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Cosmetic & Plastic Surgery

Cosmetic Injectable Fillers

What are cosmetic fillers?

Cleveland Clinic Cosmetic & Plastic Surgery Center offers non-surgical options to soften these facial lines and restore volume and fullness in the face with the latest techniques in cosmetic injectable fillers. The use of cosmetic injectable fillers, also known as soft tissue augmentation, can plump thin lips, enhance shallow facial contours, soften facial creases and wrinkles, or improve the appearance of recessed scars.

Before & After Photos



Female shown before Restylane® injections (left) and one year following (right).

Female in her mid forties who had lip augmentation with one syringe of Juvederm®. Patient before Juvederm® injections (left) and after Juvederm® injections (right).

Female in her late fifties who had Juvederm® injections to her hands to eliminate appearance of veins. Patient is shown before injections (left) and after injections (right).

Am I a candidate for cosmetic injectable fillers?

One of the earliest signs of aging is a loss of facial fullness and the development of wrinkles. While cosmetic injectable fillers do not stop the aging process, injectable fillers may help delay the need for more invasive procedures, such as a facelift, brow lift or other procedures.

The best way to determine if you are a candidate for an injectable filler 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 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?

Preparation for your cosmetic injectable filler procedure at Cleveland Clinic Cosmetic & Plastic Surgery Center may include:

  • Discussing why you want the procedure, your expectations and desired outcome
  • Review of your medical conditions, drug allergies and medical treatments
  • Review of your current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
  • Discussing any past treatment with injectable fillers, facial shaping or Botox® therapy, or other facial rejuvenation procedures.

Your cosmetic surgeon may also:

  • Evaluate your general health status and any pre-existing health conditions or risk factors
  • Discuss options available to you for facial rejuvenation
  • Examine and measure your face
  • Take photographs for your medical record
  • Discuss your options and recommend a course of treatment
  • Discuss likely outcomes of injectable fillers and any risks or potential complications.

How is a cosmetic injectable filler procedure performed?

Injectable fillers are used during an office visit to Cleveland Clinic Cosmetic & Plastic Surgery Center. The filler is injected 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 icing or a topical numbing agent to make more sensitive patients comfortable. The filler itself may contain an anesthetic agent, or you may receive a local anesthetic or combination of local anesthesia and conscious sedation (also known as “twilight sleep”).

Multiple injections are often needed to fill wrinkles or recessed scars. Enhancing your lips with fillers also requires multiple injections to distribute the filler for enhanced lip fullness and to raise or define a cupid’s bow or vermillion border.

Cosmetic injectable fillers for the face are often used to:

  • Address nasolabial folds (facial creases between the nose and mouth)
  • Improve marionette lines (lines or wrinkles that extend from the outer corners of the mouth down toward the chin)
  • Correct “lipstick lines” around the mouth
  • Restore fuller cheeks
  • Create fullness in the lips
  • Improve forehead frown lines, when used in conjunction with Botox®.

What are the different types of injectable fillers?

There are many different cosmetic injectable filler options. Your first step in determining which filler is best for your needs is through a consultation with a Cleveland Clinic Cosmetic & Plastic Surgery Center cosmetic surgeon. Schedule a Consultation.

There are a variety of cosmetic injectable fillers to suit different patients’ needs:

Is a natural protein that is the primary component of the second layer of the skin, the dermis. Collagen acts as the support structure of the skin for the growth of cells and blood vessels.
Injectable collagen formulas derived from human dermis including Cosmoderm® or Cosmoplast®. Alternatively, Zyderm® and Zyplast® are forms of purified bovine collagen that, unlike human-derived collagen, require allergy testing. Results from collagen injections generally last three months.
Collagen injections historically were the first of the tissue fillers, but, because of their short-lived effectiveness, they have largely been replaced by newer types of fillers.
Hyaluronic Acid
A natural substance found in your body that is effective for plumping thin lips and filling facial creases between the nose and mouth (nasolabial folds) and the jowl area (marionette lines). Hyaluronic acid may also be effective for some surface wrinkles and concave scars, under the eyes (nasojugal grooves) and in the forehead region and elsewhere.
Common hyaluronic acid products include Juvederm®, Restylane® and Perlane® with results from these injectables lasting six months or longer depending on both the individual patient and location of injection. Hyaluronic acids are currently the most popular of the cosmetic injectable fillers.
Hydroxylapatite (Radiesse®)
A mineral-like compound found naturally in human bones, which is suspended within a gel-like formation. It is 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. Radiesse’s® results last from six months to one year.
Human fat
Which is harvested from your own body and can be 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 prior to injection. Fat injections are somewhat unpredictable in how long they last. Length of action varies from patient to patient and location of injection.
Poly-L-lactic Acid (Sculptra®)
Developed to treat facial wasting, a condition commonly resulting from HIV. FDA-approved for this purpose, it also has recently been approved for facial aging. It functions similarly to human fat injections by enhancing facial volume in patients who appear to have lost facial fat. Studies have shown results from Sculptra® lasting up to two years.
PMMA (polymethylmethacrylate) fillers
(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, gradual, but long-lasting correction is established. The Food and Drug Administration (FDA) approved PMMA fillers for the correction of facial wrinkles, such as smile lines.

Note: The FDA reviews and approves pharmaceutical fillers. However, some fillers may be used on an off-label basis, which means they have been approved for wrinkle correction in a given area only, or for some other medical indication, but not directly reviewed for a specific application. For a more detailed discussion of off-label uses of fillers, consult your plastic surgeon or dermatologist.

What results can I expect?

Injectable fillers offer immediate results, but your results will vary depending on which filler is used. A filler's effectiveness can range from six months (such as hyaluronic acids) to over one year (with the use of PMMAs).

In some cases, the length of your results or effectiveness of correction depends on the filler used, the area treated and the individual patient. Because injectable fillers are not permanent, the best way to ensure results is through repeated treatments with your cosmetic surgeon. In general, less filler is required on subsequent 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.

What is involved in recovery?

Injectable filler procedures are performed on an outpatient basis at Cleveland Clinic Cosmetic & Plastic Surgery Center.  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.

These side effects are easily managed with topical icing and will improve within hours or just a few days.

Are cosmetic injectable fillers safe?

All surgical procedures carry some risk, but complications from filler procedures are uncommon. Possible risks and considerations regarding injectable fillers include:

  • Fillers derived from non-human sources may require a pre-treatment allergy test
  • Certain fillers may lead to an infection at the injection site
  • Fillers that are not completely fluid and contain microscopic granular substances (PMMAs) carry a risk of “clumping” as a result of facial movement and the natural aging process. Over time, these can result in lumps or nodules that may require surgery to treat
  • Acne-like skin eruptions
  • Antibodies to filler material may reduce the effectiveness of future injections
  • Asymmetry
  • Bleeding, bruising and swelling
  • Skin death, also called skin necrosis (extremely rare)
  • Skin rash, itching and swelling
  • Skin redness
  • Skin sensitivity
  • Under or over correction of wrinkles.

Why Choose Us

If you’re considering a cosmetic injectable filler procedure, look for a board-certified cosmetic surgeon with specialized training and significant experience performing this procedure. Consider going to a cosmetic surgeon who is affiliated with a major medical center, such as Cleveland Clinic. Ask your cosmetic surgeon about his or her credentials, training and how many of these procedures he or she has performed.

Is this procedure covered by health insurance?

Like all cosmetic procedures, injectable filler procedures are not covered by health insurance. Ask to talk with a financial representative from Cleveland Clinic Cosmetic & Plastic Surgery Center who can explain the costs of the procedure and payment options.

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

Have Questions? Contact the Cosmetic & Plastic Surgery Center