Part of our complete guide to Periocular Rejuvenation — this page covers dermal fillers in depth.
Dermal Fillers — Overview
Dermal fillers restore volume and improve facial contour in areas affected by aging, sun damage, or natural anatomy. Unlike neuromodulators, which relax muscles to soften dynamic wrinkles, fillers physically occupy space beneath the skin — adding volume, smoothing folds, and restoring structural support. Oculoplastic surgeons are expert injectors for periorbital filler treatments, where precise anatomical knowledge is essential to both achieve natural results and avoid rare but serious complications.
Fillers complement Botox for a complete non-surgical rejuvenation approach, and work alongside surgical options like Blepharoplasty and Brow Lift.
Hyaluronic acid fillers restore lost volume and smooth contours; the gel binds water beneath the skin
Hyaluronic Acid Fillers
Hyaluronic acid (HA) is a naturally occurring glycosaminoglycan that retains water and gives skin its plumpness. HA fillers are cross-linked to increase longevity and come in varying particle sizes and viscosities for different depths and areas of treatment. The critical safety advantage of HA fillers is their reversibility — an enzyme called hyaluronidase that can break down HA filler (often requiring adequate dosing and sometimes more than one treatment).
Juvéderm® Family (Allergan/AbbVie)
Voluma® XC — deep injection for cheek volume; lasts up to 2 years
Vollure® XC — moderate-depth folds; lasts up to 18 months
Ultra Plus XC — medium-depth folds and lips
Volbella® XC — lips and perioral lines; subtle volume
Restylane Eyelight — FDA-approved for the periorbital tear trough area
Tear Trough & Periorbital Filler
The tear trough — the concave groove at the junction of the lower eyelid and cheek — is one of the most requested and technically demanding filler treatments. As the midface descends with age and orbital fat herniates forward, this groove deepens and creates a shadow that imparts a tired, hollow appearance even in well-rested patients.
A thin-caliber, low-viscosity HA filler is placed in the deep fat compartment over the inferior orbital rim
Cannula technique is preferred to reduce bruising and the risk of intravascular injection in this high-risk area
Conservative treatment is the rule — over-correction produces a puffy, unnatural appearance difficult to reverse
Tyndall effect: a bluish-gray discoloration from superficially placed HA is a known complication, resolved with hyaluronidase
Patients with significant lower lid fat herniation may benefit more from lower blepharoplasty than from fillers alone
Midface & Cheek Volume
Midface volume loss is one of the earliest signs of facial aging — the malar fat pad descends, deepening the nasolabial fold and creating a triangular "skeletonized" appearance. High-viscosity fillers (Voluma, Restylane Lyft) placed in the deep fat compartments or at the periosteum restore structural support, elevate descended soft tissues, and improve the nasolabial fold indirectly:
Injected in the deep medial cheek fat, submalar region, or directly on the malar eminence
Results last 12–24 months; among the longest-lasting applications for HA fillers
Natural-appearing results require symmetric bilateral treatment with attention to facial proportions
Nasolabial Folds & Marionette Lines
The nasolabial fold (the crease from nose to mouth corner) and marionette lines (from the mouth corner toward the chin) deepen as midface tissues descend. Mid-viscosity HA fillers can be placed directly within these folds or used in combination with cheek volume restoration for a lifting effect. True improvement often comes from treating the structural cause (midface descent) rather than the fold itself.
Lip Augmentation
HA fillers define the vermilion border, increase lip volume, and reduce perioral lines. Precise injection into the lip body (wet vermilion), white roll (vermilion border), philtral columns, and Cupid's bow defines lip architecture. Natural-appearing results:
Preserve the natural lip ratio (upper:lower = approximately 1:1.6)
Avoid the "duck lip" deformity from over-projection of the central upper lip
Address perioral lines by placing filler just beneath the skin along the vermilion border
Lip filler typically lasts 6–12 months due to the high mobility of the lip
Biostimulatory Fillers
Unlike HA fillers, biostimulatory agents work by stimulating the patient's own collagen production over months. They are not reversible.
Sculptra® (poly-L-lactic acid) — stimulates fibroblast-mediated collagen synthesis over 3–6 months. Injected in the deep fat compartments of the cheeks, temples, and jawline over 2–3 sessions. Results last 2+ years. Ideal for diffuse volume loss and skin laxity rather than discrete folds.
Radiesse® (calcium hydroxylapatite) — immediate volumizing effect plus collagen stimulation. FDA-approved for cheeks, nasolabial folds, and hands. More viscous than HA fillers; best used in deeper planes. Not reversible with hyaluronidase.
Reversibility: Hyaluronidase
Hyaluronidase (Vitrase®, Hylenex®) is an enzyme that dissolves hyaluronic acid — making HA fillers uniquely reversible. It is used for:
Overcorrection or asymmetry after HA filler
Tyndall effect (superficially placed HA appearing blue)
Delayed inflammatory nodules
Vascular occlusion emergency — immediate high-dose hyaluronidase is the primary treatment for cutaneous vascular compromise; however, in cases of vision loss from ophthalmic artery occlusion, treatment efficacy is limited and outcomes are frequently irreversible, making prevention and immediate emergency care essential
Biostimulatory fillers (Sculptra, Radiesse) are not reversible and require greater precision at injection.
Risks & Complications
Bruising and swelling — common; resolves in days to 2 weeks. Cannula technique reduces bruising.
Nodules — from superficial placement, product migration, or inflammatory reaction. Treated with hyaluronidase, intralesional steroids, or antibiotics depending on type.
Tyndall effect — bluish discoloration from superficial HA; resolved with hyaluronidase.
Delayed inflammatory reaction — can occur months to years after HA injection, often triggered by viral illness or dental procedures. Treated with hyaluronidase plus antibiotics or steroids.
Vascular occlusion — the most feared complication; intravascular HA injection can occlude arteries supplying skin (causing necrosis) or the ophthalmic artery (causing vision loss). Risk is minimized by: anatomical knowledge, use of cannulas, low injection pressure, slow injection, and aspiration (which has a high false-negative rate and should not be relied upon alone). Requires immediate recognition and high-dose hyaluronidase. The periorbital and nasal areas carry the highest risk of vision-threatening vascular complications.
Frequently Asked Questions
What fillers are used for tear troughs?
Hyaluronic acid (HA) fillers — particularly low-viscosity, hydrophilic products such as Restylane-L, Restylane Eyelight, or Belotero Balance — are preferred for the tear trough area. The tear trough is high-risk due to thin skin, proximity to the eye, and risk of the Tyndall effect (bluish discoloration from superficial HA placement). Only experienced injectors should treat this area.
Can fillers be reversed?
Hyaluronic acid fillers can be dissolved with hyaluronidase — an enzyme that rapidly breaks down HA. This is an important safety feature. Biostimulatory fillers (Radiesse, Sculptra) cannot be reversed; they stimulate collagen and are resorbed over 12–24 months naturally.
How long do facial fillers last?
Duration varies by product and location: HA fillers in the tear trough typically last 9–18 months; cheek fillers 12–18 months; lip fillers 6–12 months. Biostimulatory fillers (Sculptra, Radiesse) last 18–24 months. Individual metabolic rate, filler volume, and injection technique all affect longevity.
What should I expect during my fillers consultation?
During your consultation, Dr. Annunziata will evaluate your facial anatomy, skin quality, and aesthetic goals to determine the best filler approach for you. They will discuss which areas would benefit most from treatment, explain the differences between hyaluronic acid and biostimulatory fillers, and review expected results and timeline. This is an excellent time to ask questions, review before-and-after photos, and ensure you have realistic expectations about what fillers can achieve for your specific concerns.
Who is a good candidate for dermal fillers?
Ideal candidates for dermal fillers are generally in good overall health with realistic expectations about results and understand that fillers provide temporary improvement rather than permanent correction. You may be a good candidate if you have volume loss in the under-eye area, cheeks, lips, or nasolabial folds due to aging or genetics. Dr. Annunziata can assess whether fillers alone are appropriate for your concerns or if combining them with other treatments might provide better results.
What are the potential risks and complications of fillers?
While dermal fillers are generally safe when administered by a qualified oculoplastic surgeon, potential complications can include temporary swelling, bruising, redness, and tenderness at injection sites. Rare but serious complications may include vascular occlusion (blockage of blood vessels) or allergic reactions, which is why treatment by a fellowship-trained specialist is important. Dr. Annunziata will discuss all risks during your consultation and provide detailed aftercare instructions to minimize complications.
What is the recovery period after filler injections?
Most patients experience minimal downtime after filler injections and can return to normal activities immediately, though some mild swelling and bruising may be visible for 24-48 hours. You should avoid strenuous exercise, excessive heat, and prolonged sun exposure for the first 24-48 hours to minimize swelling. Final results typically appear within 1-2 weeks as any initial swelling resolves, and Dr. Annunziata will schedule a follow-up appointment to assess results and make any adjustments if needed.
