Dermal fillers are gels or suspensions injected under the skin to fill wrinkles and folds or add volume to areas such as the lips, cheeks, chin and back of the hand (FDA). The FDA states that having filler injected should be considered a medical procedure, not a cosmetic treatment (FDA). This guide covers the filler materials, the FDA-approved brands, the published safety data, where to find Houston prices and who may inject in Texas.
Mechanism
How dermal fillers work
Most dermal fillers are temporary because the body absorbs the material over time; the FDA has approved only one product made from a material that stays in the body (FDA). Four materials are used:
Hyaluronic acid (HA) is a sugar found naturally in skin and cartilage. As a gel it binds water and swells, which fills the area. Some HA is chemically cross-linked to make it last longer. The FDA gives a general duration of about 6–12 months (FDA). Some products last longer in some areas: in the Juvéderm Voluma XC cheek study, 67.1% of followed patients still showed at least a 1-point improvement at 24 months (Voluma XC directions for use). HA filler can be broken down with an injected enzyme, hyaluronidase, which splits hyaluronic acid (Hylenex label).
Calcium hydroxylapatite (CaHA), sold as Radiesse, is a mineral found in teeth and bone, injected as particles suspended in a gel. Its effects last about 18 months, and it shows up on x-rays and may obscure what is underneath (FDA).
Poly-L-lactic acid (PLLA), sold as Sculptra, is a biodegradable man-made polymer. It is given as a series of injections over several months, its effect appears gradually over several weeks, and the effect may last up to 2 years (FDA). A 2022 review describes biostimulatory fillers such as PLLA and CaHA as causing new collagen formation through a controlled foreign-body reaction (Haddad et al., 2022).
Polymethylmethacrylate (PMMA), sold as Bellafill, is made of tiny beads that the body does not absorb, suspended in a gel that contains cow (bovine) collagen (FDA). The FDA says patients should be tested for allergies before fillers made with animal-derived materials such as bovine collagen (FDA).
Hyaluronidase acts on hyaluronic acid, so it does not dissolve CaHA, PLLA or PMMA. The FDA states that filler can be difficult or impossible to remove, especially permanent fillers and fillers not made of materials such as HA (FDA).
Products
FDA-approved filler brands
Dermal fillers are approved through the FDA’s premarket approval (PMA) process, and each product is approved for specific areas and uses (FDA). The approval dates below come from the FDA’s PMA database. Ask which product a provider plans to use and what it is approved for.
HA filler families
Juvéderm (PMA holder Allergan): Voluma XC was approved in 2013 for cheek augmentation (FDA PMA), with chin added in 2020 (FDA PMA) and temples in 2023 (FDA PMA). Volbella XC was approved in 2016 for lips and lines around the mouth (FDA PMA), with under-eye hollowing added in 2021 (FDA PMA). Vollure XC was approved in 2017 for facial wrinkles and folds (FDA PMA), Volux XC in 2022 for jawline definition (FDA PMA), and SkinVive in 2023 for skin smoothness of the cheeks (FDA PMA).
Restylane (PMA holder Q-Med AB): The original Restylane was approved in 2003 (FDA PMA). Later approvals include Silk for lips (2014) (FDA PMA); Lyft (2015) (FDA PMA), with the back of the hand added in 2018 (FDA PMA) and chin in 2025 (FDA PMA); Refyne and Defyne for facial wrinkles and folds (2016) (FDA PMA); Kysse for lips (2020) (FDA PMA); Defyne for chin (2021) (FDA PMA); Contour for cheeks (2021) (FDA PMA), with temples added in 2026 (FDA PMA); and Eyelight for under-eye hollowing (2023) (FDA PMA).
RHA Collection (PMA holder Teoxane): RHA 2, 3 and 4 were approved in 2017 for dynamic facial wrinkles and folds (FDA PMA). RHA Redensity was approved in 2021 for lines around the mouth (FDA PMA), RHA 3 for lips in 2023 (FDA PMA), and RHA 4 and RHA Dynamic Volume for cheek augmentation and midface contour in September 2025 (FDA PMA).
Belotero (PMA holder Merz): Belotero Balance was approved in 2011 for facial wrinkles and folds such as nasolabial folds (FDA PMA). Belotero Volume (+) Lidocaine was approved in May 2026 for the midface (FDA PMA) and Belotero Intense (+) Lidocaine in July 2026 for lips (FDA PMA).
Evolysse (PMA holder Symatese): Evolysse Smooth and Evolysse Form were approved in February 2025 for moderate to severe dynamic facial wrinkles and folds (FDA PMA).
saypha (PMA holder Croma-Pharma): saypha MagIQ was approved in September 2025 for facial wrinkles and folds such as nasolabial folds (FDA PMA), and saypha ChIQ in June 2026 for cheek augmentation and midface volume (FDA PMA).
Non-HA fillers
Radiesse (PMA holder Merz): Calcium hydroxylapatite, approved in 2006 for moderate to severe facial wrinkles and folds (FDA PMA) and for facial fat loss in people with HIV (FDA PMA). The back of the hand was added in 2015 (FDA PMA), and Radiesse (+) was approved for jawline contour in 2021 (FDA PMA).
Sculptra (PMA holder Q-Med AB): Poly-L-lactic acid, approved in 2004 for facial fat loss in people with HIV (FDA PMA); Sculptra Aesthetic was approved in 2009 for nasolabial fold contour deficiencies and other facial wrinkles in people with healthy immune systems (FDA PMA).
Bellafill: PMMA, approved for nasolabial folds and, since December 2014, for moderate to severe atrophic acne scars on the cheek in patients over 21 (FDA PMA).
The FDA warns that unapproved versions of Juvéderm, such as Juvéderm Ultra 2, 3 and 4, have been sold in the U.S., including online, and should not be used (FDA). It also advises against buying filler online and states that needle-free devices are not approved for injecting dermal fillers (FDA).
What to expect
During and after treatment
The filler is injected with a needle or a blunt-tip cannula. Some fillers contain lidocaine, a numbing medicine; Voluma XC is one (Voluma XC directions for use). Ask your provider how long your appointment will take and how much swelling to plan for.
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First 24 hours
The Juvéderm Voluma XC label tells patients to avoid strenuous exercise and extensive sun or heat exposure for the first 24 hours, and to apply an ice pack briefly if the area is swollen (Voluma XC directions for use). Follow the instructions for the product you receive.
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First weeks
The FDA states that most side effects, such as swelling and bruising, occur shortly after injection and many resolve in a few days to weeks (FDA). In the Voluma XC cheek study, reactions at the treatment site were mostly mild or moderate and lasted 2 to 4 weeks; for moderate or severe reactions, the median time to complete resolution was 6 days (Voluma XC directions for use).
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Months to years
The FDA's general durations are about 6–12 months for HA, about 18 months for calcium hydroxylapatite and up to 2 years for poly-L-lactic acid; PMMA is not absorbed (FDA). Some side effects can appear weeks, months or years after injection (FDA).
Safety
Vascular occlusion and blindness
The FDA calls unintentional injection into a blood vessel the most concerning risk of dermal fillers. It blocks blood flow to tissue; the FDA says the chance is low, but complications can be serious and permanent and include tissue death, vision problems including blindness, and stroke (FDA).
The numbers
- How often occlusion happens: In a study of 370 dermatologists reporting on about 1.7 million syringes injected over 10 years, there was 1 occlusion per 6,410 one-milliliter syringes injected with a needle and 1 per 40,882 with a cannula. Of the occlusions, 85% had no long-term effects (Alam et al., 2021).
- Published vision-loss cases: A 2024 review found 365 published cases of partial or complete vision loss after filler injection reported between September 2018 and March 2023. Earlier reviews by the same group covered 98 cases (2015) and 48 more (2019) (Doyon et al., 2024).
- Where: The most frequent injection sites in those 365 cases were the nose (40.6%), forehead (27.7%) and glabella, the area between the brows (19.0%). HA was the filler in 79.6% (Doyon et al., 2024).
- Recovery: Of the 318 cases with outcomes reported, 6.0% fully recovered vision, 25.8% partly improved and 68.2% had no recovery. Partially preserved vision at onset was associated with improvement; no treatment was significantly associated with improvement (Doyon et al., 2024).
Warning signs
The FDA says to seek immediate medical attention for unusual pain, vision changes, skin near the injection site that looks white, gray or blue, or any sign of stroke (such as sudden difficulty speaking, numbness or weakness in the face, arms or legs, difficulty walking, face drooping, severe headache, dizziness or confusion) during or shortly after the procedure (FDA).
Hyaluronidase and emergency preparation
The Voluma XC label tells injectors that if the skin blanches and normal color does not return, they should treat according to American Society for Dermatologic Surgery guidelines, which include hyaluronidase injection. It also encourages injectors to have supplies immediately available and to identify a local ophthalmologist in case of an eye-related event (Voluma XC directions for use). Using hyaluronidase to dissolve filler is off-label: its FDA-approved uses are as an aid to fluid and drug absorption and in urography (Hylenex label). Hyaluronidase does not act on non-HA fillers such as Radiesse, Sculptra or Bellafill.
Before an HA filler treatment, ask whether the practice keeps hyaluronidase on site and how it handles a suspected injection into a blood vessel.
Emerging safety
The bone resorption question
A 2020 study compared CT scans of 80 patients who had HA filler injected into the chin with 80 matched controls. Bone thickness in the chin was significantly lower in the filler group, and patients injected with 1 mL or more per session had more bone loss than those injected with less. The number of injections and the time between them made no significant difference, and the authors reported no loss in appearance. They concluded that large-volume HA injections in the chin should be done with caution and that patients should be told about this complication beforehand (Guo et al., 2020). The study was a preliminary retrospective study of Asian patients at one hospital.
Safety
Side effects and safety
The FDA lists these common risks: bruising, redness, swelling, pain, tenderness, itching and rash, plus difficulty performing activities after injection into the back of the hand (FDA). Rates from one product’s label:
| Treatment site reaction | Voluma XC cheek study (N = 265) |
|---|---|
| Tenderness | 92.1% |
| Swelling | 85.7% |
| Firmness | 82.3% |
| Lumps/bumps | 81.1% |
| Bruising | 77.7% |
| Pain | 66.4% |
Source: Voluma XC directions for use. Rates differ by product and area; ask for the label of the product you will receive.
Less common risks listed by the FDA include inflammation near the injection site after a viral or bacterial illness, a vaccination or a dental procedure; nodules or granulomas that may need injections, oral antibiotics or surgical removal; infection; open or draining wounds; and allergic reaction. Rare risks reported to the FDA include anaphylactic shock, migration of filler from the injection site, leakage or rupture of filler, permanent hard nodules, and death (FDA).
Pregnancy and breastfeeding. The FDA states that the safety of dermal fillers is unknown during pregnancy and while breastfeeding (FDA).
Other cautions on the Voluma XC label: it should not be used in people with a history of anaphylaxis or multiple severe allergies, or allergies to gram-positive bacterial proteins or lidocaine; treatment should be put off where there is active inflammation or infection; it should be used with caution in people on immunosuppressive therapy; and aspirin, NSAIDs and warfarin can increase bruising or bleeding (Voluma XC directions for use).
Pricing
Houston pricing
Prices vary by spa, by product and by how many syringes you need. Each neighborhood page on this site lists the regular filler prices that med spas there publish on their own websites, with a link to each.
Nationally, the American Society of Plastic Surgeons gives an average cost of $715 for hyaluronic acid fillers (ASPS). That is a national figure from plastic surgeons, not a Houston med spa price. Ask which product a quote is for and how many syringes it includes.
Choosing a provider
How to choose a dermal filler provider
The FDA recommends choosing a licensed health care provider with experience in dermatology or plastic surgery who is trained to perform filler injections, and asking about their training and experience injecting the face and hands (FDA).
Who may inject in Texas
In Texas, injecting a substance for cosmetic purposes is a nonsurgical medical cosmetic procedure (22 TAC §169.25). The Texas Medical Board’s current Chapter 169 rules took effect January 9, 2025 (Texas Medical Board). When a physician delegates the injection:
- Before the procedure, a physician, or a PA or APRN acting under the physician’s delegation, must establish a practitioner-patient relationship with you (22 TAC §169.26). The industry often calls this a good faith exam; the rule does not use that term.
- The person injecting must have training in the technique, contraindications, and recognizing and managing complications (22 TAC §169.26).
- A physician, PA or APRN must be onsite or immediately available for emergency consultation, and at least one person trained in basic life support must be present while you are onsite (22 TAC §169.26).
- The procedure requires a written order (22 TAC §169.27). The person performing the procedure must also sign and date a written protocol (22 TAC §169.26).
- The delegating physician’s name and Texas license number must be posted in each public area and treatment room (22 TAC §169.28).
Estheticians cannot inject fillers. TDLR states that facial treatments under an esthetician license do not include injectables or fillers, and that filler services must be provided under the order and delegation of a licensed physician (TDLR).
2025 Texas legislation
- HB 3749 relates to elective intravenous (IV) therapy. It was signed June 20, 2025, and took effect September 1, 2025 (Texas Legislature Online). Dermal filler injection falls under the Texas Medical Board’s Chapter 169 rules above.
- SB 378, relating to certain prohibited practices by a barber or cosmetologist, was vetoed by the Governor on June 2, 2025 (Texas Legislature Online).
Checking credentials
- Physician and PA licenses: search the Texas Medical Board’s Look Up a License page. Confirm the license is active and check for disciplinary actions.
- Board certification: ask the physician which specialty board certified them, and check it with that board.
- Nurse licenses (RN and APRN): check through the Texas Board of Nursing’s license verification.
Questions to ask at consultation
- Which filler product do you recommend for my treatment, is it FDA-approved for this area, and why that one?
- Who is the delegating physician, and is their name and license number posted here?
- Who will establish the practitioner-patient relationship with me before treatment (often called a good faith exam)?
- Do you keep hyaluronidase on site?
- What is your plan if I have signs of a blocked blood vessel, such as pain, skin turning white or blue, or vision changes?
- How many of this procedure have you personally performed?
- Can I see before-and-after photos of your own work?
- Can I read the patient labeling for the product you will use?
Red flags
- No identifiable delegating physician
- No posted physician name and license number (Texas requires this) (22 TAC §169.28)
- No practitioner-patient relationship established before treatment (22 TAC §169.26)
- Estheticians performing injections (TDLR)
- Filler bought online or injected with a needle-free device (FDA)
- No hyaluronidase on site for HA filler treatments
Treatment Areas