Dermal fillers



Most current trends in minimally invasive cosmetic head and neck surgery cannot go without dermal fillers. Their primary purpose is to emphasize or compensate for the volume loss, correct the defects of the contours of certain regions of the face and to emphasize certain fine facial details. Sometimes we call fillers tissue chargers.

The age when wrinkles on the face and neck become problematic are partly determined by our genetics. Additionally, skin type, sun exposure, smoking and eating habits have a major impact on how our skin ages. Furthermore, some of the wrinkles are simply the result of the grooves of the skin created by the muscles on the face by constant activity (mimic musculature).

Aplikacija dermalnog punila
Hyaluronic filler application

Many of these outpatient procedures involve injecting preparations to fill wrinkles, furrows or depression in tissues. Simultaneously we can use fillers with Botox in some wrinkles dependent on muscle function (most often glabellar frown lines between the eyes). Some more invasive and thus more effective methods may include chemical peeling, laser and dermabrasion. Occasionally, in very deep wrinkles, we combine some of these procedures with facelifting or other techniques aimed at repositioning the skin or
improving texture

Basically, there are many materials and preparations available, and in the Polyclinic we use some of them, with which we have the most experience. The most basic current division of fillers is into the group of hyaluronic (HA) and non-hyaluronic.


Hyaluronic dermal fillers are by far the safest and most effective minimally invasive aesthetic treatment in today’s practice. HA is a chemical natural sugar (polysaccharide) that is normally found in the skin. Some of the preparations may also contain a local anesthetic.

At the Polyclinic, we have large experience with the leading HA-based dermal fillers. 

Other fillers legally available on the Croatian market can be applied according to the patient’s wishes.

Different brands of fillers vary according to how they are chemically produced (the so-called cross-linking effect), how they are prepared in an ampule (more gelatinous or like small particles), whether we add a local anesthetic, as well as the concentration of active substance. All in all, these factors can affect the appearance and longevity of the effect.


Dermal fillers that do not contain HA represent an interesting and somewhat neglected range of products. Each of them has a different composition, mechanism of action and indications.

Most interesting products are below, with which we have the most experience.

Radiesse is a dermal filler with triple effect:

  1. wrinkle reduction
  2. lifting by adding volume
  3. skin rejuvenation

It is made from calcium hydroxyapatite, in a gel soluble in water. It is present naturally in bones and teeth.

After the injection, a resorption of the gel is formed, which disappears after 8 – 12 weeks, after which only the CHA material remains. In the longer term, it contributes to the stimulation of collagen in deeper tissues.

It has been specifically approved by the FDA to increase volume, especially in facial lipoatrophy. With an excellent safety profile, Radiesse covers various indications:

  • moderately pronounced and deep nasolabial grooves
  • deep grooves around the corners of the lips (lips komisusure), marionette lines
  • adding volume to the cheeks
  • deep depression from traumatic scars and acne
  • defining the contour line of the chin

This filler lasts 10 – 14 months with excellent tolerance. In most cases, a local anesthetic is not required.

The swelling and bruises that may occur after Radiesse administration are due to the addition of volume, massage and depth at which the product is injected.

We do not recommend to use it to enlarge the lips!

Poly-L-lactic acid (PLLA) (Sculptra®) is an injectable dermal filler, and as a collagen stimulator that helps to compensate for lost collagen. Sculptra Aesthetic helps to restore deep tissues and improve the appearance of deep wrinkles on the face.

After application patient needs to massage area injection for 5 days to increase the volume of the active substance PLLA.

The expected duration of the effect is up to 2 years.


Application areas

Currently, fillers are injected into the dermis (second layer of skin) or under the skin (subcutaneously).

  • Nasolabial grooves/wrinkles
  • Fine lines or deeper grooves (volume compensation) on the face
  • Lips and perioral region
  • Contouring of eyebrows, cheekbones and chin


Before applying the filler itself, the patient should have clear goals what he wants to achieve. As part of the consultation, the doctor joins suggestions and suggestions. If you don’t know what your doctor wants to do, ask questions.

In most cases, the use of anesthetic cream is sufficient, only exceptionally the doctor can advise a local anesthetic in the form of a nerve block (similar to dental anesthesia).

The effect of HA at the injection site comes partly due to the added volume itself, and partly from the fact that HA is hydrophilic (attracts water to the area). This hydrophilic effect is partly responsible for the appearance of swelling for the first few days to weeks after application. Most often it occurs with lip augmentation.

Longevity of effect

In all reabsorbing fillers of the hyaluronic acid type, the length of the effect is different from person to person and depends on the intensity of facial displacement at the injection site. The rule is that the effect does not stop suddenly, but resorption occurs slowly over time.

Some patients choose re-treatment earlier than others, which is a matter of personal selection.

Augmentacija usnica prije poslije
Lip treatment with HA filler, before and after
Fileri NLB prije poslije
Treatment of nasolabial wrinkles (NLB) with HA filler, before and after