Filler Treatment

Along with the aging process, various factors such as genetic factors, sun exposure, gravity, lifestyle, weight fluctuations, and smoking and alcohol use can alter skin structure and facial volume distribution over time. Changes in the amount of collagen, elastin, and hyaluronic acid in the skin can lead to volume loss in soft tissues, decreased elasticity, sagging, and wrinkles.

Filler treatment is an injection-based medical aesthetic method applied to support volume loss in suitable areas of the face and body, accentuate facial features, and reduce the appearance of certain lines and depressions. Hyaluronic acid-based dermal fillers are most commonly used in the procedure. In addition, in suitable patients, fat injections obtained from the person's own fat tissue can also be evaluated for volume augmentation purposes. Filler applications can be planned in different facial areas such as the lips, cheeks, cheekbones, chin, and jawline, in line with the individual's anatomical features and needs. In some cases, a more balanced facial appearance can be targeted by addressing volume loss in specific regions of the face.

Dr. Lida Çiteli, providing services in the field of medical aesthetics in Istanbul, determines the appropriate application approach in filler treatments by evaluating the person's facial anatomy, skin structure, and expectations.

What is Filler?

Filler is an injection-based medical aesthetic method applied to provide volume support beneath the skin or in appropriate soft tissue layers. One of the most frequently used filler materials is hyaluronic acid. Fillers with different densities and structures can be preferred based on the characteristics of the product used and the application area. Dermal fillers can be used to support volume loss in the face, accentuate specific facial features, and reduce the appearance of certain fine lines, grooves, or hollows. While they can be applied to areas such as the lips, cheeks, cheekbones, chin, and jawline, they can also be evaluated for different anatomical areas in suitable patients. Filler treatment is not a surgical operation. Tools such as fine needles or cannulas can be utilized during the procedure, and comfort can be enhanced before the process using products containing local anesthetics according to the person's sensitivity and the area to be treated.

An important characteristic of hyaluronic acid-based fillers is that they can be broken down using the hyaluronidase enzyme when necessary. However, this feature does not apply to all types of fillers. Fillers with different contents, such as calcium hydroxyapatite or polycaprolactone, cannot be dissolved with hyaluronidase. Therefore, the type of filler material to be used, the application area, and the amount must be carefully evaluated before the procedure. The longevity of the filler varies depending on the content of the product used, the application area, the amount applied, and the person's metabolic characteristics. For this reason, rather than providing a single standard duration prior to the procedure, it is more accurate to make an evaluation based on the characteristics of the product to be used and personal factors.

Fillers and Botox are not applied for the same purpose. Botox is primarily used to reduce the appearance of dynamic wrinkles resulting from the movement of mimic muscles, whereas fillers are mostly preferred to support volume loss, shape facial features, and reduce the appearance of specific hollows or lines. In some individuals, both applications can be part of the same treatment plan aimed at different needs. Whether filler treatment is suitable should be decided by jointly evaluating the person's facial anatomy, skin structure, existing volume loss, health status, and expectations.

What Are the Types of Fillers?

Fillers used in medical aesthetics vary according to their contents, physical properties, and intended uses. When selecting a filler, the application area, required volume, skin and soft tissue characteristics, targeted outcome, and the individual's general health status are evaluated together.

The main fillers and volume-enhancing methods used today include the following:

• Hyaluronic acid fillers: They are among the most commonly used dermal filler types for providing volume and moisture support. Depending on the product's density and properties, they can be used in the lips, cheeks, cheekbones, chin, jawline, and other areas deemed appropriate.
• Calcium hydroxyapatite (CaHA) fillers: Due to their denser structure, they can be preferred particularly for supporting facial features and creating structural volume in specific areas. They also have collagen-stimulating effects.
• Polycaprolactone-containing fillers: These are products that can be used to support collagen production in addition to volume support. Their areas of application may vary depending on the product's features and application technique.
• Fat injection: This is the application of fat tissue harvested from the person's own body to another area for volume enhancement after undergoing appropriate processes. Unlike other filler materials, a separate procedure is required to obtain the fat tissue.

Each filler material has its own unique features, advantages, limitations, and areas of use. Therefore, a choice is not made based solely on the name of the filler substance; the appropriate product and technique are determined in line with the person's facial anatomy and targeted result.

Which Filler Type is Applied to Which Region?

The anatomical structure, skin thickness, mobility, and required support of each facial region are different. For this reason, the same filler material is not used in the same manner in every region.

Hyaluronic acid fillers can be used in regions such as the lips, cheeks, cheekbones, chin, jawline, and under the eyes in certain suitable patients, depending on the product's density and properties. Softer and more flexible products are preferred in dynamic areas like the lips, while products with higher structural support can be evaluated in areas where accentuating facial features is intended.

Calcium hydroxyapatite fillers, due to their denser structure, can be evaluated in areas where structural support is important, particularly the chin, jawline, cheekbones, and the back of the hands in suitable patients. They are generally not preferred in delicate areas such as the lips and under-eye region.

Polycaprolactone-containing fillers can be used in different regions of the face to support volume or stimulate collagen production, depending on the product's characteristics and the purpose of application.

Fat injections can be evaluated to address volume loss over larger areas. Since the application is made using the person's own fat tissue, a suitable donor area from which fat can be harvested must be identified before the procedure.

Which filler type to use must be determined by the physician after evaluating the facial anatomy, skin and soft tissue characteristics, degree of volume loss, and the person's expectations.

What is Hybrid Filler?

Hybrid filler refers to a filler approach where components with different properties or mechanisms of action are combined within the same product. Depending on the content of the product, the goal may be to support skin structure and collagen production in addition to volume support.

Since the content and application characteristics of hybrid fillers can vary from product to product, "hybrid filler" alone does not represent a specific single product or a standard application.

Suitable products can be evaluated for structural support or volume adjustment in areas such as the cheekbones, cheeks, chin, and lateral aspects of the face. The content, application area, amount, and technique of the product to be used must be determined in line with the person's facial anatomy and needs.

What is Calcium Hydroxyapatite Filler?

Calcium hydroxyapatite (CaHA) filler is a filler material that can be used to provide volume and structural support while also possessing collagen-stimulating properties.

As the calcium hydroxyapatite particles in its content break down over time through the body's natural processes, they can contribute to supporting collagen production in the application area. Due to this feature, it can be evaluated for accentuating facial features and supporting volume loss that occurs with age.

It can be used particularly in areas where structural support is important, such as the chin, jawline, and cheekbones. In suitable patients, it can also be preferred to reduce the appearance of volume loss on the back of the hands.

Due to the structure of CaHA fillers, their use in delicate areas such as the lips and under-eye region is generally not appropriate. Which area to apply it to and the amount of product to be used must be decided by evaluating the person's anatomical features and targeted outcome.

What Does Calcium Hydroxyapatite Filler Do?

Calcium hydroxyapatite filler can primarily be used to provide volume and structural support and to stimulate collagen production.

In the facial area, it can:

• Support a more defined appearance of the chin and jawline.
• Contribute to addressing volume loss in the cheekbone and cheek regions.
• Help facial contours appear more balanced.
• Contribute to supporting collagen production in the skin.

On the back of the hands, it can be evaluated to support soft tissue volume that decreases with age and to reduce the prominent appearance of structures such as veins and tendons. The effect and longevity of CaHA fillers can vary according to the product used, application technique, application area, and individual characteristics. Therefore, the treatment plan should be created specifically for the individual.

What is the Difference Between Calcium Hydroxyapatite Filler and Hyaluronic Acid Filler?

The contents, physical properties, and intended uses of calcium hydroxyapatite and hyaluronic acid fillers differ from one another.

Hyaluronic acid fillers can be manufactured in various densities, allowing them to be used across many areas of the face for volume, contouring, and moisture support. Hyaluronic acid products with appropriate properties can be preferred in more mobile and delicate areas like the lips. An important feature of hyaluronic acid fillers is that they can be dissolved using hyaluronidase when deemed necessary.

Calcium hydroxyapatite fillers, on the other hand, exhibit denser and more structural properties. They can be evaluated particularly in areas where supporting facial contours is aimed, such as the chin, jawline, and cheekbones. They also feature collagen-stimulating properties. Unlike hyaluronic acid fillers, CaHA fillers cannot be dissolved with hyaluronidase.

Both types of fillers have their own distinct advantages and areas of use. There is no single answer to the question "Which filler is better?" The appropriate product should be determined by evaluating the person's facial anatomy, the degree of volume loss, the application area, and the targeted result.

How Long Do Fillers Last?

The longevity of filler applications varies according to the content of the filler material used, product characteristics, application area, amount used, application technique, and the person's metabolic traits. Therefore, it is not correct to give a single duration of longevity valid for all fillers.

The duration of effect for hyaluronic acid-based fillers can vary depending on the product used and the application area. While the effect of the filler may last for a shorter duration in highly mobile areas such as the lips, the result can be maintained longer in less mobile areas like the cheekbones or chin.

In calcium hydroxyapatite and other filler materials that stimulate collagen production, longevity also varies depending on the product used and personal factors. In fat injections, a portion of the applied fat tissue may be absorbed by the body over time; the longevity of the remaining fat tissue can differ from person to person. When the effect of the filler diminishes, whether a new application is necessary is evaluated by the physician based on the person's needs and current appearance.

How Long Does Swelling Last After Fillers?

Light swelling, redness, tenderness, or bruising at the injection site after a filler application are common temporary reactions. The duration of these effects can vary depending on the application area, product used, injection technique, and the person's characteristics.

Swelling is most noticeable during the first few days in most people and decreases over time. While it subsides significantly within a few days for some, it may take longer for mild edema or tenderness to resolve completely. Swelling can be more prominent particularly in delicate areas like the lips and around the eyes.

After the procedure, adhering to the physician's recommendations, avoiding unnecessary pressure on the application area, and steering clear of strenuous physical activity and excessively hot environments in the first few days may be advised.

Swelling is expected to decrease gradually. Instead, if symptoms such as swelling accompanied by increasing or severe pain, distinct blanching (whitening) of the skin, grey or bluish discoloration, or changes in vision occur, the performing physician should be contacted without delay for a necessary medical evaluation. Such symptoms may be signs of rare but serious complications.

When Does the Face Settle After Fillers?

The emergence of the final facial appearance after a filler application varies from person to person and according to the area treated. During the initial hours and days, the application area may appear fuller or asymmetrical than intended due to swelling, redness, or tenderness caused by the injection.

As the swelling subsides, the appearance becomes more natural. Therefore, to evaluate the final result of the filler, one should wait for the edema to resolve significantly. When deemed necessary, the result of the procedure can be evaluated during a follow-up consultation to decide whether an additional procedure or touch-up is required.

It is important for individuals planning to get fillers before an important event or special day to take into account the possibility of temporary swelling and bruising that may occur after the procedure.

Does Filler Make the Face Look Larger Than It Is?

The goal of filler application is not to enlarge the face excessively, but to support volume loss in needed areas and help facial features appear more balanced.

Due to temporary edema formed after the procedure, the face may appear puffier or more volumetric in the first few days. As the edema decreases, this appearance changes as well.

However, using an excessive amount of product, performing an application unsuitable for the person's facial anatomy, or unplaned repetition of fillers in different areas can create an overly full or disproportionate look on the face. Therefore, the amount and area of product to be applied should be planned looking at the overall proportions of the face, not just at a single point.

When a natural result is targeted, the objective is not to volumize the face as much as possible, but to provide measured support in required areas taking the person's existing facial features into consideration.

What is the Difference Between Liquid Facelift and Filler?

A liquid facelift is not the name of a specific filler material on its own. It is a holistic, injection-based application approach that evaluates volume losses across different areas of the face and aging-related changes together.

Filler, on the other hand, refers to the material used to support volume loss, shape specific facial features, or reduce the appearance of certain hollows and lines. In classic filler applications, a specific region such as the lips, chin, cheekbones, or cheeks is usually targeted. In the liquid facelift approach, an application plan can be created for multiple areas by evaluating proportions and volume distribution across the entire face.

The goal is to support the overall balance of the face and achieve a more harmonious appearance rather than merely filling a single line or region. The type, amount, and injection points of the products to be used must be determined based on the person's facial anatomy, skin structure, and expectations. Liquid facelift should not be considered an alternative to surgical facelift. For some individuals with significant skin sagging or advanced signs of aging, surgical methods may be a more suitable option.

Which is More Suitable: Filler or Liquid Facelift?

The choice between a filler and a liquid facelift approach is made based on the person's facial structure, the distribution of volume loss, and the targeted result. If there is noticeable volume loss or shape asymmetry in a single region, a localized filler application can be evaluated. For instance, if volume support is needed specifically in the lips, chin, or cheekbones, an application targeting only the relevant area may be sufficient.

If there is volume loss in multiple areas of the face and the overall proportions of the face need to be evaluated together, a more holistic injection plan can be considered. In this approach, the aim is to take the entire face into account rather than evaluating volume changes in different regions independently.

However, filler or liquid facelift does not need to be applied for every instance of volume loss. The appropriate treatment option should be decided by evaluating the person's skin structure, facial anatomy, degree of sagging, health status, and expectations.

Does Getting Fillers Age the Face?

The purpose of filler application is not to accelerate aging. When performed on a suitable patient, using the correct product and appropriate amount, fillers can be used to support certain volume losses occurring with age and to balance facial features.

However, using more product than necessary, applying excessive treatments to the same area, or performing repeated procedures without considering the overall proportions of the face can negatively affect the natural facial appearance. The face appearing fuller, heavier, or more disproportionate than it is can be the result of such applications.

Therefore, the goal in filler treatment is not to create as much volume as possible, but to provide measured support to needed areas considering the person's facial anatomy and existing volume distribution. As evaluations regarding the long-term and repeated use of filler applications may vary on a product basis, the frequency of procedures and re-application decisions should be made based on individual assessment.

In Which Situations Are Fillers Not Recommended?

Prior to filler application, the person's health status, medications used, allergies, previously undergone aesthetic procedures, and the skin condition of the application area must be evaluated. In certain cases, the procedure may be postponed or a different treatment option may be preferred.

A detailed physician evaluation is required prior to the procedure, particularly in cases such as:

• Presence of an active infection or significant inflammatory skin issue in the application area,
• Known severe allergies or a history of anaphylaxis,
• Presence of a disease related to bleeding or clotting,
• Known allergy to any of the components of the product to be used,
• History of a severe reaction associated with a previous filler application. In areas with active infection or inflammation, the filler application may need to be postponed.

Since there is insufficient data regarding the safety of dermal fillers during pregnancy and breastfeeding, the procedure is generally deferred until after this period. If there are regularly used medications or supplements, it is important to inform the physician prior to the procedure. Medicines that may affect bleeding risk in particular should not be discontinued without the physician's recommendation. Before deciding to get fillers, the person's health history, expectations, anatomical features of the application area, and characteristics of the product to be used must be evaluated together.

How is Filler Treatment Applied?

Filler treatments are generally short-duration and well-tolerated procedures. Topical anesthetic creams or appropriate anesthesia methods used prior to the procedure can increase comfort during the application. Beforehand, the skin is cleansed with antiseptic materials. Subsequently, determined amounts of filler material are injected into the targeted points.

Which Regions Can Receive Filler Procedures?

Filler applications can be evaluated in different anatomical regions such as the lips, cheeks, cheekbones, chin, jawline, and, in certain special cases, under the eyes, the nose, or the back of the hands in suitable patients. The application area is determined in line with the person's anatomical features and needs.

What Are the Most Commonly Treated Filler Regions?

• Lip Filler: Lip fillers are frequently utilized to plump the lips, add volume, and define lip contours and border lines.
• Under-Eye Light Filler: It can be evaluated in suitable patients to reduce the appearance of prominent hollows under the eyes and make the transition around the eye area more balanced. Since the under-eye area is anatomically delicate, conducting a detailed evaluation before the procedure is important.
• Cheekbone and Cheek Filler: With advancing age, both volume loss and sagging occur in the cheek region. Cheekbone and cheek fillers are utilized to address these issues, lift the cheeks, and restore lost volume to the face.
• Chin and Jawline Filler: The chin area is one of the most important defining elements of facial expression. It is preferred to elongate the chin tip, add volume, and ensure a sharper jawline.
• Nose Filler: Nose fillers can be evaluated in suitable patients to temporarily alter the appearance of certain contour irregularities in the nose. Nose filler is not an alternative to surgical rhinoplasty and may not be a suitable option for every nasal structure. Due to the anatomical and vascular structure of the nasal region, conducting a detailed evaluation prior to the procedure is important.

What Are the Filler Substances Used?

• Hyaluronic Acid: It is one of the widely used filler materials today. Hyaluronic acid is a naturally occurring substance in the body, and products with different properties can be used across various regions of the face for volume support and shaping purposes. The product to be used and the application method must be determined according to the person's needs and the application area.
• Smart Fillers (Collagen Stimulators): Smart fillers are products aimed at supporting the skin's own natural collagen production. The onset period and longevity of their effect can vary according to the content of the product used, the application area, and personal factors.

What Are the Advantages of the Procedure?

• Since it is not a surgical procedure, it leaves no scars.
• It is a very short-duration and comfortable treatment option. Sessions can be completed within fifteen to thirty minutes.
• The effects of the procedure can be seen right after; however, the final appearance can be evaluated more clearly as post-procedure swelling and edema subside.

Your daily life is not interrupted; you can resume your normal routine right where you left off.

Who Can Get Fillers?

Suitability for filler treatment is not determined based on the person's age alone. A physician evaluates the person's health status, application area, expectations, product to be used, and existing risk factors to decide whether they are suitable for the procedure.

What is the Difference Between Fillers and Botox?

Botox is applied primarily to reduce the appearance of dynamic wrinkles formed due to the movement of mimic muscles. The injected botulinum toxin temporarily reduces the movement of the relevant muscles, helping wrinkles appear less prominent. Fillers, on the other hand, are used to support volume loss and reduce the appearance of certain lines, grooves, or hollows.

What Are the Side Effects of Filler Procedures?

Temporary bruising, swelling, redness, tenderness, or pain may be observed following filler treatment. Bleeding, nodules, or discoloration at the injection site may also occur. In rarer cases, complications such as infection, inflammatory reactions, or granulomas may develop. Very rare but serious complications include tissue damage due to intravascular injection and vision-related problems. Therefore, it is important that filler applications are performed under appropriate healthcare conditions by an experienced and qualified physician.

What Should Be Considered Before a Filler Procedure?

Prior to a filler application, all medications used, supplements, and known allergies must be shared with the physician. The physician should be informed particularly about the use of medications or supplements that may affect bleeding and bruising risks. Regularly used medications should not be discontinued or altered in dosage without the physician's advice. The skin condition of the area to be treated and the person's general health status should also be evaluated before the procedure.

What Needs to Be Considered After Getting Fillers?

Light redness, bruising, and edema may be observed in the treatment area. Most people can continue their daily activities after a filler application. Nevertheless, following the physician's recommendations and taking necessary precautions according to the application area after the procedure is important. It is necessary to avoid excessive physical activities following the application. For a period, one should stay away from hot, humid, and steamy environments such as Turkish baths, pools, and saunas.

Do Filler Applications Require Surgery?

Hyaluronic acid-based filler injections do not require surgical intervention. Hyaluronan-based filler applications can generally be performed within a short time under clinical conditions. The duration of the procedure may vary depending on the application area, the product to be used, and the scope of the procedure. If fillers are to be applied via fat injection, anesthesia and operating room conditions may be required for the fat harvesting procedure.

Can Fillers and Other Skin Rejuvenation Methods Be Used Together?

Yes, filler treatment can be applied in combination with laser treatments and PRP procedures. If filler and laser or other energy-based applications need to be planned together, the sequence of the procedures should be determined according to the method used, the application area, and the properties of the product. Therefore, the timing of combination procedures should be planned by the physician.

What Are the Prices of Filler Applications?

The price of filler treatment can vary based on many factors. The type of filler used, the application area, product quantity, the performing physician's experience, clinical conditions, and additional services provided can affect pricing. For up-to-date and exact price information, details should be obtained through the clinic's communication channels.

In Which Cities Do We Provide Filler Treatment Services?

Medical Aesthetics Specialist Dr. Lida Çiteli also provides filler treatment services to patients and clients coming from various parts of Turkey and the world at her Istanbul-based clinic.