Using dermal fillers to get rid of wrinkles around the face and get a younger look has become so popular nowadays. So, what are these substances? How many types are there? How are they used? And is Botox considered a dermal filler? Let’s find out…
By definition, dermal fillers are gel-like substances that are commonly injected beneath the skin using a needle to smoothen the skin and reduce wrinkles. These substances are regulated by:
· The FDA 
· The Medicines and Healthcare products Regulatory Agency in the UK 
· The European Regulations (EU 2017/745) starting from May 2020, which consider dermal fillers as medical devices 
How can fillers get you a younger skin?
Fillers play on various aspects to get the desired effect including:
· Filling in wrinkles
· Lifting cheekbones
· Increasing the lips volume
· Smoothing of both deep under eye-circles and lip lines
· Enhancing thin contours
· Improving the appearance of scars  
Figure 1: Treatment areas that can be targeted by dermal fillers 
What are dermal fillers composed of?
· Hyaluronic Acid (HA):
A natural substance found in the skin. HA injections last for 6-12 months before they’re digested by the body and then another dose is required to maintain the same effect.
· Collagen injections
Purified collagen that is extracted either from cows or humans.
· Poly L- Lactic Acid (PLLA):
A safe bio degradable substance; it helps in treating deep wrinkles, and lasts for more than 2 years.
· Polymethylmethacrylate (PMMA):
Another safe substance in the shape of a microsphere. It contains collagen, and it’s the only permanent filler approved by the FDA.
· Calcium Hydroxyapatite (CaHA):
A natural substance found in bones. It has more consistency and lasts longer compared to HA fillers.
· Autologous fat injections (facial fat grafting):
The only filler that requires a surgery. Fat is transported from the same person undertaking dermal fillers by liposuction, then this fat is purified, and after that it is injected into the face. Results last for many years .
How long do fillers last?
This depends on three main factors: type of the product, the treated area, and the patient. In general, the denser and the deeper the product is injected, the longer it will last.
Natural dermal fillers like Hyaluronic acid usually last between 6-18 months depending on which area is injected. For example, injections for the lips will fade way faster than the ones to the nasolabial folds. On the other hand, synthetic fillers like PMMA last longer since they’re not absorbed by the body .
Figure 2: Commonly used fillers accompanied by the areas they treat and duration per each 
How is the filling procedure performed?
The use of dermal fillers is a non-surgical process, it can be normally done within one session with the specialist. The desired area to be filled is cleaned, then a local anesthetic, like lidocaine, is used to minimize the feeling of pain when injected (nowadays many fillers contain local anesthetics). After that, a specific amount of the filler is injected beneath the skin. The procedure in general requires between 20-30 minutes depending on the injected area .
Are dermal fillers bad for your health?
Dermal fillers are usually considered to be safe, but side effects may occur, and this depends on two main factors: the type of filler used, and the proficiency of the specialist applying the procedure.
In general, side effects contain redness, and swelling of the injected area. Serious implications are rare, and include:
· The formation of scars
· A granular appearance under the skin
· Movement of the filler from the injected area to other parts of the face
· The blocking of some blood vessels in the face which might lead to tissue death .
Can dermal fillers be used during pregnancy and breast feeding?
No studies are available for the safety of using fillers during pregnancy. However, it’s recommended not to use them during this period . Regarding breast feeding, it’s safe to use dermal fillers as long as individuals taking them are healthy and showing no symptoms of mastitis or any other kind of infection .
Is Botox considered a dermal filler?
No, Botox is not a dermal filler, it works in a different mechanism. Botox is the abbreviation of BOTULINUM TOXIN, which is produced by a group of bacteria called clostridium botulinum. This toxin functions by relaxing the muscle tension on the skin helping to reduce wrinkles and lines. It usually lasts shorter than dermal fillers (3-6 months) .
Figure 3: A comparison between treatment areas of both dermal fillers and Botox 
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