What are soft tissue fillers?
Soft tissue fillers are injectable, gel-like substances that are used to add volume and fullness to your skin. They’re often used to plump thin lips, enhance shallow facial contours, soften facial creases and wrinkles or improve the appearance of recessed scars.
How are soft tissue fillers used?
Soft tissue fillers are often used to:
- Address wrinkles and lines:
- Smooth laugh lines.
- Reduce nasolabial folds (the deep creases running from the nose to the mouth corners).
- Fill marionette lines (the vertical lines extending from the mouth corners down the chin).
- Enhance facial contours:
- Plump lips.
- Define and enlarge cheekbones.
- Reshape the jawline.
- Correct facial asymmetries.
- Restore volume and youthfulness:
- Address volume loss in areas like cheeks, temples and under the eyes.
- Reduce acne scars.
Why choose us?
Cleveland Clinic Cosmetic & Plastic Surgery Center can help you explore options to rejuvenate or refine your appearance. To get the best results from any cosmetic procedure, you need the highest quality team. You can rely on our experts, who are nationally ranked for their expertise and care. Our physicians have advanced training in the use of soft tissue fillers.
How to Prepare
Am I a candidate for cosmetic injectable fillers?
In general, most patients are candidates for injectable fillers. However, the best way to determine if you’re a candidate is through a consultation with a cosmetic surgeon at Cleveland Clinic Cosmetic & Plastic Surgery Center.
Tissue fillers are a good option if you:
- Are physically healthy.
- Have a mild or moderate degree of facial aging.
- Have specific, but realistic, goals in mind for the improvement of your appearance.
How do I prepare for a cosmetic injectable filler procedure?
The most important step in preparing for a cosmetic injectable filler procedure is a thorough consultation at Cleveland Clinic Cosmetic and Plastic Surgery Center. During this consultation, you’ll discuss your desired outcomes, expectations, medical history, allergies and current medications. It’s critical that you’re open and honest about your motivations and avoid unrealistic expectations.
Risks and benefits will also be explained to you. It’s important to discuss potential complications — like bruising, swelling and temporary asymmetry — and to be aware of rare but serious risks like infections and allergic reactions.
It’s crucial that you clarify costs, including the filler itself, injections and potential follow-up appointments. Ask about payment options and insurance coverage.
Physical preparation is also key to ensuring a safe treatment and the best result. Physical preparation includes:
- Medications: Discuss any medications you’re taking with your healthcare provider. You might need to temporarily stop some medications, like blood thinners and NSAIDs (a class of pain relievers), or have them adjusted before the procedure to minimize bleeding risk.
- Supplements: Certain supplements like fish oil, garlic, and ginkgo biloba can increase bleeding risk. Stop taking them at least a week before the procedure.
- Alcohol and smoking: Avoid alcohol and smoking for at least 24 to 48 hours before the procedure. Both can thin the blood and increase swelling.
- Hydration: Staying properly hydrated helps the filler integrate better and promotes faster healing.
- Skincare: Avoid exfoliating or applying strong skincare products near the treatment area in the days leading up to the procedure.
- Sun exposure: Minimize sun exposure for a few days before and after the procedure to avoid irritation and potential pigment changes.
- Exercise: Avoid strenuous activities or heavy exercise for a few days before and after the procedure to minimize swelling and promote healing.
What to Expect
How is a cosmetic injectable filler procedure performed?
You’ll receive injectable fillers during an office visit to Cleveland Clinic Cosmetic & Plastic Surgery Center. Most commonly, you’re awake for the procedure and can go home immediately after. Your provider injects the filler with a fine needle into strategic points on your face, in combination with topical or local anesthesia.
The injection sites are cleansed with an antibacterial agent, followed by ice or a topical numbing agent to make more sensitive patients comfortable. The filler itself may have an anesthetic agent, or you may receive a local anesthetic. If the filler procedure is combined with other surgeries, then you may undergo general anesthesia or conscious sedation (also known as “twilight sleep”).
You may need multiple injections to fill wrinkles or recessed scars. Enhancing your lips with fillers also requires several injections to distribute the filler for enhanced lip fullness and to raise or define a cupid’s bow or vermillion border.
After injection, your provider may gently massage or mold the filler to ensure even distribution and achieve a natural-looking result. They’ll carefully assess your appearance to ensure symmetry and make any necessary adjustments.
What are the different types of injectable fillers?
There are many different cosmetic injectable filler options. Your first step in deciding which filler is best for you is through a consultation with a Cleveland Clinic Cosmetic & Plastic Surgery Center cosmetic surgeon.
There are a variety of cosmetic injectable fillers to suit different patients’ needs:
Hyaluronic acid is a natural substance found in your body that’s effective for plumping thin lips and filling facial creases between the nose and mouth (nasolabial folds) and the jowl area (marionette lines). Hyaluronic acid is also commonly used to augment cheeks, define the jawline and augment the chin. Hyaluronic acid may also be effective for some surface wrinkles and concave scars, under the eyes (nasojugal grooves), in the forehead region and elsewhere.
Common hyaluronic acid products include Juvéderm®, Restylane® and Perlane®, with results from these injectables lasting six months or longer depending on both the patient and location of injection. Hyaluronic acid fillers are reversible and are currently the most popular of the cosmetic injectable fillers.
Hydroxylapatite (Radiesse®) is a mineral-like compound found naturally in human bones, which is suspended within a gel-like formation. It’s the heaviest of facial fillers and is recommended to fill deeper creases such as nasolabial folds and marionette lines, as well as to enhance fullness of the cheeks and other facial contours. Results from Radiesse® last from six months to one year.
Fat grafting is a procedure in which fat is harvested from your own body and reinjected to enhance facial fullness, fill deep creases and to build up shallow contours. Augmentation through fat injections requires a more extensive procedure than other injectable fillers because it involves the use of liposuction techniques to extract the fat before injection. Fat injections are somewhat unpredictable in how much fat survives. The fat that does survive, however, will last for years.
Poly-L-lactic acid (Sculptra®)
Poly-L-lactic acid (Sculptra®) treats facial wasting, a condition commonly resulting from HIV. While originally approved for this purpose, it’s also approved to treat facial aging. Sculptra may also stimulate your body to make new collagen. Studies have shown results from Sculptra lasting up to two years.
PMMA (polymethylmethacrylate) fillers
These fillers (such as Artecoll®, ArteFill®, Artesense™, Artes Medical®) are a type of permanent filler. Unlike temporary fillers, the immediate filling effect of PMMAs disappears rather quickly and, over time, they establish gradual, but long-lasting, correction. The U.S. Food & Drug Administration (FDA) approved PMMA fillers for the correction of facial wrinkles (such as smile lines).
Adipose allograft matrix (Renuva®)
Renuva® is an alternative to fat grafting. It uses processed fat from donors. This processed fat supports the extracellular matrix, containing essential components like collagens, proteins and growth factors. It acts as scaffolding that triggers and supports your body’s own fat production at the injection site. It takes weeks to see the final result and may require multiple treatments. The fat your body makes in response can last years.
What is involved in recovery?
Injectable filler procedures are performed in an outpatient setting at Cleveland Clinic Cosmetic & Plastic Surgery Center, meaning you’ll go home the same day. Your initial appearance after treatment with any filler may include:
- Mild swelling or bruising.
- Temporary numbness or redness.
- Temporary irregularity to touch in the soft tissue or skin.
You can easily manage these side effects with ice, and they’ll improve within hours or a few days.
Are cosmetic injectable fillers safe?
While soft tissue fillers are generally safe and effective, there are potential complications you should be aware of before considering the procedure. These can be categorized into early and late complications:
- Early complications (occur within days or weeks of treatment):
- Injection site reactions (these are the most common and typically include bruising, swelling, redness and pain).
- Allergic reactions.
- Vascular occlusion (this is a serious complication where the filler blocks a blood vessel, potentially leading to tissue damage or even blindness. While rare, it’s more likely with injections in certain areas like the glabella and nose).
- Late complications (appear weeks or months after treatment):
- Granulomas (these are small, noncancerous lumps that can form around the filler material. They can be tender and require medical treatment for removal).
- Filler migration (the filler can migrate from the injection site to surrounding areas, leading to an unnatural appearance).
- Hyperpigmentation or hypopigmentation (changes in skin pigmentation around the injection site).
- Scarring (although rare, scarring can occur in some people).
- Late-onset infections (while unusual, infections can occur even months after the procedure).
Remember, you can minimize the risk of complications by choosing a qualified and experienced healthcare professional who uses high-quality fillers and follows proper injection techniques. Discussing your medical history and potential risks with your healthcare provider is important before undergoing any aesthetic procedure. Be attentive to any unusual symptoms after the procedure and contact your provider immediately if you experience any signs of infection, allergic reaction or vascular occlusion.
What results can I expect?
Many injectable fillers offer immediate results, but fillers that stimulate collagen or fat production may take weeks to months before you see the final results. A filler’s effectiveness can range from six months (such as hyaluronic acids) to over one year (with the use of PMMAs).
The duration of results or effectiveness of correction depends on the filler used, the area treated and the patient. Because injectable fillers aren’t permanent, the best way to ensure results is through repeated treatments with your cosmetic surgeon. In general, you’ll need less filler on repeat injections. View our injectable fillers before-and-after photos to see results from actual patients.
A thorough consultation with a Cleveland Clinic cosmetic surgeon will help determine the best injectable filler treatment based on your age, skin condition, amount of sun damage and genetics.
Insurance & Financing
Insurance rarely covers the cost of elective cosmetic surgery and procedures. Please call 216.444.4004 and ask to speak with one of our financial representatives who can explain payment options, including CareCredit financing.