Dermal fillers: types, comparisons, risks and care

Start with the change you actually want

In suitable patients, fillers can improve selected hollows, volume loss and folds related to tissue structure. Adding volume does not generally treat pigmentation, active acne, enlarged pores or hair loss. Under-eye darkness can involve pigment, vessels, shadows or swelling; darkness alone does not establish a need for filler.

Bring one specific goal, such as softening a particular hollow, rather than requesting total rejuvenation. Ask what improvement is realistic and whether skin care, treatment of an underlying condition, another procedure or no intervention is preferable. Fillers and muscle-relaxing injectable medicines address different mechanisms.

Section sources: American Academy of Dermatology — Fillers: Overview · American Academy of Dermatology — Fillers: Preparation · FDA — Dermal Filler Do’s and Don’ts for Wrinkles, Lips and More · Mayo Clinic — Dark circles under eyes: causes

Hyaluronic acid: flexibility with real limitations

Hyaluronic acid, or HA, is a water-binding sugar. Injectable gels differ in cross-linking, firmness and tissue behaviour; the material name alone does not identify the right product for a site. Volume change is usually apparent early, but initial swelling can exaggerate fullness or asymmetry.

A practical advantage is that a qualified clinician can use hyaluronidase to break down HA. Dissolvable does not mean an instant, exact or risk-free return to baseline. A small randomized trial demonstrated reduction of experimental arm nodules; it did not establish guaranteed reversal of vascular injury or blindness. Hyaluronidase can itself cause allergic reactions.

Section sources: FDA — FDA-Approved Dermal Fillers: materials · American Society of Plastic Surgeons — Types of Dermal Fillers · Effectiveness of Low Doses of Hyaluronidase to Remove Hyaluronic Acid Filler Nodules: A Randomized Clinical Trial (2018) · American Academy of Ophthalmology — Vision-Threatening Complications of Soft Tissue Fillers (2025) · FDA-hosted recombinant hyaluronidase prescribing information (2024)

Calcium hydroxylapatite: support with harder correction

Calcium hydroxylapatite, or CaHA, contains mineral particles in a gel carrier and may be considered for selected structural and collagen-stimulation goals. The carrier’s early filling effect differs from later tissue changes. It has no HA-like dissolving enzyme, making unwanted results potentially harder to correct.

A 60-participant randomized nasolabial-fold study found longer correction than one HA comparator. This does not establish superiority over every modern HA product, at every facial site or for every person. The proposed site and the exact product instructions still need checking.

Section sources: FDA — FDA-Approved Dermal Fillers: materials · American Society of Plastic Surgeons — Types of Dermal Fillers · Calcium hydroxylapatite versus nonanimal stabilized hyaluronic acid for the correction of nasolabial folds: a 12-month randomized split-face trial (2008)

Poly-L-lactic acid: gradual change and greater commitment

Poly-L-lactic acid, or PLLA, is a biodegradable polymer used to stimulate a collagen response. Improvement develops over weeks to months and may require several visits. Immediate post-injection fullness is not necessarily the final effect, making it a poor fit for a guaranteed result within days.

A randomized comparison with human collagen found improvement persisting in some patients through 25 months after the final treatment. That is evidence for a specific regimen, not a two-year promise for everyone. Delayed nodules and difficult correction matter, and hyaluronidase does not dissolve PLLA.

Section sources: Subject global evaluation and subject satisfaction using injectable poly-L-lactic acid versus human collagen for nasolabial fold wrinkles (2011) · American Society of Plastic Surgeons — Types of Dermal Fillers · FDA — FDA-Approved Dermal Fillers: materials · FDA-hosted PLLA product patient labelling — Sculptra, P030050/S039

PMMA and permanent fillers: a long-term responsibility

Polymethylmethacrylate, or PMMA, microspheres are not absorbed. Some formulations use bovine collagen, requiring product-specific allergy assessment. Permanent material does not guarantee a permanently satisfactory appearance or freedom from late complications. Complete removal can be difficult or impossible and may require surgery.

In one five-year study of 1,008 recipients of a specific PMMA–collagen formulation, biopsy-confirmed granulomas occurred in 1.7%; this is not the risk rate for all fillers. Unknown gels and injectable silicone are not interchangeable with a licensed filler. Canadian authorization must be checked for each product.

Section sources: Health Canada — Cosmetic injections · Five-Year Safety and Satisfaction Study of PMMA-Collagen in the Correction of Nasolabial Folds (2015) · FDA — Dermal Filler Do’s and Don’ts for Wrinkles, Lips and More · Health Canada — Medical Devices Active Licence Listing (MDALL)

Fat transfer: surgery using your own tissue

Fat transfer involves harvesting fat elsewhere on the body and grafting it to the target area; it is not an off-the-shelf filler syringe. Some fat is reabsorbed, and retention is not precisely predictable. Results can be long-lasting, with possible asymmetry and repeat or corrective procedures.

Assessment must include the donor site, anaesthesia, bleeding, infection and fat necrosis as well as facial risks. Being your own tissue does not eliminate risk; severe visual complications have also been reported after facial fat transfer. It requires a separate surgical assessment.

Section sources: American Society of Plastic Surgeons — Fat Injections as Dermal Fillers · American Society of Plastic Surgeons — Cheek Augmentation Risks and Safety · American Academy of Ophthalmology — Vision-Threatening Complications of Soft Tissue Fillers (2025)

Skin boosters are not the same as volumizing fillers

Skin booster is not one standardized formulation. Some injectable HA preparations have been studied for hydration, fine lines or skin quality. They are distinct from structural fillers, topical HA serums, mixed mesotherapy cocktails and other products marketed as rejuvenators. Exact composition and local authorization matter.

A 30-person saline-controlled trial and a 448-person no-treatment-controlled trial reported improvements in selected skin-quality measures. Products, follow-up and controls differed. These findings do not establish equal performance for all boosters, whole-body anti-ageing or the absence of rare complications.

Section sources: The Effects of a Non-cross-linked Hyaluronic Acid Gel on Aging Signs versus Normal Saline: A Randomized, Double-blind, Placebo-controlled, Split-faced Study (2023) · A Prospective, Multicenter, Randomized, Assessor-Blinded Study of Injectable Non-Cross-Linked Hyaluronic Acid for Facial Skin Rejuvenation (2026) · Health Canada — Medical Devices Active Licence Listing (MDALL)

Visible duration is different from material persistence

Published broad estimates range from months for some HA products to around two years for some PLLA regimens. Site, product and individual response affect duration. A marketing interval is not an automatic refill deadline; further treatment should follow reassessment of the result and tissues.

In an observational imaging study of 33 selected patients, midface HA remained detectable beyond two years. This does not predict every patient’s cosmetic duration or prove that all residual material is harmful. It supports reviewing previous treatment and existing fullness before adding more.

Section sources: Health Canada — Cosmetic injections · Hyaluronic Acid Filler Longevity in the Mid-face: A Review of 33 Magnetic Resonance Imaging Studies (2024) · Subject global evaluation and subject satisfaction using injectable poly-L-lactic acid versus human collagen for nasolabial fold wrinkles (2011)

When should treatment wait or require more assessment?

Discuss active infection or inflammation, cold sores, inflammatory acne, previous anaphylaxis, bleeding disorders and ingredient allergies before booking. A short checklist cannot replace the exact product’s contraindications. Elective cosmetic treatment is generally deferred in pregnancy or breastfeeding because adequate safety evidence is lacking.

Provide all medicines, supplements, conditions, recent dental treatment and previous injections or implants. Do not stop prescribed anticoagulants, aspirin or other necessary treatment to reduce bruising without the prescriber’s advice. A negative app screening answer does not medically clear you for injection.

Section sources: Health Canada — Cosmetic injections · American Academy of Dermatology — Fillers: Preparation · FDA — Dermal Fillers (Soft Tissue Fillers) · FDA-hosted PLLA product patient labelling — Sculptra, P030050/S039 · FDA-hosted CaHA product patient labelling — Radiesse, P050052/S162

Your Canadian provider and product checklist

Check the provider’s professional status with the provincial regulator; Ontario examples are CPSO for physicians and CNO for nurses. Registration alone does not prove filler expertise. Ask about specific training, experience with the proposed area, follow-up and immediate access to complication care.

Request patient labelling and record the exact product, manufacturer, lot and expiry. Check the actual device in MDALL and clarify the proposed use. FDA approval concerns the United States and does not substitute for Canadian authorization. Discuss total cost, likely visits, complication care and the option of no treatment before consenting.

Section sources: College of Nurses of Ontario — Confirm a nurse’s status · College of Physicians and Surgeons of Ontario — Physician Register · College of Nurses of Ontario — Thinking about aesthetic services from a nurse? · Health Canada — Medical Devices Active Licence Listing (MDALL) · Health Canada — Unauthorized injectable health products seized from a Hamilton business

Expected recovery: what may be normal?

Limited tenderness, bruising and swelling can occur and often improve over days to approximately two weeks, depending on the site and product. Do not assume a bruise-free next day for an important event. Early swelling is a poor basis for judging the final result.

Get written, treatment-specific aftercare, including when to exercise, apply makeup, touch the area or use cooling. Massage instructions differ by material; do not improvise. Routine aftercare instructions must never override unusual pain or a concerning colour change.

Section sources: American Academy of Dermatology — Fillers: FAQs · FDA — Dermal Filler Do’s and Don’ts for Wrinkles, Lips and More · FDA-hosted CaHA product patient labelling — Radiesse, P050052/S162

Which skin-care products have a useful role?

Once the surface is closed and your clinician agrees, a mild cleanser and simple fragrance-free moisturizer can support comfort. A glycerin-, ceramide- or petrolatum-based formula may be easier to tolerate than a multi-active serum. This is general skin-barrier care, not evidence that a cream prolongs filler results.

Use shade and clothing, adding broad-spectrum SPF 30 or higher on healed, tolerating skin. Do not experiment with cosmetics on open, draining or possibly infected areas. Antibiotics, steroids, acids, retinoids and so-called filler-dissolving creams are not self-treatment for swelling. No cosmetic cream restores an obstructed blood supply.

Section sources: American Academy of Dermatology — 7 rosacea skin care tips dermatologists recommend · American Academy of Dermatology — Minimize a scar: Proper wound care tips · American Academy of Dermatology — How do I know if I’m using the right sunscreen? · FDA — Dermal Fillers (Soft Tissue Fillers)

Urgent warnings: do not wait for spontaneous improvement

Compromised blood supply can cause tissue death, blindness or stroke. Visual disturbance or loss, facial droop, sudden one-sided weakness or numbness, speech difficulty or a sudden severe headache after injection require emergency action: call 911 in Canada and mention the recent filler. Breathing difficulty or tongue/throat swelling is also an emergency. Do not drive yourself.

Unusual or increasing pain, blanching, or grey, blue or mottled skin may indicate compromised blood supply; absence of severe pain does not rule it out. Contact the treating clinician immediately for in-person assessment; if immediate care is unavailable, attend an emergency department. Photos, makeup, massage or self-medication must not delay evaluation.

Section sources: FDA — Dermal Fillers (Soft Tissue Fillers) · American Academy of Ophthalmology — Vision-Threatening Complications of Soft Tissue Fillers (2025) · Heart & Stroke — Signs of stroke · Public Health Agency of Canada — Anaphylaxis and other acute reactions: Canadian Immunization Guide

Delayed problems and follow-up

Spreading redness, warmth, pus, fever or swelling that worsens after initially improving needs prompt same-day assessment. Persistent lumps, recurrent swelling, discoloration or asymmetry also deserve review, even months later. Not every lump is an infection, and treatments differ.

Do not squeeze a lump or use leftover antibiotics or steroids. Bring the injection date, product record and unfiltered photographs. After obtaining care, suspected device problems can be reported to Health Canada with your clinician’s help; reporting never replaces urgent treatment.

Section sources: FDA — Dermal Filler Do’s and Don’ts for Wrinkles, Lips and More · Health Canada — Cosmetic injections · Health Canada — Consumers: Report a medical device problem · FDA-hosted CaHA product patient labelling — Radiesse, P050052/S162

Recognize unsafe shortcuts

Online products for self-injection, injection parties and unnamed heavily discounted products are unsafe shortcuts. Health Canada has warned about unauthorized and counterfeit injectables. Professional-looking packaging and follower counts do not verify authenticity or injection competence.

Needle-free does not mean risk-free. Health Canada’s checked advisory states that needle-free filler devices, including hyaluron pens, are not authorized for sale in Canada and describes infection and tissue/vessel injury risks. A product labelled for topical use must not be repurposed for injection.

Section sources: Health Canada — Needle-free dermal filler devices are not authorized in Canada · Health Canada — Unauthorized injectable health products seized from a Hamilton business · FDA — Dermal Filler Do’s and Don’ts for Wrinkles, Lips and More

A traceable decision and the limits of evidence

Keep a decision record: your goal, why this material was proposed, realistic benefit, alternatives, total cost and after-hours contact route. Compare photographs with similar light, angle, distance and expression. Advertising before-and-after images alone do not establish your likelihood of benefit.

This is an original synthesis of sources checked on 17 October 2026. Studies involve different products and sites and cannot definitively rank all fillers. Independent review of this guide by a licensed clinician has not yet occurred; no reviewer or Canadian authorization for an individual product is claimed. Product labelling and personal assessment remain necessary before treatment.

Section sources: American Academy of Dermatology — Fillers: Preparation · College of Nurses of Ontario — Thinking about aesthetic services from a nurse? · Calcium hydroxylapatite versus nonanimal stabilized hyaluronic acid for the correction of nasolabial folds: a 12-month randomized split-face trial (2008) · Subject global evaluation and subject satisfaction using injectable poly-L-lactic acid versus human collagen for nasolabial fold wrinkles (2011) · Health Canada — Medical Devices Active Licence Listing (MDALL)

Comparison for consultation, not automatic product selection

Frequently asked questions

Related guides to explore

• Botulinum toxin type A
• Hyaluronic acid fillers
• Collagen-stimulating fillers: CaHA & PLLA
• HA skin-quality injections
• PRP for facial skin

Sources and context

Canadian sources take priority for regulatory context. FDA or other foreign information does not establish Canadian authorization for a product or use. A source-check date is distinct from publication date or independent clinical approval.

1. American Academy of Dermatology — Fillers: OverviewProfessional society: consumer guidance · 2026-10-17
2. American Academy of Dermatology — Fillers: PreparationProfessional society: consultation guidance · 2026-10-17
3. FDA — Dermal Filler Do’s and Don’ts for Wrinkles, Lips and MoreUS regulator: consumer guidance; not Canadian authorization · 2026-10-17
4. Mayo Clinic — Dark circles under eyes: causesClinical institution: original patient information · 2026-10-17
5. FDA — FDA-Approved Dermal Fillers: materialsUS regulator: material characteristics; not Canadian authorization · 2026-10-17
6. American Society of Plastic Surgeons — Types of Dermal FillersProfessional society: material overview; indications require local verification · 2026-10-17
7. Effectiveness of Low Doses of Hyaluronidase to Remove Hyaluronic Acid Filler Nodules: A Randomized Clinical Trial (2018)Original randomized trial: nine volunteers; experimental arm nodules, not emergency outcomes · 2026-10-17
8. American Academy of Ophthalmology — Vision-Threatening Complications of Soft Tissue Fillers (2025)Professional society evidence assessment: case-based evidence, not population incidence · 2026-10-17
9. FDA-hosted recombinant hyaluronidase prescribing information (2024)US prescribing information: allergy warning, not a filler dissolution protocol · 2026-10-17
10. Calcium hydroxylapatite versus nonanimal stabilized hyaluronic acid for the correction of nasolabial folds: a 12-month randomized split-face trial (2008)Original randomized trial: 60 participants; specific products and nasolabial folds · 2026-10-17
11. Subject global evaluation and subject satisfaction using injectable poly-L-lactic acid versus human collagen for nasolabial fold wrinkles (2011)Original randomized trial with 25-month PLLA follow-up · 2026-10-17
12. FDA-hosted PLLA product patient labelling — Sculptra, P030050/S039US product-specific patient labelling: used for limitations, not Canadian authorization or brand recommendation · 2026-10-17
13. Health Canada — Cosmetic injectionsCanadian regulator: consumer safety guidance · 2026-10-17
14. Five-Year Safety and Satisfaction Study of PMMA-Collagen in the Correction of Nasolabial Folds (2015)Original prospective five-year safety study · 2026-10-17
15. Health Canada — Medical Devices Active Licence Listing (MDALL)Canadian regulator: licence verification · 2026-10-17
16. American Society of Plastic Surgeons — Fat Injections as Dermal FillersProfessional society: surgical fat transfer · 2026-10-17
17. American Society of Plastic Surgeons — Cheek Augmentation Risks and SafetyProfessional society: surgical and fat-transfer risks · 2026-10-17
18. The Effects of a Non-cross-linked Hyaluronic Acid Gel on Aging Signs versus Normal Saline: A Randomized, Double-blind, Placebo-controlled, Split-faced Study (2023)Original randomized trial: 30 participants; product-specific short-term skin-quality outcomes · 2026-10-17
19. A Prospective, Multicenter, Randomized, Assessor-Blinded Study of Injectable Non-Cross-Linked Hyaluronic Acid for Facial Skin Rejuvenation (2026)Original randomized trial: 448 participants; no-treatment control and short follow-up · 2026-10-17
20. Hyaluronic Acid Filler Longevity in the Mid-face: A Review of 33 Magnetic Resonance Imaging Studies (2024)Original observational imaging study: selected sample, not a universal duration estimate · 2026-10-17
21. FDA — Dermal Fillers (Soft Tissue Fillers)US regulator: safety and limitations; not Canadian authorization · 2026-10-17
22. FDA-hosted CaHA product patient labelling — Radiesse, P050052/S162US product-specific patient labelling: used for precautions and follow-up, not Canadian authorization or brand recommendation · 2026-10-17
23. College of Nurses of Ontario — Confirm a nurse’s statusOntario professional regulator: public register · 2026-10-17
24. College of Physicians and Surgeons of Ontario — Physician RegisterOntario professional regulator: public register · 2026-10-17
25. College of Nurses of Ontario — Thinking about aesthetic services from a nurse?Ontario professional regulator: informed consent and professional responsibilities · 2026-10-17
26. Health Canada — Unauthorized injectable health products seized from a Hamilton businessCanadian regulator: safety alert · 2026-10-17
27. American Academy of Dermatology — Fillers: FAQsProfessional society: recovery and expectations · 2026-10-17
28. American Academy of Dermatology — 7 rosacea skin care tips dermatologists recommendProfessional society: general sensitive-skin principles; not a filler aftercare trial · 2026-10-17
29. American Academy of Dermatology — Minimize a scar: Proper wound care tipsProfessional society: general wound-care principles; not a filler aftercare trial · 2026-10-17
30. American Academy of Dermatology — How do I know if I’m using the right sunscreen?Professional society: sunscreen selection · 2026-10-17
31. Heart & Stroke — Signs of strokeCanadian health charity: emergency stroke action · 2026-10-17
32. Public Health Agency of Canada — Anaphylaxis and other acute reactions: Canadian Immunization GuideCanadian public health authority: emergency recognition principles, not filler-specific aftercare · 2026-10-17
33. Health Canada — Consumers: Report a medical device problemCanadian regulator: consumer reporting pathway · 2026-10-17
34. Health Canada — Needle-free dermal filler devices are not authorized in CanadaCanadian regulator: safety advisory · 2026-10-17