By: Dr. Roberto Montiel Guadarrama y Lic. Andrea López.
Dermal fillers have revolutionized aesthetic medicine, making it possible to restore volume, smooth wrinkles, and harmonize facial proportions. In my practice, I have found that therapeutic success depends on a comprehensive patient assessment, the appropriate selection of materials, precise dosing, and technique grounded in anatomical knowledge.
Hyaluronic acid (HA) remains the cornerstone due to its versatility and reversibility with hyaluronidase; however, it is now essential to also consider biostimulators as key tools to improve not only volume but also quality.
Materials such as calcium hydroxyapatite (CaHA) and poly-L-lactic acid (PLLA) work by stimulating collagen production, enhancing skin texture, elasticity, and firmness in a gradual and sustained manner. While HA corrects defects and provides immediate support, biostimulators offer a regenerative effect that helps reduce skin laxity and improve overall skin quality in both facial and extra-facial areas, making them especially valuable for patients with diffuse volume loss or advanced skin aging.
Product selection is key and should always align with a specific objective, tissue quality, and safety profile. When reversibility or a conservative first approach is desired, HA is typically the initial option; however, if the goal includes long-term improvement in skin quality, incorporating CaHA or PLLA can be decisive. In areas with higher vascular risk and thinner skin, softer formulations and less aggressive techniques are preferred.
The practitioner’s experience also plays a crucial role in product selection—working with familiar, well-mastered products provides predictability, which is essential for achieving successful therapeutic outcomes.
To achieve facial harmony, I perform a comprehensive analysis: treating structural support areas such as the cheeks or temples often improves folds without the need to directly fill them.
The technique is adapted according to the injection plane and the objective—deep placements on the periosteum for structural support, and more superficial techniques or microinjections to stimulate the dermis with biostimulators when the goal is to improve skin texture and firmness.
Complications may range from transient bruising and edema to delayed inflammatory reactions or vascular occlusions. Prompt management and an experienced injector help minimize sequelae: bleeding control, anti-inflammatory measures, and, in suspected HA-related vascular occlusion, immediate use of hyaluronidase when indicated. In reactions to biostimulators, evaluation and management should be individualized, and clinical experience significantly reduces the incidence of complications.
Ultimately, dermal filler technology combined with biostimulators allows for a comprehensive approach to aging: restoring volume, providing structural support, and improving skin quality. Safety, continuous training, and clear communication with the patient are essential to achieving successful outcomes.
My professional recommendation is a gradual and personalized approach
