Dermal fillers are gels injected beneath the skin to restore volume that has been lost with age, smooth folds and creases, and shape features such as the lips, cheeks and chin. As we age, the face loses fat, bone and collagen. Cheeks flatten, the folds between the nose and mouth deepen, lips thin, and the backs of the hands start to show tendons and veins. Filler puts back some of that lost support, with no incision and usually no downtime.
Most fillers used today are made of hyaluronic acid, a substance that occurs naturally in the skin and helps it hold water. Hyaluronic acid fillers have one important safety feature: if a result is uneven or a complication occurs, an enzyme can dissolve them.
At NYMD Center, fillers are part of our medical spa, which operates inside a multi-specialty medical practice. Filler is a medical procedure with real, if uncommon, risks, and we treat it that way.
What fillers treat
According to the FDA, approved dermal fillers are used for moderate to severe facial wrinkles and folds, such as the lines from the nose to the corners of the mouth and lines around the lips; to add volume to the lips, cheeks and chin; to restore volume to the back of the hand; and to correct certain acne scars and contour deficiencies. In practice, the most common requests we see are softer smile lines, fuller or better-defined lips, restored cheek volume and more youthful-looking hands.
Fillers are not the answer to every sign of aging. Lines that appear only when you frown or squint come from muscle activity and respond better to Botox. Loose skin and poor texture respond better to collagen-building treatments such as Morpheus8. Filler used to chase a problem it cannot fix is how faces end up looking overfilled.
How we evaluate you
Your consultation begins with what you would like to change, followed by an assessment of your face or hands at rest and in motion. Your provider looks at where volume has been lost, the quality of the skin and how your features relate to one another, then explains what filler can realistically achieve and what it cannot. We review your medical history, allergies, medications and supplements (blood thinners and some supplements raise the chance of bruising), prior filler or surgery in the area, and any history of cold sores, since treatment around the mouth can trigger an outbreak.
We will tell you which product we recommend, why, and roughly how long it tends to last in the area being treated.
Treatment options
Hyaluronic acid fillers
Hyaluronic acid products come in different thicknesses. Firmer gels are used to support the cheeks and chin; softer ones suit the lips and fine lines. The Cleveland Clinic notes that hyaluronic acid fillers usually last six months to a year, and in some areas where there is little movement they may last longer. Lips, which move constantly, tend to lose filler sooner than cheeks.
Their main advantage is reversibility. As the Cleveland Clinic explains, a provider can dissolve fillers that contain hyaluronic acid with an enzyme called hyaluronidase, regardless of where the filler was placed. That option matters if the result is uneven, a lump forms or, most importantly, if filler blocks a blood vessel.
What we use, and PRP
At NYMD Center we use hyaluronic acid fillers, because they can be dissolved if needed. Other filler types, such as calcium hydroxylapatite and poly-L-lactic acid, last longer but cannot be reversed the same way. We also offer PRP (platelet-rich plasma), prepared from a small sample of your own blood, and your provider will tell you whether PRP fits your goals.
Combining treatments
Filler is often combined with Botox in the same visit: Botox to soften expression lines, filler to restore volume. Collagen-building treatments can be scheduled separately to improve skin quality over time.
Risks, and why medical supervision matters
Most side effects are temporary and local: bruising, swelling, redness, tenderness and small bumps that settle over days. Swelling in the lips can be noticeable for a few days.
The serious risk is rare but must be taken seriously. The FDA warns that the most concerning risk of dermal fillers is unintentional injection into a blood vessel, which can block blood flow to the skin and cause tissue death, and, very rarely, vision problems including blindness, or stroke. The FDA also warns against injectable silicone, against needle-free filler devices, and against buying filler online or injecting yourself.
These are the reasons we perform filler in a medical setting. Your provider knows the anatomy of the vessels in the areas being treated, uses careful technique, watches for early signs of a problem during and after the injection, and knows that hyaluronidase can dissolve hyaluronic acid filler quickly if blood flow is compromised. We care for adults only, and we do not perform elective filler during pregnancy or while breastfeeding.
What to expect at your visit
After the consultation, the area is cleaned and marked. Many fillers contain a local anesthetic, and we can apply numbing cream to sensitive areas such as the lips. Treatment usually takes under an hour. You will see a result immediately, although swelling can exaggerate it for the first few days, and the final look settles over about two weeks. The Cleveland Clinic notes that most people return to their usual activities right away, with a day or two off from strenuous exercise. Schedule at least two weeks before an important event, and plan a follow-up if you want a touch-up.
When to call us urgently
Call us right away at (212) 991-9991, a line that is answered after hours as well, if you notice skin that turns white, gray, dusky or blotchy near the treated area, pain that is worsening rather than improving, or any change in vision. Seek emergency care for vision loss, or for weakness, trouble speaking or other signs of stroke. Early treatment of a blocked vessel matters, so do not wait to see if it improves.
Questions patients ask
How long do dermal fillers last?
It depends on the product and the area. Hyaluronic acid fillers usually last about six months to a year, sometimes longer in areas that move little, while lips tend to lose filler sooner. We use hyaluronic acid filler, which can be dissolved if needed. Your provider will tell you what to expect for the product and area you choose.
Can filler be reversed?
Hyaluronic acid filler can. An enzyme called hyaluronidase breaks it down, and it works wherever the filler was placed. It is used for uneven results, lumps and, urgently, when filler blocks a blood vessel. Fillers made of other materials cannot be dissolved this way, which is one reason we discuss the product choice carefully before treatment.
What is the most serious risk of fillers?
The FDA identifies accidental injection into a blood vessel as the most concerning risk. It can block blood flow, damaging the skin, and very rarely causes vision loss or stroke. It is uncommon, and careful technique, knowledge of facial anatomy and having hyaluronidase ready lower the risk. Report skin color change, worsening pain or any vision change right away.
Can fillers be used on the hands?
Yes. Restoring volume to the back of the hand is an FDA-approved use for certain fillers. As we age, the backs of the hands thin and tendons and veins become more visible. Filler can soften that appearance. Your provider will assess the skin and discuss whether hand treatment suits you.
What is the difference between filler and Botox?
They solve different problems. Botox relaxes the muscles that cause expression lines, such as frown lines and crow's feet. Filler restores volume that has been lost, softening folds, shaping lips and supporting cheeks. Many people benefit from both, and they can often be done at the same appointment.
Is there downtime after filler?
Usually very little. Most people go back to their normal activities the same day, with a day or two off from strenuous exercise. Bruising and swelling are common for several days, especially in the lips. Plan treatment at least two weeks before an important event so the result has settled.