Injectable fillers can have a huge impact on reversing the signs of aging and have become a large part of cosmetic practices in the United States.

In a skilled hand, these products can lead to dramatic results for patients. But in less skilled hands, these products can lead to either less dramatic results on one end of the spectrum or facial distortion and scarring on the other end.

Types of Injectable Fillers

There are a number of different types of injectable fillers, and more are coming into the market every year.

Currently, there are three classes of fillers.

The first class is temporary fillers such as Hyaluronic Acids and Collagen. Most of the temporary fillers currently used in the U.S. are hyaluronic acids such as Restylane®, Juvederm®, and Belotero®. These are nice to use because they give good results and are reversible, if necessary, with an enzyme called Hyaluronidase.

The second class of fillers is the semi-permanent fillers such as Radiesse® and Sculptra®. These last longer but cannot be reversed when injected.

The final class is permanent fillers such as Artefill® and Silicone. These, as their name indicates, also cannot be reversed when injected.

How Can Patients Know They’re Getting Treatments That Lead to Good Results?

Here are 11 key things to keep in mind when considering any type of injectable filler treatment:

1. First, it’s important to find a qualified injector, and it’s best if this person is a doctor with a background in facial surgery. It’s even better if they have many years’ experience in using injectable fillers for facial rejuvenation themselves. (Some doctors have their staff do all of their injectable filler treatments.) I recommend you evaluate the actual before-and-after photos of patients treated by the injector before you consider treatment with them.
2. There are non-physician injectors (such as physician assistants and nurse practitioners) who can be good, but it’s important that they have many years’ experience using fillers and their own before-and-after photos you can examine before considering treatment with them.
3. The practitioner doing filler treatments must have Hyaluronidase and Nitropaste in their office. If they don’t, walk away. Rarely, fillers can cause complications such as an obstruction of blood flow to part of the face. This can lead to devastating results (see below).

   If the practitioner has Hyluronidase and Nitropaste in their office, these can be used to treat such problems if administred quickly. Once again, if the injector doesn’t have these products in their office when they do injectable fillers, walk away!

4. Be careful with the use of semi-permanent and permanent fillers. These don’t have the ability to be reversed but can be used very effectively and safely by those practitioners with years of experience using them.
5. Know the background of the person injecting you. Does your injector have a background in facial procedures, or are they a practitioner who decided to enter this field later in their careers? Today, we have internal medicine doctors, dentists, ER doctors, pediatricians, OB-GYNs, nurses and physician assistants with little experience in facial anatomy using injectable fillers. Some can be good injectors, but only after extensive training and years of experience.
6. 

   Using Loupes, shown here on Dr. Scheiner, enable more detail-oriented procedures.

   Experienced injectors often use magnifiers called Loupes when injecting to enable them to better see the anatomy and avoid vessels. Ask if you injector uses these magnifiers. If they do, it usually means they’re more careful and detail-oriented about their injectable procedures.
7. It’s important to be very careful with those practitioners who recommend injectable filler placement under the eyes. This often leads to more problems than it does successful outcomes. See the blog I wrote specifically about this subject.


Using facial fillers under the eyes can result in an irregular appearance if done by an inexperienced practitioner.



8. Ask about the type of anesthesia options the practitioner offers. Options include topical anesthesia placed directly on the skin, injectable anesthesia and nerve block injected into the skin, and ice anesthesia.
   
   Topical anesthesia combined with the anesthesia often incorporated into injectable fillers (e.g. Restylane® and Juvederm® often come with anesthesia mixed into them) is one option which can be good for injections in the cheeks to address lines that come from the nose down to the corner of the mouth (nasolabial folds) and for the lines that come from the corner of the mouth to the jaw line (melolabial folds). These products are appropriate for for injections into the lip, but if the anesthesia used is only topical, expect to feel significant pain in the lips during the procedure.

   Nerve blocks and direct injection of anesthesia usually provide the best comfort out off all of these options, making lips more comfortable during the injection process.

   Ice is mildly effective and one of the least-sophisticated methods of reducing pain from injections.

   Experienced injectors know how to offer all of these types of anesthesia. If the injector only offers topical anesthesia or ice, it usually means they don’t have as much experience or skill in using injectable fillers.

9. Only seek lip injections from those very experienced injectors who have many before-and-after photos to show you. The injection process is very artistic, and many injectors don’t have a good artistic sense. Many often think they are just filling a line. Avoid those types of injectors.
10. The best injectors know about and employ facial balance in the injection process. I wrote a blog about the proportions that belong in the face. The practitioner needs to have exquisite knowledge of proper facial ratios and balance if they are going to be injecting a patient’s face.
11. Finally, it’s important to stop using any blood thinners before the procedure as they can increase the bruising you may see afterwards. These blood thinners aren’t only medicines, but include Aspirin, headache powders with Aspirin, ginko biloba, energy drinks, herbal tea, garlic, and ginseng, among others. Avoid these two weeks before the injection procedure, and you’ll have less bruising afterwards.

I hope these tips are helpful to the many people seeking injectable filler treatments.

Injectable filler treatments are a safe and effective way of helping people restore their appearance back to a more youthful and vibrant state. Following these 11 steps will make it more likely that you will receive a result that looks both beautiful and natural.