Dermal Fillers- How Much is Enough? General Guidelines

April 26, 2011/1 Comment/in Dermal Fillers /by MichaelMacri

“Doctor how much will I need to fill this area?” I hear this question frequently throughout the week. I will attempt to provide general guidelines as to how much filler is needed to fill certain areas. I will also use as my “typical patient” a female 35- 45 years old. Exceptions will be obviously younger and older than this demographic patient and varying with individuals who have deeper lines, lighter lines, lost weight or have scars. I will also exclude “touch ups” since touch ups vary with the amount of touching up the patient desires.

So my typical 35-45 year old female will come in noting her naso-labial folds are becoming more pronounced. She is probably coming in because she has been watching this area and the line getting deeper or perhaps she read what can be done to prevent this line from getting deeper. Usually one syringe of dermal fillers will fill this patient nicely. Now this is important…. if you needed filler in this area.. chances are you need filler in the area just below this area called the marionette lines as well. The marionette (puppet lines) are just a continuation of the naso-labial folds anyway. So if you need the upper lines filled, chances are you’ll need the lower ones filled as well. There can be exceptions but form usually follows suit!

Also sometimes this same patient may  come in wanting to fill her naso-labial folds when  in fact her problem is that the cheek has dropped. The fat pad of tissuedropped from the cheek bone to the area just above the naso-labial fold . Patients are amazed when I pinch this area and pull upward on their face  and say….a few years ago you used to look like this? Right? The answer unequivocally  is YES!   Augmenting the cheek area or the area under the eyes (eye hollows, tear troughs) will fix this but in my experience usually requires two syringes (one for each side) to correct. I usually use a long lasting filler in this area so that patients  wouldn’t have to repeat this more than once a year.

Sometimes in an older patient the naso-labial folds, marionette lines and cheeks must all be addressed since obviously more volume has been lost due to age.  Correcting all areas together will result in a better overall outcome.

One Syringe usually fills one of the following areas:

Naso-labial folds
Marionette lines
Smoker’s lines around the mouth
Lips- mild correction
Glabella (frown lines not responsive to Botox or Dysport)
Ear lobes
Nose (Non- Surgical Rhinoplasty)

Two Syringes usually fill one of these areas:

Cheek hollows
Tear troughs, Eye Hollows
Lips- full correction- fuller lips
Hands (both hands)

What is said above about dermal fillers doesn’t apply to fat transfer since morefat volume is required to result in the same correctionas compared to using dermal fillers, but you’re not limited by cost per syringe with fat. For more information please see my previous blogs:

Lastly, splitting a syringe in more than one place usually only works out for someone who has done fillers before and has sufficient filler remaining in all areas. I call this technique  “Layering” but it amounts to more of a  “touch up”.