Injectable filler (injectable cosmetic filler, injectable facial filler) is a soft tissue filler made of
polysaccharides injected into the skin at different depths.
They help fill in facial
wrinkles, provide facial volume, and augment facial features. Side effects include bruising or infections from improper sterilisation. This may include
HIV infection, also allergic reactions, which may cause scarring and lumps. Blindness due to retrograde (opposite the direction of normal blood flow)
embolization into the
ophthalmic and
retinal arteries can occur.
Materials used
Fillers are made of
polysaccharides such as
hyaluronic acids, a naturally occurring in skin and cartilage,[1]collagens which may come from pigs, cows, cadavers, or may be generated in a laboratory,[2] the person's own transplanted fat tissue, and/or biosynthetic polymers. Examples of the latter include
calcium hydroxylapatite,
polycaprolactone,
polymethylmethacrylate, and
polylactic acid.[3] In 2012, "Artiste Assisted Injection System" was launched in the US market to assist in the delivery of dermal fillers. A study in 2013 concluded that the injecting device can achieve reductions in patient discomfort and adverse events by controlling the rate of flow of injection of the filler the practitioner is using to fill in the lips and frown lines.[4]
Medical uses
Dermal fillers, also known as "injectables" or "soft-tissue fillers," fill in the area under the skin, and have some non-cosmetic uses, such as non-surgical
facial cleft repair or cleft modification, treating fat loss secondary to
HIV:[5] Fillers were found to give a temporary acceptable therapeutic effect in
HIV‐infected patients with severe facial
lipodystrophy caused by highly active
antiretroviral therapy.[6][7] A 2009 review concluded that injectable fillers resulted in high satisfaction, but further research was needed to determine safety of its use.[8][9]
Pharmacokinetics
Most wrinkle fillers are temporary because they are eventually metabolized by the body. Some people may need more than one injection to achieve the wrinkle-smoothing effect. The effect lasts for about six months. Results depend on health of the skin, skill of the health care provider, and the type of filler used. Regardless of material (whether synthetic or organic) filler duration is highly dependent on amount of activity in the body area where it is injected. Exercise and high intensity activities such as manual labor can stimulate blood flow and shorten the lifespan of fillers.[10]
Side effects and risks
Risks of an improperly performed dermal filler procedure commonly include bruising, redness, pain, or itching. Less commonly, there may be infections or allergic reactions, which may cause scarring and lumps that may require surgical correction.[11] In 2024, a cluster of
HIV infections was described amongst clients receiving microneedling facials at a Spa.[12] More rarely, serious adverse effects such as blindness due to retrograde (opposite the direction of normal blood flow)
embolization into the
ophthalmic and
retinal arteries can occur.[13] Delayed skin necrosis can also occur as a complication of embolization.[14] Embolic complications are more frequently seen when
autologous fat is used as a filler, followed by
hyaluronic acid. Though rare, when vision loss does occur, it is usually permanent.[15]
Society and culture
In the US, fillers are approved as medical devices by the
Food and Drug Administration (FDA) and the injection is prescribed and performed by a provider. What defines a qualified dermal injection provider varies by country and is a point of debate between
board-certified doctors and injectors who operate under cosmetic or aesthetician licenses.[citation needed]
Fillers are not to be confused with
neurotoxins such as
Botox. Fillers are not approved for certain parts of the body where they can be unsafe, including the penis.[16] In Europe and the UK, fillers are non-prescription medical devices that can be injected by anyone licensed to do so by the respective medical authorities. They require a CE mark, which regulates adherence to production standards, but does not require any demonstration of medical efficacy. As a result, there are over 140 injectable fillers in the UK/European market and only six approved for use in the US.[17] In China, the market of cosmetic surgery increase in recent 10 years, NMPA (formerly CFDA) also has issued several guidance to regulate injectable filler.[18]
^Sturm, Lana P.; Cooter, Rodney D.; Mutimer, Keith L.; Graham, John C.; Maddern, Guy J. (September 2009). "A systematic review of permanent and semipermanent dermal fillers for HIV-associated facial lipoatrophy". AIDS Patient Care and STDs. 23 (9): 699–714.
doi:
10.1089/apc.2008.0230.
ISSN1557-7449.
PMID19673594.
^Sturm, Lana P.; Cooter, Rodney D.; Mutimer, Keith L.; Graham, John C.; Maddern, Guy J. (September 2009). "A Systematic Review of Permanent and Semipermanent Dermal Fillers for HIV-Associated Facial Lipoatrophy". AIDS Patient Care and STDs. 23 (9): 699–714.
doi:
10.1089/apc.2008.0230.
ISSN1087-2914.
PMID19673594.
^Beleznay, K; Carruthers, JD; Humphrey, S; Jones, D (October 2015). "Avoiding and Treating Blindness From Fillers: A Review of the World Literature". Dermatologic Surgery. 41 (10): 1097–117.
doi:
10.1097/dss.0000000000000486.
PMID26356847.
S2CID205583192.