of the appropriate steps in performing your injections, including informed consent about the risks and benefits of the injection process.
You have the option to request the doctor perform your injections.

Are injectables safe?

When injected by a properly qualified and trained clinician in an appropriate medical setting, U.S. FDA-approved injectable treatments are safe.

Are injectables used only in the face?

Injectables are commonly used in the face, but can be used in off-label applications on the body. In some cases, a scar, cellulite dimple or other limited depression can be treated with a U.S. FDA-approved dermal filler for temporary improvement. Fat injections are commonly used on the body to improve the shape of the buttocks.

What does off-label mean?

U.S. FDA-approved drugs and devices come with labels and directions for their approved use; any other use is considered “off-label.”

What are the risks of injectables?

Each injectable carries its own specific risks. In general, the post-treatment experience can include swelling, redness or bruising at the injection site. This usually will resolve within a week. There is a slight risk of infection with injectable treatments, and a very rare but potential risk of injury to the skin.

FAQ Information Courtesy of: Physicians Coalition for Injectable Safety at http://www.injectablesafety.org