Facial Plast Surg 2019; 35(03): 224-229
DOI: 10.1055/s-0039-1688843
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Overview of Deep Dermal Fillers

Michael H. Liu
1   Department of Dermatology, University of California Los Angeles, Los Angeles, California
David P. Beynet
1   Department of Dermatology, University of California Los Angeles, Los Angeles, California
2   Department of Dermatology, VA Greater Los Angeles Healthcare System, Los Angeles, California
Nima M. Gharavi
3   Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, California
› Author Affiliations
Further Information

Publication History

Publication Date:
12 June 2019 (online)


Dermal fillers have become an integral part of both medical and cosmetic dermatology. Our expanding knowledge of the aging face has allowed us to shift the focus from skin-reduction lifting procedures to soft tissue augmentation. Within the past 5 years alone, nine new dermal fillers have been approved by the U.S. Food and Drug Administration for soft tissue augmentation. The rise in both the use and number of dermal fillers in recent years is a testament to their safety and efficacy. Dermal fillers can be broken down to three major types: temporary, semipermanent, and permanent. The former, which include hyaluronic acid based fillers, provide safe and effective correction but only for a limited time, typically approximately 1 to 2 years at best. This review will cover the semipermanent (poly-L-lactic acid and calcium hydroxylapatite) and permanent (polymethylmethacrylate and liquid silicone) injectable fillers. These so-called deep dermal fillers are valuable, durable tools in correcting the aging face. Given their extended duration of effect, these fillers inherently carry their own risk for potential adverse events. Thus, it is essential that clinicians have a thorough understanding of these products to best counsel, recommend, and perform soft tissue augmentation using these fillers.

Supplementary Material

  • References

  • 1 Broder KW, Cohen SR. An overview of permanent and semipermanent fillers. Plast Reconstr Surg 2006; 118 (3, Suppl): 7S-14S
  • 2 Lam SM, Azizzadeh B, Graivier M. Injectable poly-L-lactic acid (Sculptra): technical considerations in soft-tissue contouring. Plast Reconstr Surg 2006; 118 (3, Suppl): 55S-63S
  • 3 Klein AW, Elson MLJDS. The history of substances for soft tissue augmentation. Dermatol Surg 2000; 26 (12) 1096-1105
  • 4 Jones DH. Semipermanent and permanent injectable fillers. Dermatol Clin 2009; 27 (04) 433-444 , vi
  • 5 Alam M, Tung R. Injection technique in neurotoxins and fillers: indications, products, and outcomes. J Am Acad Dermatol 2018; 79 (03) 423-435
  • 6 Vleggaar D, Bauer U. Facial enhancement and the European experience with Sculptra (poly-l-lactic acid). J Drugs Dermatol 2004; 3 (05) 542-547
  • 7 Lemperle G, Morhenn V, Charrier U. Human histology and persistence of various injectable filler substances for soft tissue augmentation. Aesthetic Plast Surg 2003; 27 (05) 354-366 , discussion 367
  • 8 Valantin M-A, Aubron-Olivier C, Ghosn J. , et al. Polylactic acid implants (New-Fill) to correct facial lipoatrophy in HIV-infected patients: results of the open-label study VEGA. AIDS 2003; 17 (17) 2471-2477
  • 9 Galderma Laboratories. Sculptra Aesthetic injectable poly-L-lactic acid. Instructions for Use. Available at: https://www.galderma.com/us/sites/g/files/jcdfhc341/files/2019-01/Sculptra_Aesthetic_IFU.pdf?_ga=2.112146628.1576575081.1551360421-1559681121.1551360421 . Accessed January 20, 2019
  • 10 Vleggaar D. Soft-tissue augmentation and the role of poly-L-lactic acid. Plast Reconstr Surg 2006; 118 (3, Suppl): 46S-54S
  • 11 Jacovella PF. Use of calcium hydroxylapatite (Radiesse) for facial augmentation. Clin Interv Aging 2008; 3 (01) 161-174
  • 12 Merz. Radiesse Injectable Implant. Instructions for Use. Available at: https://www.radiesse.com/wp-content/uploads/RadiessePlus-IFU.pdf . Accessed January 20, 2019
  • 13 Marmur ES, Phelps R, Goldberg DJ. Clinical, histologic and electron microscopic findings after injection of a calcium hydroxylapatite filler. J Cosmet Laser Ther 2004; 6 (04) 223-226
  • 14 Carruthers A, Carruthers J. Evaluation of injectable calcium hydroxylapatite for the treatment of facial lipoatrophy associated with human immunodeficiency virus. Dermatol Surg 2008; 34 (11) 1486-1499
  • 15 Zide BM. Radiance Short-term experience. Aesthet Surg J 2003; 23 (06) 495-499
  • 16 Lemperle G, Knapp TR, Sadick NS, Lemperle SM. ArteFill permanent injectable for soft tissue augmentation: I. Mechanism of action and injection techniques. Aesthetic Plast Surg 2010; 34 (03) 264-272
  • 17 Lemperle G, Gauthier-Hazan N, Wolters M, Eisemann-Klein M, Zimmermann U, Duffy DM. Foreign body granulomas after all injectable dermal fillers: part 1. Possible causes. Plast Reconstr Surg 2009; 123 (06) 1842-1863
  • 18 Galderma Laboratories. Bellafill Skin Test Instructions for Use. Available at: https://bellafill.com/wp-content/uploads/2018/12/7254Rev00_Bellafill-Skin-Test_e-IFU_CANADA-EN.pdf . Accessed January 20, 2019
  • 19 Galderma Laboratories. Bellafill Instructions for Use. Available at: https://bellafill.com/wp-content/uploads/2018/12/7251Rev00_Bellafill_e-IFU_US.pdf . Accessed January 20, 2019
  • 20 Joseph JH, Eaton LL, Cohen SR. Current concepts in the use of Bellafill. Plast Reconstr Surg 2015; 136 (5, Suppl): 171S-179S
  • 21 Gold MH, Sadick NS. Optimizing outcomes with polymethylmethacrylate fillers. J Cosmet Dermatol 2018; 17 (03) 298-304
  • 22 Rohrich RJ, Potter JK. Liquid injectable silicone: is there a role as a cosmetic soft-tissue filler?. Plast Reconstr Surg 2004; 113 (04) 1239-1241
  • 23 Woodward J, Khan T, Martin J. Facial filler complications. Facial Plast Surg Clin North Am 2015; 23 (04) 447-458
  • 24 Barnett JG, Barnett CR. Treatment of acne scars with liquid silicone injections: 30-year perspective. Dermatol Surg 2005; 31 (11 Pt 2): 1542-1549
  • 25 Athre RS. Facial filler agents. Oper Tech Otolaryngol 2007; 18: 243-247
  • 26 Ellis LZ, Cohen JL, High W. Granulomatous reaction to silicone injection. J Clin Aesthet Dermatol 2012; 5 (07) 44-47
  • 27 Duffy DM. The silicone conundrum: a battle of anecdotes. Dermatol Surg 2002; 28 (07) 590-594
  • 28 Weinkle S, Lupo M. Attitudes, awareness, and usage of medical antiaging treatments: results of a patient survey. J Clin Aesthet Dermatol 2010; 3 (09) 30-33
  • 29 Sobanko JF, Dai J, Gelfand JM, Sarwer DB, Percec I. Prospective cohort study investigating changes in body image, quality of life, and self-esteem following minimally invasive cosmetic procedures. Dermatol Surg 2018; 44 (08) 1121-1128
  • 30 Rkein A, Ozog D, Waibel JS. Treatment of atrophic scars with fractionated CO2 laser facilitating delivery of topically applied poly-L-lactic acid. Dermatol Surg 2014; 40 (06) 624-631
  • 31 Nowacki M, Pietkun K, Pokrywczyńska M. , et al. Filling effects, persistence, and safety of dermal fillers formulated with stem cells in an animal model. Aesthet Surg J 2014; 34 (08) 1261-1269
  • 32 Sclafani AP. Platelet-rich fibrin matrix for improvement of deep nasolabial folds. J Cosmet Dermatol 2010; 9 (01) 66-71