Body Fillers

What is body filler, and how is it different from facial filler?

Body filler is the injection of a filler into areas other than the face to support volume, contour and skin quality. It is not the name of a single procedure; the aim, the type of filler used and the tissue layer where the filler is placed vary by area.

The difference between the face and the body is not only one of scale. The elasticity, thickness (viscosity) and viscoelastic behaviour of four commercial hyaluronic acid gels used for body contouring were measured in a laboratory and found to differ from one another. This was a laboratory measurement, not a comparison in patients; even so, the researchers state that, because of these differences, the filler may need to be chosen according to the requirements of the area being treated. Skin thickness, the volume of the fat layer under the skin, muscle movement and the structure of the blood vessels also differ between the body and the face.

What this means for you: something you have read about facial filler (how long it lasts, how much is used, the technique or the risks) cannot simply be applied to the body. Scientific studies also look at these areas separately, so each area needs to be assessed on its own data.

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When is it considered?

Body filler is considered for these areas in the following situations:

• Volume loss on the backs of the hands: as the fat under the skin decreases, the tendons and veins become more visible. From a regulatory point of view, the back of the hand stands apart from the other areas; the details are in the Regulation section below.
• Fine lines and changes in skin quality on the décolletage. Options other than injection have also been described for this area; injection targets only one component of the change.
• The contour of the legs and the knee area. The only publication on this is a case report that presents just two patients.
• Definition of the abdominal muscles. This treatment has been described in a pilot study carried out only in male patients.
• A visible difference in symmetry between the two sides of the body.

This list shows when the treatment may be considered; whether it is suitable for you is assessed at a consultation. The scientific evidence behind these items does not carry the same weight either: what is known about the backs of the hands is not at the same level as what is known about the abdomen.

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Regulation

For body treatments, the clinic uses hyaluronic acid (HA) fillers that are suitable for use on the body. Product selection is based on the product’s CE marking (the European conformity mark), its registration and conformity status in Türkiye, and the manufacturer’s intended purpose and indications (approved uses). FDA approval is not, on its own, a criterion for this assessment; the FDA is the US regulator. For body treatments, each product is assessed separately according to its intended purpose.

If you are curious about how another country’s regulator approaches this: in its information for consumers, the US Food and Drug Administration (FDA) limits the approved uses of absorbable fillers to the face and the backs of the hands. The FDA does not recommend using fillers for body contouring or to add volume to the body; breast augmentation, buttock augmentation, increasing fullness in the feet, and placing filler into bone, tendon, ligament or muscle are not among the approved uses. The FDA also warns that injections for these purposes can cause serious harm, including long-term pain, infection, permanent scarring or disfigurement, and even death.

The back of the hand, however, stands apart here: increasing volume in the back of the hand is explicitly among the FDA’s approved uses, and there are hyaluronic acid (HA) filler products specifically approved for this area. For this reason, the backs of the hands are not placed in exactly the same category as other body areas.

This information is one country’s regulator describing its own product approvals; on its own, it does not determine whether a product is safe or suitable. Before the procedure, you can ask which class the product to be used on you belongs to and what it is registered for.

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Why are areas other than the face discussed separately?

There are many studies on facial fillers, defined approved uses, and accumulated experience in managing complications. The same cannot be said for areas other than the face. This difference matters in three ways.

The first is the product and its intended purpose. For body treatments, each product is assessed separately according to its intended purpose; a use defined for a product on the face cannot simply be applied to the body.

The second is the amount. The amount of filler used on body areas can be much larger than on the face. The more material that remains in the tissue, the bigger any potential problem becomes.

The third is reversal. Hyaluronic acid fillers can be dissolved with an enzyme called hyaluronidase. However, publications state that there are no standard protocols or official guidelines on what dose of this enzyme to use or how to give it; current recommendations are also mostly based on experience with the face.

These three points are not meant to put you off the treatment; they are meant to show clearly that what you read about facial filler cannot simply be applied to the body.

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Backs of the hands

Among the areas covered here, the backs of the hands are where the scientific evidence is relatively well established, and they differ from the others in one respect: the FDA explicitly lists increasing volume in the back of the hand among the approved uses of absorbable fillers. Apart from the face, it is the only area named on that list.

This is how ageing shows in the hand: as the fat under the skin decreases, the tendons, veins and joints become more visible; the skin becomes thinner and loses its elasticity. Filler targets this volume loss. Pigmentation, enlarged blood vessels and skin thinning are separate problems; filler does not target them. Two methods have been described for this area: filler injection and transfer of the person’s own fat (autologous fat grafting).

In a study that reviewed thirty-one studies on hand rejuvenation together, the two most frequently studied methods were found to be calcium hydroxylapatite (CaHA) filler and fat grafting. However, most of these studies are case series (studies that report the results of a group of patients without a comparison group), and the ways they measure results are not standardised. The positive reports of results and of patients’ own assessments should therefore be read with this limitation in mind.

Data on how long the effect lasts are scarce: in one hyaluronic acid treatment for volume loss on the backs of the fingers, the effect was reported to last twelve months. This finding should be read with caution: its source is a short, two-page publication, and the study’s design, number of patients and follow-up method could not be verified. This is not a promise of permanence, it cannot be generalised to the whole hand, and it is not the clinic’s own data.

Which layer of the hand is treated, with which method and in what amount depends on the doctor’s assessment and technique.

RELATEDHand Rejuvenation

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Legs and the knee area

The legs and the knee area are among the areas people ask about for body filler; however, there is very little scientific evidence on this.

The only published study is a case report presenting two patients, which describes adding volume to the inner calf muscle (medial gastrocnemius) with hyaluronic acid. In the paper, this approach is described as a non-surgical option for legs that curve outwards (genu varum, commonly known as bow legs). One patient was a thirty-year-old woman with a moderate curve, and the other a twenty-six-year-old woman with a mild curve. Improvement in calf symmetry and leg appearance was reported in both patients.

Two patients are not enough evidence to draw conclusions. These data are enough to say that such an approach has been described for the legs, but not enough to answer the questions ‘for whom, how much, and with what result?’

It is also important to know what the aim is: the goal is not to correct the curve in the bone itself, but to balance the volume around it. A curve caused by the bone structure is not corrected with filler. You can find the clinic’s approach to the legs in the How is treatment planned at this clinic? section below.

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Décolletage

After the face, the décolletage is one of the areas where sun damage shows clearly. The change here is not a single problem: skin laxity, lines and wrinkles, darkening of the skin, redness, roughness you can feel when you touch it, skin thinning and visible small blood vessels are each considered separately. A scale developed to measure patients’ own views also assesses evenness of skin tone and smoothness of texture as separate items.

This is why no single treatment addresses all the changes on the décolletage. Methods other than injection have also been described for this area; injection targets only one component of the problem. The fact that a method has been described in scientific publications does not mean it is used at this clinic. On a décolletage with darkened skin or visible small blood vessels, filler does not remove this concern.

There are few publications on how safe and effective these methods are when used together. In addition, the main source for the information here is a review from 2016, now ten years old; it is not based on as many sources as the other areas.

Which change is most prominent in your case, and which of these relates to filler, is discussed at the consultation. You can find the clinic’s approach in the How is treatment planned at this clinic? section below.

RELATEDCollagen Stimulator Treatments

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The abdomen

Scientific evidence for the abdomen is limited. The published study is a small pilot study on defining the muscle contours in male patients, and on its own it does not carry enough weight to base a decision on. This study reported aesthetic improvement; however, no conclusion about safety can be drawn from a single pilot study in a small group of patients.

This method does not reduce fat. If the fullness in the abdomen is caused by fat or loose skin, filler does not address that concern. The clinic’s approach to the abdomen is described separately in the How is treatment planned at this clinic? section below.

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The buttocks

Treatments for the buttocks are described in detail on the Buttock Filler page, because the volume used, the layer where the filler is placed and the safety issues in this area are clearly different from other areas. When studies on buttock augmentation with hyaluronic acid were reviewed together, serious complications were reported, including widespread bleeding in the lungs (diffuse alveolar haemorrhage) and death, although the complication rate was moderate.

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Limits of this treatment

In short: filler addresses problems with volume and contour, not fat, loose skin or the skeleton.

This means:

• Body filler is not a weight-loss method; it does not reduce fat.
• It does not tighten advanced skin laxity.
• It does not change a curve caused by the skeleton, or the bone structure.
• On the décolletage, it does not remove darkened skin, pigmentation or visible small blood vessels.
• Hyaluronic acid (HA) fillers are not permanent; the body breaks them down over time.
• It is not a substitute for surgical body contouring.

The scientific evidence and the regulatory rules are not the same for every area. Before the procedure, you have the right to ask which class the product to be used on you belongs to and what it is registered for.

Possible side effects and complications

The effects commonly reported after hyaluronic acid fillers are reactions at the injection site. In a comprehensive review bringing together studies on facial treatments, these were listed in order of frequency as swelling, bruising, pain, lumps and firmness you can feel, and redness. According to the same review, these effects are mostly mild, go away on their own and are reversible.

The rates of these effects are not given here as percentages: the differences between studies are very large, and a single percentage would give an impression of certainty that the data do not support. In addition, these data come from facial treatments; they cannot simply be applied to body areas, and they are not the clinic’s own data.

Later on, delayed-onset nodules (small lumps you can feel under the skin), foreign body granuloma (an inflammatory lump that forms in reaction to the filler) and infection have been reported. Research describes biofilm formation (a sticky layer of bacteria around the filler) as a risk factor for late complications; it is linked to bacteria getting into the injection site and to infection that causes no symptoms.

The most serious complication reported is filler entering a blood vessel. In such cases, tissue damage, skin necrosis (tissue death), scarring, vision loss and stroke have been reported. In a study that reviewed fourteen studies on vascular occlusion (a blocked blood vessel) together, hyaluronic acid was found to be the most commonly used filler. The same study reported that outcomes were better in cases that were recognised and treated in time, while delays of more than five days were associated with permanent damage.

What this means for you is clear. Before the procedure, you must be told two things: which symptoms count as an emergency, and where to go if you have one. Pain that is out of proportion (much worse than expected) or getting worse, blanching (the skin turning pale or white), a net-like skin discolouration, coldness or numbness, spreading swelling and fever are emergency symptoms; if you have any of these, contact the clinic straight away. You can ask your doctor about anything on your mind before the procedure.

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