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Fillers are the anatomical regions where materials are injected in order to enhance volume.

Basically we can enhance volume in two ways:

Grafts: A graft is an anatomical portion completely separated from its bed and transplanted to another area with no vascular connection whatsoever. In oculoplastic surgery it is very commonly used. The main grafts used in the periocular area are lipodermoid, ultrafiltered fat, cartilage, skin, lip, and palate. These grafts have different uses in reconstructive surgery, both to improve eyelid retractions, to reconstruct volume tumours, or to fill anophthalmic cavities. They are less frequently used in cosmetic surgery.

Implants: These are used primarily in cosmetic surgery. It is an inorganic material introduced into the body with the intention of permanence. In recent years many different typos of material have been commercialised, such as polymers, plastics, silicon, metals, or textiles.

Implant type

Non-biologic or synthetic implants incluye the following types:

Absorbable implants

They are implants that have a body length between 2 and 6 months later. They incluye collagen and its derivatives (autologous or bovine), as well as hyaluronic acid (of animal origin or synthetic). Others like Scultra consist of polylactic acid and its duration may reach 12 months.

The absorbable type is used to give volume to soft tissues. In those of non-animal origin they require no previous allergy test.

Nonabsorbable implants

There are reabsorbed and therefore we have less control over their complications. Silicone granules are not authorised in our country. Some available materials are: Methacrylate (Artecoll and Dermalive), Acrylamides (Aquamid and Evolution) and Polialquilimidas (Bioalcamid).

These materials are used in deep tissues to give support. They can give more complications and therefore we must be careful when administering them.

Hyaluronic acid

It is the most widely used filler due to safety reasons. There are, depending on their density, various preparations.

Hyaluronic acid is present in all tissues of animal species. It replenishes through water retention.

Used since 1996, it may be of animal or biological origin.

Available preparations include Juvederm, Achyal, Perlane, Restylane, and Hyalform Rofilan.

There is no need to do prior allergy testing, although is not recommended in those allergic to chicken proteins or eggs.


It is s reabsorbable over a period of 8-12 months. It is convenient to use together with or laser peeling. Incapable of reacting with benzalkonium chloride.

In cases of fine wrinkles and crow's feet we use the less crosslinked form (18 mg/g). The denser forms (24 mg g) are used for deeper depressions such as glabellar or nasolabial folds.


In this case the hyaluronic acid is not of animal origin. It is compatible with human hyaluronic acid. There is no risk of disease transmission.

It is used for moderate to severe wrinkles us as nasogenian ones. Additional punctures are usually needed.


It is used to soften and stuffed deep profiles of the face and neck. It is more viscous than the previous form. It may take longer than a year to reabsorbe.

Hyal Rofilan Gel

Non-animal origin. Its use is intradermal. It is more viscous and 30G Needles must be used.

Choice of implant

The type of implant to be introduced is a dependant on the area we wish to fill, defect characteristics, and a deep knowledge of all packing materials we have at our disposal.


We introduce implants in cases in which there is atrophy, or loss of soft tissue or bone. We fill a volume, either for reconstructive or cosmetic purposes, provided that we do not have biological material for these purposes, or cases in which surgery is deemed more invasive or aggressive.

How to apply

We always think of this as a surgical procedure, and therefore we must maintain the same level of asepsis.

Before application a thorough medical history should performed, asking the patient about allergies, collagen diseases or possible pregnancy.

Photographs will be taken only for private use in the treatment areas, detailing the history, previous injuries or complications predisposing to keloid scars, such as skin type, race etc.

The patient must sign an informed consent form.

It is very important that the patient manifests what is wrong and how he thinks he can improve. Your doctor will explain the degree of consistency between what you expect and what can be improved. It is the job of the physician properly explain treatment goals in order to achieve realistic patient expectations.


  • The patient should wash their face with soap the day befote, and remove makeup
  • Clean with a disinfectant such as povidone iodine
  • Draw the treatment area
  • We use an anesthetic: it can be applied topically as Emla 2 hours before or cold. We can also use lidocaine infiltration
  • We use a 18-20G needle to infiltrate the material
  • Where do we place the filling? We can deposit it at various levels depending on what we want to achieve. In the epidermis, the filling almost becomes transparent and hyaluronic acid may be used. In the dermis and hypodermis we can also put hyaluronic acid, but in the deeper dermis polylactic acid is used instead. In the subcutis and subcutaneous tissue, filling is more global and high density materials are needed. The same applies to the subperiosteal level where you can place the nonabsorbable
  • Stuffed materials should not be used round the eyes. Their use is restricted to the nasolabial folds or under the inferior orbital region, where we can use absorbable materials such as hyaluronic acid, which is employed at greater depths than finer wrinkles where we do this very superficially. That way we avoid phenomena such as fibrosis
  • Injection pattern may be in linear network or microdots
  • At the end of the technique, the patient is instructed to apply ice on the puncture site. There may be transient points of hematoma. Patients can return to work immediately
  • Check-ups are made at a week and a month where we can better see the final outcome

Who can apply this treatment?

Treatment can be applied by a doctor qualified to perform the procedure. Your ophthalmologist is trained to perform this technique.

Filler materials meet the strictest legislation criteria.

Despite being an easy technique to perform, only a doctor is qualified to do it.

Side effects

With absorbable materials side effects and complications are less common, such as granulomas, fibrosis or necrosis, which are more common with collagen and nonabsorbable materials.


Results can be highly variable and dependent on the tissue that is infiltrated, as well as viscosity of the product and the depth of the deposited filling.

The result is usually immediate with hyaluronic acid or collagen. With alquilimide or other fillers duration is variable. Polylactic acid is capable of forming new tissue and the effect is longer-term and more permanent.

To treat a nasogenic sulcus we must inject two or three times polylactic or hyaluronic acid two or three times.