Dermal fillers are gel-like products placed under the skin to replace volume lost with age, soften lines and define the contours of the face. They are often simply called “fillers” and have nothing to do with dental fillings.

With age, bone support in the face decreases, fat pads thin out and slide downward, and the skin loses collagen and hyaluronic acid. As a result, the cheeks flatten, the temples and under-eye area hollow, the lines beside the nose deepen and the lips get thinner. Fillers replace the volume lost through these changes and help the face look more rested and youthful.

Fillers are not only used for signs of aging. In areas such as the lips, chin, jawline and nose, they are also used to balance facial proportions and define features.

Fillers need no surgery, take a short time and show results right away. Hyaluronic acid fillers can be dissolved with a special enzyme if needed, which makes them reversible.

Fillers differ in ingredients, density and how long they stay in the body, so no single filler suits every area.

• Hyaluronic acid fillers: The most widely used fillers. Hyaluronic acid is a substance found naturally in the body that holds water. Denser versions are chosen for support points such as the cheekbones and chin, while softer, more fluid ones are used in delicate areas such as the lips and under the eyes. They can be dissolved if needed.
• Calcium hydroxylapatite fillers: These add volume and also stimulate the skin’s own collagen production. They are used over bony areas such as the cheekbones, temples and jawline. For a hybrid option combined with hyaluronic acid, see HarmonyCA filler.
• Plant-based fillers: Agarose-based fillers derived from seaweed may be considered as an option for some people. See Algeness vegan filler.

The product is chosen according to the area, skin thickness, the effect you want and your expectations. Non-dissolving fillers that stay in the tissue indefinitely are generally not recommended for the face, because they carry a long-term risk of unwanted reactions.

Fillers can be used in many areas of the face. The fillers most often done at our clinic in Istanbul are:

• Lips: For volume, contour and symmetry. See lip filler.
• Cheekbones, cheeks and temples: To lift the midface and fill hollows. See facial filler.
• Smile lines: To soften deepened nasolabial folds. See nasolabial fold filler.
• Under the eyes: For hollows and a tired look. See under-eye filler.
• Chin and jawline: To define the lower face and balance the profile. See chin and jawline filler.
• Neck, décolleté and back of the hands: To add volume and vitality to thinned skin.

In Dr. Sevgi Ekiyor’s Facial Architecture (Yüz Mimarisi®) approach, filler is planned by looking at the whole face rather than one area. A deep smile line, for example, is often caused by volume loss in the midface; supporting the cheekbones first then tends to give a more natural result.

First, your face is analyzed for volume loss, proportions and symmetry, and the plan is set.

1. The area is cleansed and disinfected.
2. Numbing cream is applied and left on for 15–20 minutes; ice may be used if needed. Most fillers also contain a local anesthetic.
3. The filler is placed at the right depth with a very fine needle or a blunt-tipped cannula, depending on the area.
4. The area is checked and gently shaped, if needed, so the product spreads evenly.

The appointment takes 15–45 minutes depending on how many areas are treated. You see the result right away, but because of early swelling, the final look appears in about 10–14 days. Small touch-ups can be made at the follow-up visit during this period.

Safety in filler treatment depends on a detailed knowledge of the blood vessels and nerves of the face. That is why fillers should be done with licensed products by a doctor with a thorough understanding of facial anatomy.

How long fillers last depends on the product, the area and your metabolism:

• Lip filler: Usually 6–12 months, since the lips move a lot.
• Face and cheek filler: Usually 12–15 months with hyaluronic acid fillers.
• Calcium hydroxylapatite fillers: Up to 20–24 months, as they stimulate collagen.

Smoking, strong sun, frequent saunas, rapid weight changes and intense sport may make filler break down faster. Small top-ups before the filler has fully dissolved can help maintain the result with less product. Once the filler has dissolved, the face returns to how it looked before treatment.