Dermal fillers help to diminish facial lines, restore volume and fullness in the face and give our patients a fresher and youthful look.

As we age, our face loses subcutaneous fat, facial bones volume, especially from the cheekbones and jaws, facial muscles are moving closer to the skin surface and static, persisting wrinkles start to show.

Types of fillers

Modern medicine provides plastic surgeons with a variety of types of fillers. The choice is based upon surgeons preferences and patients’ needs.

The most commonly used fillers in plastic surgery are:

Absorbable (temporary) fillers:

  • Calcium hydroxyapatite – Radiesse®
  • Fat grafting
  • PRP (Platelet-Rich Plasma) or/and FRP (Fibrin-Rich-Plasma)
  • Polylactic acid – Sculptra®
  • Hyaluronic acid- Juvéderm®, Restylane®, Belotero® etc

Hyaluronic acid (HA) is the most widely used filler. It is a natural component found in the skin, joints and other tissues in the body. While there are many HA fillers, Juvéderm® and Restylane® (both FDA approved) are considered to be of the highest quality with a smooth consistency that provides natural results.

Non-absorbable (permanent) fillers:
Polymethyl-methacrylate μικροσφαιρίδια (Bellafill®)

You may be a good candidate for dermal fillers if you:

  • Are physically healthy
  • Have realistic goals
  • Do not have allergies to any of the materials contained
  • Do not suffer from autoimmune diseases
  • Did not have any kind o reaction in dermal fillers in the past
  • Are aware of the potential benefits as well as the limitations related to dermal fillers
  • Are committed to maintaining the results

What dermal fillers can do

  • Plump thin lips
  • Enhance shallow contours
  • Soften facial creases and wrinkles
  • Enhance facial features
  • Improve harmony and facial proportions
  • Degrease eye-bags
  • Lift the mid face
  • Make the contour of the face more define

What dermal fillers can’t do

  • Can not be an alternative to facelift
  • They don’t give long term results

How fillers work

As one would guess, fillers practically add volume under the skin to smooth wrinkles, enhance facial contour and increase volume in areas like the lips and the cheekbones.

However, with modern materials and advanced techniques, fillers are not limited to volume restoration. Fillers are now widely use to lift facial areas such as the mid-face, the contour and the jawline with astonishing results.

How long does it last?

Fillers contain materials that are absorbed by the body over time, so most dermal fillers have a temporary effect.

The duration of the results depends on the type of filler used, the area treated, but also on patient’s individual characteristics and habits.

Needless to say that one should always use the best quality of fillers available.

Different types of fillers behave differently: HAs last from six to 11 months, Radiesse® approximately 1 year and Sculptra® a little more than 2 years.

Fat transfer lasts longer, although its duration vastly depends on the technique used.

Duration of fillers is also subject to the area treated: For example, nasolabial folds need earlier re-touches as there are exposed to strong facial muscle activity, whereas fillers to the tear draft or the temple last longer since there is almost no movement underneath. Topical skin characteristics, such as skin elasticity and thickness also affect duration of fillers.

Latest studies have shown that patient’s own metabolism rate also affects how body processes injectables, with those with a fast metabolism to run through them quicker that others. The exact pathway however is yet to be investigated.

When it comes to HAs, a very important factor affecting the longevity of the results is avoidance of excessive heat. Prolonged exposure to fireplaces, saunas, hammams, solarium etc will take you back to your plastic surgeon much sooner than you would expect.

One should note that HAs’ composition has changed over the years sacrificing duration over even highest safety and biocompabilty.

Before treatment

Highest quality HAs , such as JUVEDERM® and RESTYLANE® contain lidocaine, which is intended to decrease pain or discomfort related to the injection.

When it comes to other types of fillers your plastic surgeon will add lidocaine to the material before the treatment.

A local anaesthetic cream and/or cold patches can be used upon request to very sensitive patients.

After treatment

HAs and fat have immediate results but look even better after a week to 10 days. Radiesse® and Sculptra® require approximately 1 month, whereas PRP/FRP will need multiple sessions and an average period of 2 months.

A small oedema and/or redness may be present on the site right after injection, but both should disappear within a few minutes or hours. Like all injectables, fillers could cause bruises which are easily constrained and treated.


Fillers are considered to be one of the safest treatments available. Allergic reactions and extended oedema are extremely rare. All other complications are commonly a result of poor training or limited medical skills so choosing the right doctor is a key element.

What should a patient look for

Two things will practically guarantee safe and good results:

  1. choosing the right doctor
  2. using the best materials

Is there such thing as a regular dosage?

No. Patients have different needs and not all faces are the same.

The artistic outcome of fillers largely depends on the balance between making a difference and don’t let others realise that you have something done.

Temporary or permanent filler?

Most permanent or semi-permanent fillers don’t have FDA clearance and as so, Dr Pagkalos is strongly against using them.

Although Bellafill® is FDA approved, Dr Pagkalos still suggests not to use permanent fillers all together since facial characteristics change over time and future proportions can not guarantee aesthetically pleasing results over time.

Combination of treatments

Combining treatments always brings optimal results since we address the problem with multiple treatments, each adding to the final result.

Fillers can be combined with threads, mesotherapies, botox or even invasive (facelift) or minimal invasive (micro lift) procedures.

The modern era

Today using fillers has moved beyond mere adding volume to a face. Advanced techniques (such as Liquid Face Lift, Liquid Mid Face lift, periorbital rejuvenation, the MD codes etc) in combination with modern materials give plastic surgeon the tools for astonishing, yet natural results