Within the field of cosmetic procedures, facial fillers are becoming increasingly popular. In fact, according to the American Society of Plastic Surgery, minimally invasive procedures like facial fillers and neurotoxins accounted for over 70% of all the cosmetic procedures in 2015–and for good reason. Patients opt for cosmetic fillers to restore structure back to their faces that may have been lost due to natural aging or excessive sun exposure. They’re usually looking for solutions to saggy cheeks, less well-defined jawlines, deep wrinkles or lines, or just a plumper set of “Angelina Jolie lips.” Not only are they minimally invasive, but they’re also effective and can give instantaneous results. Patients typically want to know three things about cosmetic fillers: if the fillers will look natural, which type of filler is best for them, and how long the results will last. Looking Natural The majority of my patients want to appear as if they’ve had no work done. If you are interested in learning more about or pursuing filler injections, it is important to visit a board-certified dermatologist or plastic surgeon. These practitioners have extensive experience in the evaluation of the face and with injection techniques. Qualified practitioners are trained to understand your facial anatomy to reduce the risk of side effects from filler injections. Perhaps most importantly, experienced injectors are able to produce natural-looking results by enhancing existing facial features and by injecting only the necessary amounts of filler in the desired areas. Ultimately, how natural the results look and how effective the filler is depends on the injection technique as well as the choice of filler for the area of the face being treated. There are many different types of filler options, all of which are meant for injection into specific locations of the face and at varying depths. Certain filler options are meant to be injected into deeper layers of the skin, and restore volume to areas of the face such as the cheeks, temple or jawline areas. Other filler options are meant for filling in more superficial wrinkles and lines such as around the mouth, lips and underneath the eyes. Finding the Right Filler In addition, board-certified practitioners are able to make a “global” assessment of your needs, sometimes suggesting mixing and matching filler injections with other cosmetic procedures for the best results. Some patients benefit from combining filler injections with neurotoxin injections (like Botox), or lasers and chemical peels. In addition, your doctor should advise you on other important skin care techniques to keep your skin looking healthy and young. Mixing and matching the various cosmetic procedures, as well as proper skin care, can enhance the results of the filler injections and give you longer-lasting and more favorable results. Frequency Like anything else in life, the recommended frequency of filler injections depends on the type of the filler. The duration depends on several different factors inherent to both the filler and the patient. Because the composition and viscosity of the gel used to make fillers varies drastically from brand to brand, they are absorbed by the body at different rates. In general, there are two broad categories of facial fillers: natural fillers, made from substances similar to the collagen found in our skin; and synthetic fillers, made from substances not similar to what is found in the human body. The more natural fillers types include Restylane, Restylane Silk, Juvederm, Voluma and Belotero. Restylane and Restylane Silk typically last about 6 to 9 months, while Voluma can last 18 to 24 months. Belotero has a shorter lifespan, typically lasting up to 6 months in most patients. Juvederm can last up to 6 to 12 months. The more synthetic filler options include Radiesse and Sculptra, and tend to last longer, often quoted to last 2 to 3 years. Despite these projections, the reality is that the majority of patients come back for repeat injections when they notice a loss of volume or structure. There are no official recommendations from the Food and Drug Administration (FDA) for length of time between filler injections. It’s also important to consider factors inherent to the patient. Older patients, for example, are likely to have lost more facial volume and therefore require more filler. Some patients metabolize fillers more quickly than others, and depending on where the filler is injected, it may dissolve at different rates. For example, if the filler is injected into the laugh lines, it might dissolve faster because that area of the face moves more than an area like the cheeks. In conclusion, no one filler fits all. How effective a dermal filler is, and how long the effects last, requires a global assessment by a board-certified dermatologist or plastic surgeon.