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Dermal Fillers

What is dermal filler therapy?

Dermal filler therapy has been widely accepted by patients in North America, much more so than cosmetic dentistry. You don’t need to believe me — just ask any esthetic patient if they have heard of dermal fillers injections. Ask patients if they have ever had Botox or dermal fillers and you will quickly find that these are immensely popular esthetic therapies.

Simply put, a dermal filler injection is a material injected underneath the skin in the nasolabial folds, marionette lines, cheeks, and oral commissures, which plump up these areas and smooth out the wrinkles. Lip augmentation is also done with dermal fillers. Traditionally, plastic surgeon and dermatologist offices provide these services. Today these services can be provided by MDs, dentists, nurses and medical estheticians who work in a medical / dental office or medspa.

Generally, when you look at the world of esthetic injectable treatment, botulinum toxin (Botox Cosmetic) is generally for the top half of the face, and dermal fillers are for the bottom half. The main areas where dermal fillers are used in the lips, cheeks, nasolabial folds, the oral commissures, and marionette lines. These are the areas that frame the teeth and mouth, and are certainly within the realm of dentistry and dental treatment. Dermal fillers are gently placed in these areas through an extraoral injection right under these folds and creases to plump them up. By the way, these are exactly the same areas that you routinely inject. The only difference is that you typically inject these areas intraorally when you deliver local anesthesia.

What was really interesting to me during my dermal filler training courses is that the nurses and MDs that I trained with had absolutely no problem giving the extraoral injections for face fillers, but were a bit squeamish about delivering local dental anesthesia and giving intraoral injections. The dentists that I trained with were exactly opposite and were very comfortable with the intraoral injections, but were initially a little unsure of themselves on the extraoral injections.

Dermal Fillers training is the key to performing this exciting treatment. I have trained many dentists and medical professionals in facial injectable therapies such as dermal filler and botulinum toxin. You need to become competent in the mechanisms of these materials, reviewing the facial expression muscles, indications, risks and benefits of these treatments, hands-on training in placing these materials, and preventing and managing complications. With some practice, you’ll be well on your way to performing these procedures.

In general, the results from most injectables are temporary; commonly lasting from a few months to about a year. This depends on the type of facial filler or injectable used. For optimal results, additional treatment sessions are encouraged. A dermal filler or injectable treatment entails a series of tiny injections under the skin’s surface – at the subdermal-dermal levels. The amount administered depends on the depth and size of the skin defect or wrinkle. With the evolution of dermal fillers and injectable fillers it would be a great resource to add to your dental or medical practice.

Facial Fillers / Injections


Facial fillers are products which contain collagen, hyaluronic acid, or calcium hydroxyapatite that rejuvenate facial skin by reducing or eliminating wrinkles, raising scar depressions, enhancing lips and replacing soft-tissue volume loss through facial injections. With age, our skin becomes more susceptible to wrinkles and sagging. Exposure to sun and years of muscle movement (squinting, chewing, smiling) contribute to tissue breakdown of the skin.

Facial fillers are temporary to long-lasting solutions administered through a few tiny facial injections on specific areas of the face. Various types of facial fillers are available; each is designed with one or several purposes, such as wrinkle reduction and lip augmentation. A qualified dental or medical professional can help you determine which facial injections and what injectable fillers treatments are right for you. Dermal fillers which act as wrinkle fillers will volumize creases and folds in the face in areas that have lost fat and collagen as we age. Hyaluronic acid is the natural filler substance in your body. As we age the amount of Hyaluronic acid we have lessens, and the face starts to lack volume and appears aged with deeper nasolabial folds, unaesthetic marionette lines, a deeper mentalis fold, the lips start to thin, and turning down the corners of the lips. Hyaluronic acid fillers such as Restylane Revanesse, and Juvederm are then injected extraorally right underneath these folds to replace the volume lost which creates a younger look in the face. Dermal fillers can be used for high lip line cases, asymmetrical lips, lip augmentation, and completing cosmetic dentistry cases by creating a beautiful, young-looking frame around the teeth.

• Juvederm Facial Filler: Made of hyaluronic acid gel, Juvederm is a naturally-occurring substance in the skin that contributes to volume and hydration. Juvederm is designed to temporarily correct moderate to severe facial wrinkles and folds. Juvederm is made by Allergan, the makers of Botox. Other variations of Juvederm include Juvederm Ultra, Juvederm Ultra Plus, Voluma, Vollure, and Volbella. 

• Restylane Facial Filler: A non-animal, biodegradable gel composed of hyaluronic acid, Restylane is a soft tissue wrinkle filler that adds volume to the skin through tiny injections; smoothing facial folds and wrinkles in areas around the mouth and eyes.

• Revanesse Facial filler: A hyaluronic acid dermal filler that can be used to treat moderate to severe facial wrinkles and folds, including nasolabial folds.

Other Dermal Fillers

• Sculptra: An injectable made of synthetic polylactic acid contained in microspheres, Sculptra is the first FDA-approved injectable for the restoration of lost facial volume (correction of lipoatrophy) in people with HIV infection.

• Radiesse: A synthetic dermal filler made of calcium hydroxyapatite is utilized for the correction of moderate to severe wrinkles and folds. This injectable is a longer-lasting filler because the body forms collagen around the microspheres; adding bulk to the injected areas. Other variations of Radiesse include Radiesse + and Belotero Balance. 

The average length of an appointment for filler injections is about 15 to 30 minutes per session, depending on the individual and the amount of areas being treated. Some of the most common side effects include: allergic reaction, bruising at the injection site, numbness, and temporary redness, swelling, pain/tenderness, or discoloration. Dermal filler injections require very minimal downtime, allowing patients to return to work and their normal activities directly following treatment. Yet for the first 24 hours, individuals may be instructed to refrain from strenuous activities and excessive sun or heat exposure. Some of the risks of facial injections are lumps (granulomas/nodules) which are a potential risks associated with Radiesse, Sculptra, Juvederm.

In general, the results from most injectable fillers are temporary; commonly lasting from a few months to about a year. This depends on the type of facial fillers or filler injections used. For optimal results, additional treatment sessions are encouraged. A facial filler or injectable fillers treatment entails a series of tiny injections under the skin’s surface – at the subdermal-dermal levels. The amount administered depends on the depth and size of the skin defect or wrinkle. With the evolution of facial fillers and injectable filler it would be a great resource to add to your dental or medical practice.

Learn about filler procedures: juvederm, Restylane, Radiesse, Revanesse and voluma.

If you are looking for a non- surgical face lift or you just want to smooth out a few fine lines or fill in deep set wrinkles, injectables are for you. Millions of people use dermal fillers to achieve a more relaxed and smooth facial appearance while still having the freedom of expression.

As skin ages, it begins to lose collagen filled with hyaluronic acid (HA). Collagen and HA add structure and volume to the face, therefore a lack of HA causes the skin to sag and wrinkle – that’s where dermal fillers come into play.

Dermal fillers are smooth injectable gels made from naturally occurring hyaluronic acid. Cosmetic fillers add volume to weakened facial features and can stimulate collagen growth. Each dermal filler is unique in its own way but similar in two. First, they plump skin and gently lift it to restore collagen loss due to the normal aging process. Secondly, dermal fillers motivate the body to create its own natural collagen and restore your face to a more natural, youthful appearance.

Cosmetic fillers approved by the FDA are minimally invasive and very safe. As with any procedure, there are possible risks, the most common being post-procedure bruising and swelling which are usually very minimal and resolve quickly.

Dermal filler treatments typically take 15-30 minutes and the amount of dermal filler needed will depend on volume loss and the areas you would like to restore to its natural beauty. You will see results immediately after treatment.

*Disclaimer: Botox, Dysport, dermal fillers, facial injections, and other skin care information contained on this website is provided for educational purposes and should not be taken as medical advice. To consult one of our AAFE trained members, please use the doctor locator.

Juvéderm is a soft but stable injectable gel made of hyaluronic acid. Hyaluronic acid is a natural substance found in the skin that assists in adding hydration and volume. Other variations of Juvederm include Juvederm Ultra and Juvederm Ultra Plus. The difference between these variations are subtle but their qualities offer degrees of different effects. 

Juvederm Ultra Plus is much thicker and viscous than Juvederm or Juvederm Ultra. Therefore, Juvederm Ultra Plus can provide a much more dramatic result than the other treatments. Juvederm Ultra Plus is typically best suited for applying to deeper lines and hollows in the skin. 

Juvederm Ultra is thinner than Juvederm Ultra Plus and is usually better suited for finer lines and wrinkles. Like Juvederm, both of these products consist of hyaluronic acid but at different strengths and consistency.

The American Academy of Facial Esthetics trained professional clinicians carefully introduce Juvéderm into the mid to deep dermis to temporarily smooth wrinkles and fine lines; replenishing volume in the skin almost instantly. The dermis is part of the subsurface skin layer that includes nerve endings, blood vessels, sweat, oil glands, and connective tissue.

The Juvéderm dermal filler treatment process is very quick (about 15 minutes) with immediate results. Downtime is minimal and you can get back to your normal routine right away. The Food and Drug Administration approved Juvéderm in 2006 as the only hyaluronic acid filler that will last up to one year.

Juvéderm is a robust formula designed to correct moderate to severe facial wrinkles and folds  providing versatility while restoring the contours of your face to a smooth and natural look.

The Juvéderm advantage is that its supple gel consistency provides a more natural-looking appearance than other products. Juvéderm is also long lasting so you can keep your improved appearance from six to nine months. If you have a follow-up enhancement within a few weeks after the first dermal filler treatment, the benefits could last even longer. Side effects are rare, but may include tenderness, bruising, mild pain, swelling and redness at the injection site and generally resolve within a few days.

Are you a Dentist, Nurse or Medical Professional looking for additional education?