The Filler Guide, Honest Answers on Lip & Dermal Filler

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The two kinds, and why it matters

People say filler like it's one product. It isn't.

Hyaluronic acid filler is the familiar one. It adds volume right away, and it's made of something your body already produces. It can also be dissolved if you don't like the result. That's the main reason I use it for most first-timers.
Biostimulant filler works differently. It doesn't add volume so much as convince your own body to build collagen where it's placed. Results arrive gradually over months and last considerably longer. It's a strong answer for broad structural loss, and a weak one if you want a change by Saturday.

How much you really need

This is where most of the anxiety lives. The plain answer: less than the internet suggests, and more than one syringe.

A syringe holds about a teaspoon. Spread across a whole face, that's not much. One syringe can look like nothing on cheeks and plenty in lips.
For lips, I like to start conservative and let it settle for two weeks. Then I add more only if we still want to. Walking out with too much on day one is the mistake I'm avoiding.
For structural work across cheeks or jaw, it's usually a plan spread across visits rather than one trip in from Broussard or Youngsville. I'll tell you that up front instead of surprising you with it halfway through.

Where each treatment actually works

Epidermis & dermis

Peels, microneedling, your skincare

Texture, tone and pigment live here. Filler does nothing at this depth.

Fat pads

Filler and biostimulants

The fat pads are the volume that goes first, and replacing them is filler's actual job. PDO Smuth threads run along the plane just above.

Bone

Deep structural support

Bone recedes with age. Product placed down on it is what reads as a lift rather than as fullness.

Almost every disappointing filler result traces back to treating one of these layers for a problem that lives in a different one.

'Natural' is a technique, not a product

Nobody comes in asking to look overdone. What separates a natural result from an obvious one isn't the product.

Placement and restraint, in that order. The same syringe of the same filler can look beautiful or obvious depending entirely on where it goes and how much of it goes there.
Treating the cause, not the symptom. A deep smile line is often a cheek problem, not a smile-line problem. Filling the line directly is what produces that heavy, filled look.
Knowing when to stop. That's the hardest part of the job, and the most important one.

Migration, and what it really is

The word gets used loosely online. Here's the plain version.

Filler can move from where it was placed, most visibly in lips, where it can drift above the lip border and create that shelf people notice.
It's more common with too much product, or with product placed too superficially. Topping up before the last round has faded adds to it too.
It's fixable. That's the part people don't realize, and it isn't worth the panic it usually gets.

Dissolving, including someone else's work

This is a real part of my practice, and I want to say so directly.

Hyaluronidase dissolves hyaluronic acid filler. It works fast, and we can be conservative about it, dissolving one specific area instead of everything.
I'll dissolve work I didn't do. Plenty of people come to me unhappy with filler from somewhere else, and there's no lecture waiting for them. It's a common, sensible thing to want.
Sometimes the right plan is dissolve, wait, then rebuild properly. It's slower, and it's usually the better answer.

When filler is the wrong answer

The part most guides leave out.

If your concern is texture, tone, pores, or fine lines, filler won't touch any of it. That's resurfacing territory, a different treatment entirely.
If your concern is skin that's loosening rather than volume that's gone, more filler tends to read as heavier, not lifted. Threads are usually the better conversation to have first.
If you can't tell which of those you're looking at, that's normal. Almost nobody can self-diagnose it from a mirror.

The Filler Guide