Facial Skin Fillers
In another post, I discussed the difference between skin fillers and Botox. Fillers “fill” lines or areas of the face that are not affected by muscle action, and Botox and other neurotoxins stop the movement of muscles causing wrinkles. Common skin fillers are Juvederm, Radiesse and Sculptra. None of them last longer than two years.
Facial lines best treated by Botox
  • Crow’s feet on side of eyes
  • Glabellar lines between your eyebrows
  • Forehead lines, or “worry lines”

Facial areas best treated by skin fillers

  • Nasolabial lines – from the nose to lips
  • Marionette lines – from the lips toward the chin
  • Lip lines
  • Lip enlargement
  • Volume enhancement in the face
  • Lines under the eyes

There are other small wrinkles on the skin surface that are neither due to neither muscle action nor are really lines. These small wrinkles have to do with your skin quality. These are the ones that give skin a crepe-like quality, and their treatment requires resurfacing the facial skin with lasers or via the use of skin creams, such as the Retin A which I’ve found to be useful.

After ten years when I first wrote this blog surprisingly little has changed. A few new products but still essentially the same idea and same duration of efficacy.

Types of facial skin fillers


This is my current favorite for fine lines and lines under the eyes where Radiesse cannot be used. It is smoother than Juvederm and can be injected with a smaller needle causing less pain and more exact placement.


Juvederm is hyaluronic acid and a jelly-like component of the skin. It is the same as the older and better-marketed Restalyn but lasts longer (9 months vs. 6 months).

Juvederm includes its own anesthesia and is injected under the facial skin lines. There may be some swelling, but most patients go right back to their lives. Juvederm is my skin filler of choice for plumping up lips and/or for those who need just a little bit of fuller facial skin lines.


Radiesse, like Juvederm, is made from hyaluronic acid, but it also has crystals of hydroxy-apatite mixed into it. Hydroxy-apatite is a component of our bones. The addition of the crystals prolongs the effect of the filler in the skin for 1-2 years. It has the feel of toothpaste.

Like most plastic surgeons, I mix Radiesse with an anesthetic. Patients need to massage the area of injection. There is  little bruising or other side effects. Radiesse is my preference for Nasolabial lines, infra-orbital lines and marionette lines.


Sculptra is not a facial line filler, but  a facial volume filler. Initially developed about 10 years ago to treat the facial wasting or hollowness that occurs in HIV patients, it has made the transition to the cosmetic surgery market and plastic surgery patients.

Sculptra is a form of lactic acid, the same chemical our muscles make when we have worked them a great deal and feel the “burn” of the acid. A Sculptra injection stimulates the skin to become thicker and increase facial volume. It is not used in the lips.

There is a little more bruising and swelling with Sculptra than with either Radiesse or Juvederm. Initial swelling disappears after a few days, but you need six weeks to see the full effects of the injection. Most start with one bottle of Sculptra (10ml) on each side of the face but need at least a third of a bottle of Sculptra divided between the facial sides.


This is a newer product made for filling the cheeks and providing volume as well as a lift. It is easier to use than sculptra and in my hands gives less bruising and less chance of nodules forming under the skin.


Fat can be removed via liposuction and injected back under your skin as either a skin line filler or a volume filler. Fat injections were popular 10 years ago, but I almost stopped doing them because fat is unpredictable. In some it lasts two years, in others two weeks! I cannot predict the result, and that makes me nervous.

All of the above skin fillers (+/- fat) are great! Immediate gratification at the tip of a syringe. You must weigh the costs and benefits of each. I remind patients that all is fleeting.

Morad Tavallali, M.D., FACS

Cosmetic Plastic Surgeon


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