By Entela Celiku, PhD. Chemist, Ingredient Expert, and Your Honest Voice at Kungul
Have you ever looked in the mirror and thought about getting a bit of extra volume in your cheeks or a touch of fullness in your lips? You’re not alone. Dermal fillers have become hugely popular for their promise of instant transformation. But as much as they can give you that refreshed look, they also come with risks, myths, and often unexpected long-term effects. At Kungul, we believe in being honest about beauty treatments, so let’s unpack the real story behind dermal fillers, the good, the bad, and the safe.
What Are Dermal Fillers Really Made Of?
Dermal fillers are injectable substances that help restore volume, soften wrinkles, and contour the face. They’re often seen as a quick fix for signs of aging, but there’s more to know than just the promising before-and-after photos. Each filler type is formulated differently, designed to address specific cosmetic concerns. The most common types are hyaluronic acid (HA) fillers, collagen fillers, poly-L-lactic acid (PLLA) fillers, calcium hydroxylapatite (CaHA) fillers, polymethylmethacrylate (PMMA) fillers, and silicone fillers.
Hyaluronic acid fillers are particularly popular because they mimic a natural substance in the skin, making them relatively safe. These fillers help the skin retain moisture, giving a plump, hydrated appearance. They also often contain lidocaine for comfort during injection, along with cross-linking agents like BDDE (1,4-Butanediol diglycidyl ether) to make them last longer. Despite being dissolvable with hyaluronidase, complications like inflammation or uneven texture can arise if the enzyme is improperly applied.
Collagen fillers were once the go-to for softening wrinkles but have become less common due to their shorter lifespan and higher risk of allergic reactions. Originally derived from bovine collagen, many modern versions use human-derived or synthetic collagen. While still effective in some cases, they generally don’t offer the longevity of HA fillers.
Poly-L-lactic acid fillers work differently, stimulating the body’s own collagen production to gradually enhance facial volume. They are often chosen for deeper folds and significant volume loss, but the effects develop slowly over several sessions. Calcium hydroxylapatite fillers, known for their denser consistency, are used for contouring areas like the jawline and cheeks. PMMA fillers, being semi-permanent, are primarily used for deeper wrinkles but can lead to complications if not placed correctly.
Silicone fillers are a controversial choice, given that they are permanent and can migrate to unintended areas. Although once popular, their risk of chronic inflammation and the challenge of removal have made them less desirable. They are not FDA-approved for cosmetic use.
The Unspoken Reality: Long-Term Effects of Fillers
One major misconception about fillers is their reversibility. While HA fillers can be dissolved with hyaluronidase, other fillers do not offer this option. Even when dissolved, MRI scans have shown residual material in tissue, sometimes even years after the procedure. This lingering presence can lead to the infamous “pillow face,” where fillers accumulate unevenly, distorting the natural contours of the face. Surgeons have reported finding filler masses during facelift procedures, especially in areas with low blood circulation.
The Risk You Need to Know: Vascular Occlusion
Vascular occlusion is a serious but rare complication that occurs when filler accidentally blocks a blood vessel. This can cut off blood supply to the affected area, potentially causing tissue necrosis. It’s crucial to act immediately, as untreated occlusion can result in permanent scarring. Fortunately, HA fillers offer a solution since they can be dissolved with hyaluronidase. Administering the enzyme promptly can minimize damage, but this highlights why choosing a skilled, experienced injector is non-negotiable.
Should You Go for Fillers or Surgery?
Sometimes, fillers seem like the easiest way to turn back the clock. However, when volume loss becomes significant, relying on more and more filler can actually make your face look unnatural. In these cases, opting for a facelift might be more suitable. Rather than constantly topping up fillers, a surgical approach can reposition tissues, restoring natural contours without the risk of filler buildup.
MRI scan of the face by Dr. Simon Morley showing hyaluronic acid (HA) filler material, the red patches indicate HA filler.
Regretting Your Fillers? Ultrasound-Guided Filler Dissolving
If you’re unhappy with your fillers, don’t panic. For HA fillers, dissolving them with hyaluronidase usually takes just a few hours, although the process can cause some swelling or discomfort. One of the latest advances in safe filler removal is ultrasound-guided dissolving. This technique uses ultrasound imaging to precisely locate the filler, allowing targeted injection of hyaluronidase. Unlike traditional methods, ultrasound guidance reduces the risk of damaging surrounding tissues and enhances accuracy. As a result, it’s becoming a preferred approach when dealing with migrated or problematic fillers.
However, for non-HA fillers, the situation can be trickier. Techniques like High-Intensity Focused Ultrasound (HIFU) can sometimes break down stubborn filler deposits, especially when migration has occurred. Consulting a skilled dermatologist who uses ultrasound-guided dissolving techniques can make the process much safer and more effective.
Stay Informed, Stay Safe, With Care, From Kungul
At Kungul, we know how personal your choices around beauty and well-being are. Whether you’re just exploring fillers or questioning past decisions, you deserve information that’s honest, clear, and free of pressure. Fillers can be a powerful tool, sometimes, the best decision is to pause and reflect. Not every trend fits every face. And when the signs of aging become more visible, more filler isn’t always the answer, sometimes, a surgical approach may serve you better. We’re not here to sell you treatments. We’re here to help you choose better for your skin, your body, and your peace of mind.
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