What are dermal fillers?

The term “filler” derives from the verb “to fill”. In aesthetic medicine, it refers to substances that are injected precisely into or beneath the skin to smooth age-related wrinkles, correct tissue defects or aesthetically shape the lips and cheeks.

What makes an ideal filler

An optimal dermal filler should combine the highest standards of safety and aesthetics: it should be well tolerated, cause little discomfort during application and deliver long-lasting results without looking unnatural. As no single product yet perfectly combines all of these ideal properties, we select the material for you individually in our practice, after carefully weighing up the advantages and disadvantages.

A medical procedure, not a treatment “to go”

Although dermal fillers are often portrayed on social media as a risk-free lifestyle treatment, they are a demanding medical procedure.

All approved fillers have a high safety profile when used correctly; nevertheless, injection-related side effects can never be ruled out entirely.

Your safety is our top priority

Even though fillers are not legally classified as medicinal products, their use requires:

• ◆Sound expert knowledge of the complex anatomy of the face.
• ◆Continuous training in the latest injection techniques.
• ◆A deep understanding of the different properties of each material.

I. Hyaluronic acid (HA fillers): the body’s natural moisture reservoir

Hyaluronic acid is a natural component of the human body. As a long-chain polysaccharide (a complex sugar), it performs vital functions: it binds enormous amounts of water, making it the ideal active ingredient for lastingly hydrated, elastic skin.

Versatility through modern laboratory technology

In aesthetic medicine we use high-quality, laboratory-produced hyaluronic acid. Its properties are precisely controlled through the concentration and particle size of the hyaluronic acid and through the degree of cross-linking, which determines how stable the filler is.

These parameters have a decisive influence on the filler’s firmness, lifting capacity and longevity. This allows us to choose exactly the right filler for every indication – whether fine lines or pronounced volume restoration.

Added safety: hyaluronidase, the “antidote”

A decisive advantage of hyaluronic acid fillers over other materials is that they are reversible. With the enzyme hyaluronidase (Hylase®), we have an effective antidote at our disposal.

• ◆Rapid correction: injecting the enzyme allows the filler material to be completely broken down within a few hours.
• ◆Safety: overcorrections, unwanted nodules or misplaced injections can thus be easily reversed, even long after the treatment.
• ◆Please note: hyaluronidase also temporarily breaks down the body’s own hyaluronic acid; however, this effect is quickly reversible and the skin’s natural balance is soon restored.

Nose correction without surgery (non-surgical rhinoplasty)

Deformities of the nasal bridge (such as a dorsal hump or saddle nose) as well as irregularities of the nasal tip or columella can today often be harmonised without any surgery.

• ◆Hump correction: the nasal bridge is levelled by precise injection of stable hyaluronic acid.
• ◆Projection & shape: the nasal tip can be gently lifted, and a wide nose refined by visually narrowing the nasal bridge.
• ◆Combination with Botox: Botox can additionally be used to lift the nasal tip further or to subtly reduce the size of the nostrils.
• ◆Immediate effect: the result is visible immediately after treatment – with no downtime at all.

Treatment plan for maximum stability

Because dermal filler initially “settles” more in previously untreated tissue, we recommend two consecutive sessions approximately 2 months apart.

• ◆Schedule: months 0 – 3 – 12, followed by an annual top-up.

Lip aesthetics: sensuality and harmony

Lips are far more than just one part of the face – they are a symbol of sensuality and play a major role in how we come across. Full, symmetrical lips with healthy vitality have always been regarded as the ideal. At our practice in the Villa Hupfeld, we focus on precision and natural-looking results to enhance your individual beauty.

We consider the lip region as a whole and offer a wide range of options for refinement:

• ◆Lip volume: gentle volume enhancement for harmonious projection.
• ◆Contouring: defining the lip borders for clear shapes.
• ◆Cupid’s bow: accentuating the centre of the upper lip.
• ◆Corners of the mouth: gently lifting them for a friendlier facial expression.
• ◆Wrinkle smoothing: correction of fine vertical lip lines (“barcode lines”).

A gentle approach and comprehensive pain management

We attach the greatest importance to a gentle approach and comprehensive pain management:

• ◆Strong topical anaesthesia: before treatment, we apply a highly effective numbing cream and allow it to take full effect.
• ◆Built-in pain relief: we use only premium hyaluronic acid that already contains the local anaesthetic lidocaine, so the tissue is additionally numbed during the injection itself.
• ◆Precise technique: the treatment is carried out step by step using standardised, safe injection methods.

Lip treatment plan

Beauty takes time and planning. For an optimal, stable result, we usually recommend the following treatment plan:

• ◆Start: initial treatment.
• ◆Top-up: after approx. 2 months.
• ◆Stabilisation: after approx. 6 months.
• ◆Maintenance: thereafter on an individual basis, depending on your metabolism and the longevity of the filler.

A brighter look: treating dark circles and eye bags

Dark shadows or puffiness under the eyes often make us look tired, worn out or older than we feel – even after a restful night. At our practice in the Villa Hupfeld, we offer specialised treatments to restore the natural freshness of the eye area.

Different concerns often occur together:

• ◆Dark circles: dark discolouration below the lower eyelid.
• ◆Tear trough: a hollow running from the inner corner of the eye towards the cheek. It often appears at a young age or becomes more pronounced with the natural loss of fat pads with age.
• ◆Eye bags: a bulging of skin and fatty tissue that gives the face a heavy appearance.

Gentle correction of the tear trough

We use state-of-the-art active complexes that go far beyond conventional filling.

For the tear trough, we use specially developed, hydrophobic (water-repellent) hyaluronic acid. The advantage: unlike conventional hyaluronic acid, this material draws in hardly any water, which avoids unsightly swelling. The product is placed precisely beneath the eye muscle (M. orbicularis oculi), directly on the bone, to gently lift the hollow and minimise shadows.

Complementary treatments: depending on the findings, we achieve excellent synergistic effects by combining the treatment with fractional CO₂ laser, autologous plasma (PRP), polynucleotides or the minimally invasive Endolift®.

The 8-point lift: gentle contouring instead of a classic facelift

In modern aesthetic medicine, we increasingly rarely treat individual wrinkles in isolation. Instead, we look at the face as a whole. The 8-point lift is an innovative method in which hyaluronic acid depots are placed at eight strategically decisive points on each side of the face.

The aim of the 8-point lift is a refreshed, firmer appearance in which your natural facial expressions are fully preserved. It is the ideal choice for anyone seeking effective rejuvenation with minimal downtime.

The secret of the strategic points

This precise injection technique achieves a natural, gentle lift without a scalpel. The treatment targets exactly those areas where the face loses firmness over time:

• ◆Volume restoration: hollow or sagging areas regain their youthful fullness.
• ◆Sharper contours: the cheek line and the chin and jaw area (jawline) gain firmness and definition.
• ◆Wrinkle smoothing: the gentle upward pull indirectly softens wrinkles and fine lines without making the face look mask-like.

Longevity & material: tailored, long-term aesthetics

How long the result of a hyaluronic acid treatment lasts is as individual as your face. Depending on the treated area and your metabolism, the effect usually lasts between 6 and 14 months.

General side effects

• ◆A slight feeling of pressure or burning during the injection
• ◆Swelling, redness and possibly tenderness around the injection sites – sometimes for several days after the injection
• ◆Bruising (haematomas)
• ◆Infections at the injection sites
• ◆Fainting (syncope) during or after the treatment
• ◆Allergies to the ingredients (caution: intolerance to local anaesthetics)

Specific side effects

• ◆Asymmetry
• ◆Overcorrection
• ◆“Blue lines”: injections placed too superficially can create fine streaks. Because light is scattered differently (Tyndall effect), the hyaluronic acid then appears bluish.
• ◆Persistent swelling: because different hyaluronic acid products bind different amounts of water, swelling may last longer. Particularly in the lower eyelids (very thin skin), it can persist for several months or even permanently.
• ◆Abscess or granuloma formation is rare. In clinical practice, high-quality HA products lead to abscesses or granulomas significantly less often.

A serious complication: vascular occlusion

Serious side effects that require immediate follow-up treatment include vascular occlusion. If left untreated, it can lead to tissue necrosis or blindness. A vascular occlusion must be treated as quickly as possible. If hyaluronic acid was used as the filler, hyaluronidase can be injected to remove the product from the vessel.

Managing the various complications is part of our specialist medical training and is carried out by us.

II. Profhilo® Structura (lipolifting)

Profhilo® Structura is an innovative injectable filler specifically developed to treat age-related changes in the face in a targeted way. Based on the advanced NAHYCO™ technology, it combines high- and low-molecular-weight hyaluronic acid not only to tighten the skin but also to efficiently regenerate the subcutaneous fat tissue.

With age, the face loses not only elasticity but also volume, particularly as subcutaneous fat tissue diminishes. This loss of volume often leads to a tired, hollow appearance. This is exactly where Profhilo® Structura comes in: it enables targeted regeneration of fat tissue, especially in the lateral cheeks, and restores lost volume. This deep-acting effect provides natural-looking rejuvenation and a clear improvement in facial contours.

Profhilo® Structura: results and benefits

Clear results are visible after just two treatments, carried out 30 days apart. The skin looks firmer and more youthful, and volume deficits in the deep fat compartments are noticeably reduced.

• ◆Highly concentrated hyaluronic acid: with 45 mg/ml of L-HA and H-HA, Profhilo® Structura offers a higher concentration than many other products on the market.
• ◆Regenerative effect on fat tissue: promotes the restoration of subcutaneous fat tissue and supports volume restoration.
• ◆Long-lasting results: thanks to NAHYCO™ technology, the effect lasts longer than with traditional fillers.
• ◆Natural lifting effect: lifts and firms the facial features without adding unnatural volume.

III. Poly-L-lactic acid (PLLA filler)

Poly-L-lactic acid (PLLA) is a highly effective, collagen-stimulating injectable for the face and body. Unlike conventional fillers, a PLLA injection does not create immediate volume; instead, volume develops through stimulation of the body’s own fibroblasts, which produce type I collagen. Through this neocollagenesis, volume is intended to build up sustainably over approximately 6 to 12 weeks.

In total, two to three treatments are required for results lasting up to two years. The PLLA formula is equally suitable for the face, hands, buttocks, thighs, arms, décolleté and neck – whether for rejuvenation and skin tightening, for improving skin irregularities such as cellulite, or for accentuating, for example, the natural shape of the buttocks.

IV. Calcium hydroxylapatite (CaHA filler)

A CaHA injection provides immediate volume and corrects tissue defects. At the same time, the calcium hydroxylapatite microspheres it contains are intended to stimulate the skin’s own collagen production, thereby supporting natural tissue restoration. Through this neocollagenesis, volume is intended to build up sustainably over approximately 6 to 12 weeks.

The CaHA filler is not limited to correcting wrinkles. Its unique formulation produces a lasting threefold effect:

• ◆Vertical lifting
• ◆Defined contours
• ◆Regeneration of skin quality through physical biostimulation

V. Polynucleotides (from salmon sperm)

Polynucleotides are injectable treatments that hydrate the deeper layers of the skin. They are used to improve skin quality, giving the skin a natural radiance. The treatment offers many benefits – it revitalises the skin and improves skin tone and texture.

Injectable polynucleotides have the ability to stimulate cell regeneration and collagen production in the skin. After injection, the polynucleotides penetrate deep into the skin and support its natural healing and regeneration processes. The result is improved skin structure, smoother skin and a reduction in wrinkles and scars.

Polynucleotides: treatment areas and mode of action

Unlike dermal fillers, polynucleotides are not used to contour or reshape the structure of the face. They can also be used in other areas, such as the neck, décolleté, hands, scalp or body.

Their particular biochemical properties increase elasticity, thereby slowing the ageing process, and give the skin a healthier-looking, more even appearance. Polynucleotides bind water, thus regulating skin moisture, and at the same time have an antioxidant effect. These mechanisms create the best conditions for fibroblast growth, which in turn leads to improved tissue elasticity.

Polynucleotide treatments should be carried out as a series of 2–3 sessions at intervals of 4–6 weeks.

VI. Exosomes

Exosomes are the current trend in dermatology and aesthetics. They are tiny, membrane-enclosed vesicles naturally produced by the body, released by cells and containing a wide range of bioactive molecules, including proteins, lipids and nucleic acids.

In aesthetic medicine, exosomes are used for their regenerative and reparative properties. They can promote cell renewal, improve skin structure and even stimulate collagen synthesis, resulting in a more youthful complexion. For this reason, we also call the treatment “stem cell” therapy.

Exosome therapy can be performed as off-label injections or in combination with medical needling.

The results of exosome therapy improve continuously over time. After the first sessions, patients may notice an ongoing improvement in their skin. The cumulative effect of the treatment leads to long-lasting results, making it a worthwhile investment in the long-term aesthetic improvement of skin and hair.