A Complete Guide to Filler Injections

With more than a dozen filler injections now approved in the U.S., options are aplenty for achieving sculpted cheekbones, plumped-up lips, straighter noses, and much more.

Filler Injection
Photo: Malte Mueller/Getty

Although filler—a substance injected into or below the skin—has been around for decades, the biodynamics of the formulas and the way they’re used are new and continue to evolve. “Depending on their particle sizes, we can now sculpt features, improve the appearance of fine lines, and restore the volume skin loses with age,” says Shape Brain Trust member Dendy E. Engelman, M.D., a dermatologist in New York. “And we can offer incredibly subtle results or create major transformations.”

Age is also a determining factor: “Most people start losing collagen in their 20s at an approximate rate of 1 percent per year,” says Jennifer MacGregor, M.D., a dermatologist in New York. That’s also when people start to notice the first signs of aging. “My patients in their 20s and 30s are turning to filler as part of their wellness routine; the tiny tweaks we can do now are a low-maintenance way to keep your facial structure and prevent more invasive efforts in the future,” says Morgan Rabach, M.D., a dermatologist in New York. Women in their 40s and beyond experience more volume loss and tend to want bigger restorations. Here, a guide to each type of filler injection.

Hyaluronic Acid Fillers

What They Are

These are by far the most common filler injections. “Hyaluronic acid is a large sugar molecule that’s naturally found in the skin,” says Dr. Rabach. If you’re looking to add volume to your lips, cheeks, or under eyes, the injector (cosmetic dermatologist, a plastic surgeon, or a clinician at an injectable bar or med spa) will likely choose this option.

What They Do

These fillers range in firmness. Some, like Restylane Refyne, are flexible and imitate the feel of tissue. “They offer the most natural effect around the mouth, ensuring that you don’t get that stiff, frozen look you might have seen in the past. You can talk and smile normally,” says Ivona Percec, M.D., Ph.D., a plastic surgeon in Philadelphia. Restylane also works well under the eyes because it doesn’t cause much swelling, says Dr. Rabach.

But for lips she prefers Juvéderm Volbella because it resembles the texture of delicate skin; for cheeks she turns to Juvéderm Voluma. “It’s a stiffer gel, so it really helps to lift the cheeks up,” says Dr. Rabach. She also uses it in the temples and even the nose as a temporary, nonsurgical alternative to rhinoplasty (this method is often called a liquid nose job).

All filler injections eventually absorb into your bloodstream for up to two years, but expect hyaluronic acid fillers to last six to 12 months. One major bonus? “They’re dissolvable,” says Dr. Rabach. If you need to get rid of them for any reason, a doctor can inject a solution called hyaluronidase that breaks the bonds among the hyaluronic acid molecules over 24 hours.

What They Cost

Most hyaluronic acid fillers cost $700 to $1,200 for one syringe; the amount you need varies depending on the desired results. “For full, natural-looking lips, you usually need one syringe. To fill hollow under eyes, you would typically need one to two syringes,” says Dr. Rabach. (

Calcium Hydroxyapatite Fillers

What They Are

“These fillers are made of a material found in bone,” says Dr. Rabach.

What They Do

Radiesse is the most well known in this category and is often used to even out or define areas where there isn’t a strong bone structure or there has been bone loss, such as the jawline. “I often turn to this filler to balance the symmetry of the face,” says Dr. Rabach. Though radiesse lasts only one to two years, calcium hydroxyapatite filler injections are considered semipermanent because they leave trace amounts in the body even after you can’t see their effects any longer.

What They Cost

One syringe costs $800 to $1,200. “The amount you’ll need depends on the result you want to achieve and the area you’re treating,” says Dr. MacGregor. “It could be just one syringe or many.”

Poly-L-Lactic Acid Fillers

What They Are

“The particles in this synthetic polymer spread under the skin and stimulate your body’s own fibroblasts to produce more collagen,” says Dr. MacGregor.

What They Do

This filler injection doesn’t have the immediate gratification of the other types (it takes from one to two months to start showing results), but it’s well worth the wait. Sculptra, the most well-known filler in this category, was created to counteract full facial volume loss, so dermatologists tend to inject it in multiple areas like the temples, the cheeks, and along the jaw.

It can also be used in areas on the body like the neckline and butt. “We inject Sculptra a little deeper than other fillers. Over the months, your own collagen builds up around it to create the most natural-looking fullness,” says Dr. Rabach. It’s a favorite among many dermatologists. “I use it as a fertilizer in combination with other fillers,” says dermatologist and Shape Brain Trust member Elizabeth K. Hale, M.D. “It stimulates collagen production over time while the other fillers add the instant volume.”

What They Cost

Sculptra costs $800 to $1,400 per vial and requires two to three injection sessions spaced six to eight weeks apart. “After that, it lasts two to three years,” says Dr. MacGregor.

Filler Injections and Safety Concerns

The most important thing you can do to set yourself up for a positive result is to choose an experienced injector. “No matter who you go to, whether it’s a cosmetic dermatologist, a plastic surgeon, or a clinician at an injectable bar or med spa, make sure the person is well educated in anatomy,” says Dr. Percec. “Just because it’s minimally invasive and requires only a small needle doesn’t mean it can’t cause problems. And the injector needs to know how to handle those situations.” Don’t hesitate to ask about how often someone injects patients and what their experience level is with the specific treatment you want done. (

The good news is that, unlike more invasive procedures, fillers don’t require much downtime. “The lips and under eyes tend to be the most temperamental areas. You can have swelling and bruising that lasts a few days or up to a week,” says Dr. Rabach. After that, you’re looking the way you choose to.

What About Botulinum Toxin?

It’s an injectable that softens the appearance of wrinkles too, right?

“Yes, but while fillers plump up the skin to smooth a wrinkle, Botox [and other forms of botulinum toxin] is a synthetic protein that’s injected into the muscle to stop it from moving,” says Dr. Rabach. (If you're terrified of needles, try these non-injectables that are almost as good as the real deal.)

Does reducing my facial movements smooth my skin?

Repeated muscle contractions eventually carve wrinkles, like a frown line between your brows or horizontal creases across your forehead. “Reducing those movements can help soften the etches you already have, and small doses of Botox can prevent wrinkles before they form. If you use it consistently, it can even make the muscles smaller, which makes the skin smooth,” says Dr. MacGregor. (It's not just for middle-aged people either—women in their 20s are choosing to get Botox, too.)

How long does it last?

“Botulinum toxin takes up to a week to kick in and then lasts two to four months,” says Dr. Rabach.

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