Dermal Fillers

Dermal fillers are manufactured, usually through fermentation and cross-linking with proteins, to produce a clear, sterile gel for injection into the skin. Dermal fillers are injectable treatments intended to smooth lines, restore volume loss, soften creases, or enhance your facial contours. By administering dermal filler under the skin, fillers help diminish the appearance of wrinkles and provide a more youthful appearance. Many fillers also stimulate collagen production, enhancing skin elasticity and firmness over time.

Dermal filler brands include Juvederm®, Restylane®, Belotero®, Kybella®, Sculptra®, Radiesse®, and Bellafill®.

Dr. Piya offers FDA-approved dermal filler brands and matches the right filler to your specific concern, from soft cheek and lip enhancement to structural jawline definition.

Hyaluronic Acid (HA) Fillers: Hyaluronic acid is a naturally occurring sugar chain molecule found in all skin and soft tissues throughout the body, identical across species. It adds volume, hydrates and stimulates collagen production, and is popular due to its immediate effect and low risk of allergic reactions. Not all hyaluronic acids are the same — each brand has a range of "tissue tailored" products designed for specific results. One size does not fit all. Brands include Juvederm®, Restylane®, and Belotero®.

Calcium Hydroxylapatite (CaHA) Fillers: Calcium hydroxylapatite is a mineral-like compound naturally found in human bones. CaHA filler is a synthetic, biocompatible dermal filler used for deeper lines to smooth moderate-to-severe facial wrinkles, restore volume, and stimulate natural collagen production for longer-lasting effects. Brand name: Radiesse®.

Poly-L-Lactic Acid (PLLA) Fillers: A biocompatible, synthetic dermal filler that works by gradually stimulating your skin to produce its own new collagen over a series of treatments. It is used to restore volume loss. Brand name: Sculptra®.

Polymethylmethacrylate (PMMA) Fillers: A semi-permanent dermal filler made of tiny polymethylmethacrylate microspheres suspended in a purified collagen gel that stimulates collagen growth and provides long-lasting results. It is used for deeper folds and to restore volume. Brand name: Bellafill®.

Autologous Fat Injections: This procedure involves transferring fat from one area of the body to the face and provides a natural, long-lasting result. It requires a minor surgery.

Hyaluronic Acid (HA): Hyaluronic acid is a sugar molecule found naturally in your skin, joints, and eyes that attracts water to keep tissue plump and hydrated. It binds water in the skin, providing volume and hydration, while also cushioning and supporting collagen and elastin fibres and acting as a carrier for chemical messages between cells. HA filler is produced by chemically binding, or "cross-linking", the sugar molecules so the gel stays in place and resists quick breakdown by the body. Unlike other cosmetic treatments, HA fillers can be safely dissolved using an injection of a specific enzyme, hyaluronidase, if complications arise or if you dislike the appearance.

Calcium Hydroxylapatite (CaHA): A collagen booster composed of microscopic calcium-based microspheres suspended in a water-based gel carrier. The gel carrier provides immediate volume and structural support right after injection, while the microscopic CaHA particles act as a scaffold that prompts your body to build new natural collagen over time.

Poly-L-Lactic Acid (PLLA): Unlike traditional gel fillers that give immediate physical volume, PLLA acts as a collagen biostimulator. Microparticles of PLLA trigger a mild tissue response, rebuilding the skin's inner structure over a few months. The material gradually breaks down into water and carbon dioxide, but the newly grown collagen can last for more than two years.

Polymethylmethacrylate (PMMA): The carrier collagen gel instantly fills in lines and wrinkles upon injection. The body gradually absorbs the collagen gel over a few months, but the synthetic PMMA microspheres remain in place, forming a structural scaffold that encourages your skin to produce its own natural collagen. The results last for years or remain permanently because the body does not break down the PMMA microspheres.

Longevity varies between products and between individuals, but most fillers last between 6 months and several years.

• HA fillers last about 6 to 24 months depending on location.
• CaHA fillers last about 12 to 24 months, which is longer than many hyaluronic acid fillers.
• PLLA fillers last about 18 to 24 months. Most people require 2 to 4 separate treatments.
• PMMA fillers last for years or remain permanently. Because PMMA microspheres cannot be dissolved easily, treatment requires an expert, not just an injector.

Dermal fillers are an effective treatment:

• to define, correct or enhance lips
• to soften and correct facial wrinkles or folds
• to improve the tone, texture and hydration of the skin
• to correct or enhance facial contours: cheeks, temples, jawline, nose, chin
• to restore lost volume in the hands to reduce the appearance of veins and tendons

Hyaluronic Acid (HA): Used for lips (to add fullness and sharpen the border of the lips), cheeks (to restore lost mid-face structure and lift), smile lines or nasolabial folds (to smooth folds running from the nose to the corners of the mouth), and the jawline and chin (to define lower facial contours).

Calcium Hydroxylapatite (CaHA): Used for deep facial lines like nasolabial folds and marionette lines, and to restore volume in the cheeks or hands.

Poly-L-Lactic Acid (PLLA): Helps smooth deep facial wrinkles and restore lost volume. PLLA treats facial lipoatrophy (volume loss) and smooths deep wrinkles like nasolabial folds. Patients typically require a series of three or four monthly treatment sessions for optimal correction.

Polymethylmethacrylate (PMMA): Helps correct medium-to-deep facial wrinkles such as nasolabial folds (smile lines) and moderate-to-severe atrophic acne scars on the cheeks, providing long-term volume where temporary fillers wear off too quickly. It also provides contouring definition and structural support to the cheeks, chin, and jawline, and is used to restore lost volume in the back of the hands.

Hyaluronic Acid (HA): Consider it to enhance the lips and face (add fullness, define borders, or correct asymmetry in the lips, chin, or jawline), to refill volume loss in hollow areas like the cheeks, under-eye tear troughs, or temples caused by aging, and to soften smile lines, nasolabial folds (nose-to-mouth creases), and marionette lines. HA is an ideal choice for first-time patients because it can be dissolved using an enzyme called hyaluronidase if you are unhappy with the results or experience complications. Also consider it if you want results that last between 6 and 24 months rather than a permanent change.

Calcium Hydroxylapatite (CaHA): Because calcium hydroxylapatite is a mineral-like compound naturally found in human bones, it rarely causes allergic reactions and does not require pre-testing. However, unlike hyaluronic acid fillers, CaHA cannot be dissolved with an enzyme like hyaluronidase if you are unhappy with the results. It is not approved for lips, because it can lead to unwanted nodules or lumps.

Poly-L-Lactic Acid (PLLA): Consider it for deep wrinkles and folds (facial wrinkles, nasolabial folds or smile lines, and marionette lines); if you prefer gradual, natural results — a subtle, progressive transformation that builds over 2 to 3 months rather than an overnight change; for longer-lasting effects that can last two years or more once the full treatment series is complete; and to improve collagen loss, skin firmness, structure, and elasticity in areas like hollow cheeks, temples, or the jawline.

Polymethylmethacrylate (PMMA): Consider PMMA fillers only when you want a permanent or semi-permanent structural correction and are fully aware that the material cannot be dissolved. It is considered for deep facial folds, such as severe nasolabial folds (smile lines), when a long-lasting option is preferred, and Bellafill is FDA approved for smoothing pitted, distensible facial acne scars on the cheeks. It is best suited to those with proven tolerance — after you have already tried temporary hyaluronic acid (HA) fillers and confirmed you like the look and tissue response — and should be performed by an expert physician who is board certified in Aesthetic Medicine, not just an injector.

All make-up will need to be removed before treatment. Alcohol, aspirin, NSAIDs (ibuprofen) and a range of dietary supplements, including St. John's wort and ginkgo biloba, may all contribute to bruising and are best avoided for 24 hours before treatment.

Dermal fillers will not be administered if there is an active skin infection, including acne or cold sores, or if you are not feeling well, including colds, coughs, sore throats, etc.

Most dermal fillers are premixed with a local anesthetic like lidocaine, a numbing agent, to maximize comfort during treatment. We will also apply a topical anaesthetic cream prior to treatment to numb the skin.

Pre-injection: The injection area will be cleansed, and a topical numbing cream may be applied to minimize pain or discomfort.

Injection: The dermal filler will be injected into the specific area using a fine needle or cannula.

Post-injection: The area may be massaged to distribute the dermal filler evenly.

Procedure time: The procedure generally takes about 15–45 minutes, depending on the number of areas to be treated.

Most people are able to continue with normal activities with immediate improvement in their appearance. Some will have redness, possible swelling, pin-prick marks, or bruising, mostly in the lips.

Make-up should not be worn for 12 hours.

You are advised to avoid alcohol, sun exposure, vigorous exercise and extremes of heat or cold for 24–48 hours after treatment. These activities have been found to increase and prolong swelling.

Swelling may worsen in the first 24 hours and should then settle within the first few days. An ice pack can be helpful in reducing swelling. As a consequence of swelling, the dermal filler may feel harder or lumpy and you may notice some asymmetry. It takes about 2 weeks to smooth out evenly.

PLLA & PMMA: A strict at-home massage routine is recommended for several days after the procedure to ensure the product distributes evenly.

Athletes should be aware that some ingredients in the product may show a positive result in anti-doping tests.

Please contact us if redness, tenderness, itching or swelling worsens after 3 days, rather than settling.

Result: In general, you will notice the results immediately.

Duration: Most dermal fillers last between 6 and 24 months, depending on the type of filler, the area treated, and your body's metabolism. PMMA dermal fillers can last years.

Maintenance: Regular interval treatments can help maintain the expected look, and allow the collagen-stimulating effects of fillers to provide cumulative benefits.

Absolute contraindications (no treatment)

• Pregnancy
• Breastfeeding
• Known allergy or hypersensitivity to HA filler ingredients or lidocaine
• Previous anaphylactic reaction to dermal fillers or cross-linked agents, or a history of severe allergies or anaphylaxis
• Active infection or skin condition at the injection site, including acne, cold sores (herpes simplex), cellulitis, or dermatitis in the treatment area
• Bleeding disorders or a history of severe coagulopathies, which may increase the risk of bruising and hematoma formation

Relative contraindications (may not be suitable): These require caution or deferral of treatment based on clinical judgment.

• Blood-thinning medications or supplements: aspirin, NSAIDs (ibuprofen), warfarin, fish oil, ginkgo biloba
• Recent dental work, vaccination, or illness: may increase the risk of infection or inflammation near the treatment area; wait at least 2 weeks
• Previous adverse reaction to fillers, including nodules, granulomas, or migration
• History of keloids or hypertrophic scarring: not very common, but possible with dermal fillers in some patients
• Unrealistic expectations or psychological conditions: patients with body dysmorphic disorder or those seeking perfection are not ideal candidates
• Immunocompromised patients: higher risk of infection or slower healing

Common Side-Effects: Swelling, bruising, redness, and tenderness at the injection sites.

Less Common Side-Effects: Lumps or irregularities if the filler is not distributed evenly.

Rare Side-Effects: Infection, blockage of blood vessels, or allergic reactions, which are serious but very rare. Immediate treatment can help to resolve these.

Most side effects are mild and temporary, resolving within a few days to a week. Following post-treatment instructions can help minimize these effects.

CaHA: A very rare, serious event where filler blocks a blood vessel, leading to skin ischemia, tissue necrosis, or in extremely rare cases, vision loss if injected near high-risk zones like the glabella or nose.

PLLA: Weeks or months later, harder lumps or bumps can develop under the skin, which may be due to incorrect injection depth or lack of massage. Immune reactions or inflammatory masses can form months to years later and may need medical treatment.

PMMA: Rare risks include lumps, swelling, or nodules (granulomas) forming around the injection site over time. Avoid treating areas like the lips or fine superficial lines, where permanent microspheres can become visible or lump-prone. As facial bones and fat pads shift with age, a permanent filler placed today may not look natural in later years.

Please do not hesitate to contact us if you have any concerns.