As you age, your body starts to lose collagen. Collagen is an important substance that exists all over your body, including in your skin, muscles, bones and connective tissues. Decreased amounts of collagen in your skin causes skin laxity (loose) and loss of volume. Skin becomes thinner, loses its elasticity and starts to sag.

You may choose to get dermal fillers to:

• Add volume to sagging skin.
• Make your facial features more symmetrical.
• Plump up lips and cheeks.
• Smooth wrinkles and creases in your face.

Some medications prescribed to treat medical conditions such as HIV and AIDS can cause thinness in your face. Some people choose to get dermal fillers to restore volume to their face after taking these medications.

Dermal fillers are very common. Every year in the United States, more than 3 million people choose to get dermal fillers.

A dermal filler works by raising or puffing up particular areas of the face. It is most commonly used in areas that succumb to sagging skin, which creates a hollowed look. The specific manner as to how the procedure works depends on the type of fillers being used. Existing options include:

• Hyaluronic acid – The most commonly used type of dermal filler, a hyaluronic acid filler works by drawing fluid to the specified part of the face that needs a lift. This substance is used in popular filler brands such as Juvederm, Captique, and Restylane; the effects of these fillers typically last around 9 months to 1 year.
• Fat graft – A fat graft, also known as an autologous fat, refers to fat cells that are taken from another part of the patient's own body then injected into the recipient site. Since the injected filler is made of actual human fat, the effects of this type of treatment can last for years.
• Polymer – Filler brands like Sculptra uses a man-made and biodegradable polymer substance. This is another long-lasting option, with effects lasting up to two years.
• Calcium hydroxylapatite – This is the main substance used in another popular filler brand Radiesse, which can keep wrinkles and skin aging at bay for up to 12 months.
• Bovine collagen – Fillers like Zyderm and Zyplast use bovine collagen. However, due to the nature of this substance, the patient has to undergo an allergy test at least 4 weeks prior to undergoing the treatment to ensure that he or she will not have any adverse reactions to the injectable filler.
• Microscopic plastic beads – Because bovine collagen treatment does not offer permanent results, it is often mixed with microscopic beads that are made of polymethyl methacrylate or PMMA that stay under the skin for good even when the collagen melts away; they therefore effectively extend the effects of the treatment to at least 5 years.

A filler treatment can be carried out by a dermatologist or a cosmetic surgeon. Regardless of which material is used as the filling agent, a greater part of the process is generally the same. The patient first receives a local anesthesia to numb the facial area. Once the anesthesia has settled in, the surgeon or dermatologist injects the filler into the predetermined area, just under the skin. For fat graft, however, the fat that will be used as the filling agent is first harvested from another part of the body.

Each procedure will take approximately 15 minutes. However, depending on the severity of the condition and the size of the treatment area, succeeding sessions may be necessary. If so, each session is spaced at least two weeks apart.

Filler treatment sessions may cause some symptoms right after each procedure. The following symptoms are normal and temporary, typically lasting up to 3 days after the procedure:

• Redness
• Swelling
• Pain
• Itching

If symptoms do not go away after 3 days or they seem to be getting worse, it is best to go back to the dermatologist or surgeon who performed the procedure. Prolonged symptoms may be signs of possible complications linked to dermal fillers, which include:

• Infection
• Bleeding
• Bruising
• Allergic reactions, the most common of which include rashes, hives, and swelling
• Flu-like symptoms
• Granulomas or nodules, which are lumps that develop under the skin in the treatment area

There are also some serious and potentially life-threatening complications that have been reported but these are very rare.

• Anaphylactic shock
• Sepsis
• Necrosis, or breaking down of the skin
• Blindness caused by a blood clot in the retinal artery
• Abscess

Due to the large number of dermatological clinics and doctors offering dermal fillers, patients are advised to take extra care in choosing the doctor they will work with. There is a risk that the fillers used are not included in those approved by the U.S. FDA, and this exposes the patient to the possibility of uncontrolled adverse reactions.

A dermal filler treatment is most beneficial for patients who have the following signs of skin aging:

• Wrinkles
• Fine lines
• Pitted scars
• Furrowed skin

On the other hand, a filler treatment is not safe for those who:

• Are taking blood-thinning medication, including aspirin, vitamin E, or any type of NSAID
• Have herpes simplex or herpes zoster

The fillers are expected to temporarily smooth out surface flaws on facial skin. The length of time the results are expected to last may differ depending on the specific product used.

Since the fillers are only injected into the skin, the treatment does not require a long recovery and downtime. Patients can safely go back to their normal routine after the procedure, as long as they avoid strenuous activities and excessive sun exposure. Meanwhile, normal post-procedure symptoms are expected to go away after a couple days.