Many people who want to restore youthful contours to their face have heard of dermal fillers. Since there are numerous brands, many with multiple formulations, the injectable volume-adding treatments have a global reputation—and one that is growing. The American Society of Plastic Surgeons released statistics in June 2024 showing that hyaluronic acid-based fillers were administered more than 5.2 million times the year prior, making them the second most popular minimally invasive treatment in the country. This number represents an 8 percent increase over their applications in 2022.
Despite this popularity, however, many people do not understand how dermal fillers work.
What Are Dermal Fillers?
As the owner of Aesthetic Medicine in Lake Oswego, Oregon, Dr. Jerry Darm explains: “There are two main types of injectables for adding volume: dermal fillers and biostimulators. Dermal fillers typically take the form of injectable gels made of hyaluronic acid. Biostimulators are injectable substances that prompt collagen creation beneath the skin’s surface.”
Both options are designed to “fill in” areas below the skin’s surface where volume loss has led to the development of hollows or thinning, but they work in different ways.
Hyaluronic Acid
Various parts of the body naturally make a sugar called hyaluronic acid, known informally as HA. Each HA molecule is a “humectant” that can bind to 1,000 times its own weight in water, so it plays a critical role in providing moisture where needed. In some places, such as the joints, HA serves to lubricate and help different parts smooth smoothly. In other places, HA makes up the fluid or liquid that fills a structure, such as the eyes. In the skin, HA provides vital hydration, keeping the surface looking smooth and plump, as well as helping it to remain stretchy and flexible.
Hyaluronic acid breaks down over time, and although there are specialized processes that make new HA molecules, levels of the important sugar tend to drop with time. After around a person’s 20s, hyaluronic acid begins to dwindle in the skin, leading to the development of various signs of aging in the following decades. A similar loss of collagen, which provides a framework for HA in the skin along with structural support and volume, also happens as a person grows older.
Dermal fillers are made to combat this loss, with many formulations featuring hyaluronic acid molecules made into an injectable gel. Once introduced into specific areas via needle or cannula, the gel serves the same function as natural HA and collagen: It provides volume and moisture, giving the skin a more youthful look. Depending on the type of filler injected and where in the face it is introduced, results can last anywhere from six months to two years.
Collagen Stimulators
A different approach to restoring lost facial volume is collagen stimulation, which is a treatment that prompts the skin to make its own collagen. Since most people lose up to 20 percent of their collagen by the time they turn 40, the visual change can be noticeable in the bulk of the population—driving interest in treatments that target this specific sign of aging.
Collagen-stimulating injectables are not the same as hyaluronic acid-based dermal fillers, in that they don’t provide volume that is visible right away. Instead, they trigger a more gradual change. For example, they may contain a substance that builds a new framework of support in the skin in addition to encouraging specialized cells known as fibroblasts to make more of the fibrous protein.
Renewed production raises collagen levels in the skin over weeks, with results becoming visible in about a month. This collagen can remain even after the initial framework from the injectable breaks down, giving patients results that can last for up to two years.
The Importance of Choice
No one injectable treatment is ideal for every person, which explains why there are so many manufacturers making brands available to the public today. Physicians like Dr. Darm explain that patients considering a treatment may spend time deciding which filler they would like to try, but a more effective approach to addressing signs of aging is meeting with an experienced professional who can make a customized recommendation. Injectors with skill, experience, and the knowledge of how various specific fillers work in the real world are especially adept at choosing the ideal option for each patient.
It is important to seek out providers who are licensed, are trained in current techniques, and work at reputable practices known for natural-looking results delivered safely and with patient comfort in mind. Many providers decide to offer dermal fillers, so be sure to “do your homework” before making any choices. Working with a reputable provider who uses official products is the ideal way to safely get reliable and lasting results.