Facial Fillers in Brazil: restoring volume and contour with hyaluronic acid
Dermal fillers with hyaluronic acid are one of the most sought-after aesthetic procedures in my clinic in Brazil. And it is no coincidence. It is a versatile, safe treatment with immediate results that can transform the appearance of the face without the need for surgery. With over twenty years of experience as a plastic surgeon in Brazil and more than eight thousand procedures, I can affirm that facial fillers, when well planned and executed with refined technique, deliver extraordinary results. International patients seeking cosmetic surgery abroad often combine fillers with surgical procedures during their visit to my clinic.
Hyaluronic acid is a substance that already exists naturally in your body. It is present in the skin, joints, and eyes. As the years go by, natural production decreases — and it is precisely this loss that contributes to the appearance of wrinkles, grooves, and the loss of facial volume that bothers us so much. The treatment consists of strategically replenishing this substance, restoring to the face the volume, support, and contours that time has taken away.
Unlike what many think, facial fillers are not just for "filling" the face. In my practice, I use hyaluronic acid as a facial sculpting tool. Each application point, each injected quantity, and each insertion depth are carefully planned to create a naturally balanced result. The goal is not to look filled — it is to look like you, just with the vitality of years gone by.
If you are researching facial fillers, you have probably noticed that there are many options on the market and a lot of contradictory information on the internet. On this page, I will explain honestly and clearly everything you need to know: the areas that can be treated, the techniques I use, the available products, the necessary care, and what to expect in terms of results. My intention is that you finish this reading feeling secure and well-informed to make the best decision.
The main areas of the face treated with fillers
One of the great advantages of hyaluronic acid fillers is their versatility. I can treat practically any area of the face that has lost volume or needs better definition. Each region requires a specific type of product — denser or more fluid — and a particular application technique. Here are the areas I most frequently treat in my clinic:
Nasolabial fold (smile lines)
The nasolabial fold is the line that runs from the side of the nose to the corner of the mouth. It is one of the most common concerns among my patients, as it deepens with age and gives the face a tired and aged appearance. With fillers, I gradually soften this line without completely eliminating it — which would look artificial — but enough to rejuvenate the expression. Often, the secret lies in filling not only the fold itself but also restoring volume in the malar region (cheekbone), which, when it descends with gravity, is the true cause of the deepening of the fold.
Lips
Lip fillers are one of the most requested procedures and also one of those that require the most common sense from the professional. Well-filled lips are those that look naturally beautiful — plump to the right degree, with a defined outline, proportional to the face. I use low-density and highly malleable products to ensure that the lips maintain their natural mobility. I work respecting the facial proportions of each patient: the lower lip should be slightly larger than the upper lip, and the projection should sit in natural balance with the nose and chin.
Jawline and facial contour
The definition of the jawline is one of the most transformative applications of facial fillers. A well-defined jaw angle conveys youth, determination, and beauty. With high-density products, I can create or enhance the jaw angle, define the entire jawline, and even correct small asymmetries. It is a procedure I particularly value because it significantly improves the patient's profile, both in women and men. For those seeking refinement in this area permanently, genioplasty or mentoplasty can be excellent surgical alternatives.
Malar region (cheekbones)
The cheekbones are fundamental structures for a youthful and attractive face. With ageing, the malar fat descends, and the region loses projection. Filling the malar region not only restores lost volume but also subtly lifts the adjacent tissues, indirectly improving the nasolabial fold and the periorbital area. When the volume loss is more pronounced, facial fat grafting may be a more lasting option, as it uses the patient's own fat and offers regenerative benefits through stem cells.
Dark circles and periorbital region
Deep dark circles — that dark groove between the lower eyelid and the cheek — are a frequent concern. Filling this area is delicate and requires a refined technique, as the skin there is extremely thin. I use specific low-density products and apply them with a cannula to minimise risks. The result is a softening of the groove that eliminates that permanent tired appearance. For more complex cases involving excess skin or under-eye bags, blepharoplasty may be the best option.
Temples
Volume loss in the temples is a subtle but significant sign of ageing. When the temples sink, the upper third of the face loses support, and the eyebrows may droop, giving the face a skeletal appearance. Filling this area is simple, quick, and produces a remarkable rejuvenating effect, restoring the natural convexity of the region.
Marionette lines
These are the lines that descend from the corners of the mouth towards the chin, giving the face a sad expression. Filling these lines, combined with restoring volume in the malar region, significantly softens this aspect. For more comprehensive results in rejuvenating the lower portion of the face, facelift may be considered in cases of moderate to severe sagging.
Application techniques: cannula versus needle
One of the questions I receive most from patients is: "Doctor, do you use a needle or a cannula?" The answer is: it depends on the area and the goal. Each technique has its specific advantages, and I use both according to the needs of each case.
Application with cannula
The cannula is an instrument with a blunt (rounded) tip that does not cut tissues — it displaces them. This means a lower risk of puncturing blood vessels, fewer bruises, less swelling, and less discomfort. I prefer the cannula for extensive areas such as the jawline, cheekbones, and especially the under-eye region, where safety is the top priority. With a single entry puncture, I can distribute the product over a wide area, significantly reducing the discomfort of the procedure.
Application with needle
The needle offers more precision in areas that require pinpoint and detailed application. I use a needle for lip contouring, for specific points of the jaw angle, and for fine corrections. The needle technique allows me to deposit small amounts of product with millimetric accuracy, which is essential when the goal is subtle refinement.
My combined approach
In most sessions, I combine both techniques. For example, in a complete treatment of the mid-face, I may use a cannula for the malar region and the nasolabial fold, and a needle for fine adjustments on the upper lip contour. This hybrid approach maximises safety and precision of the result.
Regardless of the technique chosen, I always apply topical anaesthesia or local anaesthetic block before the procedure. Most modern hyaluronic acid products already contain lidocaine in their formula, making the application quite comfortable. My patients are often surprised at how calm the procedure is.
The products I use: quality and safety first
Not all hyaluronic acid is the same. There are huge differences between the products available on the market in terms of quality, durability, behaviour in tissues, and safety. In my clinic, I work exclusively with world-renowned brands that have extensive clinical studies proving their efficacy and safety.
Juvederm (Allergan/AbbVie)
The Juvederm line is one of the most comprehensive and researched in the world. I use different products from this family according to the need:
- Juvederm Voluma: high-density product, ideal for malar projection, jawline, and deep volume restoration. Lasts up to eighteen months.
- Juvederm Volift: intermediate density, excellent for nasolabial folds, marionette lines, and lip contouring. Lasts twelve to fifteen months.
- Juvederm Volbella: low density, perfect for lips, dark circles, and fine perioral lines. Lasts up to twelve months.
Restylane (Galderma)
The Restylane family is equally respected and offers complementary options:
- Restylane Lyft: for volume in cheekbones and jawline.
- Restylane Defyne: superior flexibility, ideal for areas with a lot of movement such as the nasolabial fold.
- Restylane Kysse: developed specifically for lips, with technology that preserves natural movement.
Why product choice matters
Each product has a different rheology — that is, a specific way of behaving within the tissues. Denser and more cohesive products better support areas that need projection. More malleable products integrate better in areas of movement. Choosing the wrong product for the wrong area can result in irregularities, an artificial appearance, or a shorter duration than expected. That is why I insist on using only products with extensive clinical studies: the predictability of the result is fundamental.
Important: all hyaluronic acid products I use are reversible. There is an enzyme called hyaluronidase that dissolves hyaluronic acid quickly and safely. This means that, in case of any dissatisfaction or rare complication, the procedure can be reversed. This additional safety is something I greatly value and provides peace of mind to my patients.
Recommendations and the ideal patient for facial fillers
Hyaluronic acid fillers are recommended for a wide range of situations. Throughout my experience, I have identified the profiles of patients who benefit most from this procedure:
Early signs of ageing
Patients between thirty and forty-five years old who begin to notice volume loss in the cheekbones, slight deepening of the nasolabial fold, and a decrease in jawline definition. In this age range, fillers work as preventive maintenance, delaying the need for more invasive procedures.
Complement to surgical procedures
Many of my patients who have undergone facelift, rhinoplasty, or blepharoplasty use fillers as a complement to maintain and refine results over the years. It is an excellent ally in post-surgical maintenance.
Balancing proportions
Young patients who wish to improve facial proportions — such as projecting the chin, defining the jawline, or enhancing the lips — without resorting to surgery. Fillers allow for "testing" changes before considering definitive procedures.
Correction of asymmetries
Every face has natural asymmetries. Fillers are an excellent tool to soften differences between the sides of the face, whether in volume, contour, or proportion.
When fillers are NOT the best option
I need to be honest: fillers have limitations. If you have significant facial sagging, excess skin on the neck, or significant tissue droop, hyaluronic acid will not solve your problem. In these situations, facelift is the correct recommendation. Trying to compensate for sagging with excessive filler volume is a common mistake that results in swollen and artificial-looking faces — something I refuse to do to my patients.
Similarly, for dynamic expression wrinkles — those that appear with movement, such as forehead lines and crow's feet — botulinum toxin (Botox) is the appropriate treatment, not fillers. The combination of Botox for dynamic wrinkles and fillers for volume loss is a powerful strategy that I frequently use.
The procedure step by step
Transparency is something I greatly value. I want you to know exactly what happens during a filler session in my clinic. No surprises, no mysteries.
Assessment and planning
Everything begins with a detailed consultation. I examine your face at rest and in motion, assess the quality of your skin, the distribution of volume, facial proportions, and asymmetries. We photograph your face from multiple angles for documentation and planning. We discuss your expectations and I outline a personalised treatment plan, including which areas to treat, which products to use, and how many sessions will be necessary.
Skin preparation
On the day of the procedure, I clean the entire area to be treated with antiseptic solution. I apply topical anaesthetic cream and, when necessary, perform local anaesthetic block — especially for lip treatment. I wait the appropriate time for the anaesthesia to take full effect.
Product application
With the skin prepared, I begin the application following the outlined plan. I work calmly and precisely, assessing the result at each stage. I ask you to sit and look in the mirror during the procedure so we can decide together if more product is needed or if the result is already satisfactory. This collaborative approach ensures that the final result meets your expectations.
Duration
A complete filler session lasts between thirty minutes and one hour, depending on the number of areas treated. It is an outpatient procedure — you enter and leave the clinic on the same day, with no need for hospitalisation or complete rest.
Immediate post-procedure
After the application, I gently position the product with massage when necessary and apply ice to minimise swelling. I provide written instructions on care for the first hours and days. You can return to your normal activities immediately, with some restrictions that I will detail below.
Care before and after fillers
Before the procedure
To minimise the risk of bruising and optimise the result, I advise my patients to follow some recommendations in the days leading up to the procedure:
- Avoid aspirin, anti-inflammatories, and supplements such as omega-3, vitamin E, and ginkgo biloba for seven days prior.
- Do not consume alcohol in the twenty-four hours leading up to the procedure.
- Inform me about any medication in use, especially anticoagulants.
- If there is a history of cold sores, inform me so we can prescribe antiviral prophylaxis in case of lip fillers.
- Avoid dental procedures one week before and one week after.
After the procedure
The post-procedure care is simple but important:
- Apply ice in the first hours to reduce swelling.
- Do not massage the treated area in the first forty-eight hours (unless I specifically advise).
- Avoid intense physical activities for twenty-four to forty-eight hours.
- Do not expose yourself to excessive heat (sauna, very hot baths) for a week.
- Sleep on your back in the first nights.
- Avoid makeup in the treated area for twelve hours.
- Do not consume alcohol for twenty-four hours.
What is normal in the first days
Some swelling is expected and normal, especially in the lips, where it may be more pronounced. Small bruises may appear at the injection points of the needle or cannula — they are temporary and resolve in five to seven days. A slight asymmetry in the first days is expected due to uneven swelling and should not cause concern. The definitive result establishes itself between one and two weeks, when all the swelling will have subsided.
Duration of results and touch-ups
One of the most frequent questions is: "How long do the fillers last?" The answer varies according to the product used, the area treated, and the individual metabolism of each patient. But I can outline a general overview:
Durability by region
- Lips: six to twelve months. The lips are an area of intense movement (speaking, chewing, expressions), which accelerates the metabolism of the product.
- Nasolabial fold: ten to fifteen months, depending on the initial depth and the product used.
- Cheeks: twelve to eighteen months. Being an area with less movement, the product tends to last longer.
- Jawline: twelve to eighteen months. High-density products maintain well in this region.
- Dark circles: twelve to twenty-four months. The infraorbital region has a slower metabolism, and the product tends to last longer than average.
- Temples: twelve to eighteen months.
The touch-up strategy
The secret to maintaining a beautiful and natural result over time is periodic touch-ups before the product is completely absorbed. I recommend a maintenance session every eight to twelve months, depending on the area. In this session, the amount of product needed is generally less than in the first application, as there is a cumulative effect: hyaluronic acid stimulates collagen production around the treated area, and the residual product still offers some support.
This regular maintenance approach is smarter and more economical than waiting for the result to disappear completely and starting from scratch. And the aesthetic result is superior, as you never go through that period of "returning to square one".
The cumulative effect
Clinical studies show that regular applications of hyaluronic acid stimulate the production of type I and III collagen in the treated area. This means that, over time, your own skin responds positively to the treatment, producing more natural support. Patients who maintain a regular filler programme often need less product at each session.
Risks and complications: what you need to know
Like any medical procedure, facial fillers carry risks. It would be dishonest of me to downplay them. However, when performed by a qualified professional, with quality products and proper technique, serious complications are extremely rare.
Common (and expected) side effects
- Swelling: present in almost all cases, lasts from two to seven days.
- Bruises: occur in about twenty to thirty percent of cases, resolving in five to ten days.
- Redness: at the needle entry points, lasts a few hours.
- Sensitivity: mild sensitivity to touch in the treated area, lasts a few days.
Rare complications
- Nodules: small palpable irregularities, usually caused by inadequate technique or poorly positioned product. They can be resolved with massage or, if necessary, with hyaluronidase.
- Tyndall effect: a bluish discolouration visible when the product is applied too superficially on thin skin. Reversible with hyaluronidase.
- Infection: extremely rare with proper aseptic technique.
- Allergic reaction: very rare with pure hyaluronic acid products.
The most serious complication: vascular occlusion
The most severe complication — and fortunately very rare — is vascular occlusion, when the product is inadvertently injected inside or around a blood vessel, potentially compromising local blood flow. This is why a deep understanding of facial vascular anatomy is absolutely fundamental. In my practice, I have rigorous safety protocols: aspiration before injection, preferential use of cannula in high-risk areas, small volumes per injection point, and always, hyaluronidase available in the clinic for immediate dissolution in case of any sign of vascular compromise.
This is one of the reasons why I insist on the importance of choosing a professional with proper training and deep anatomical knowledge. The face has a complex vascular network, with anatomical variations between individuals. There is no substitute for knowledge and experience when it comes to your safety.
Facial fillers versus other procedures
My patients often ask: "Doctor, what is better — fillers, Botox, or surgery?" The answer is that there is no competition between them. Each procedure has specific uses, and the best results usually come from the intelligent combination of different techniques.
Fillers versus botulinum toxin
Botulinum toxin works by relaxing muscles to smooth dynamic wrinkles — those that appear with movement (forehead, glabella, crow's feet). Fillers restore volume and fill static grooves — those visible even at rest. They are complementary, not competitive. Most of my patients benefit from both.
Fillers versus fat grafting
Fat grafting uses fat from the patient's own body to restore facial volume. The advantage is that the result can be permanent (the fat that survives the graft remains indefinitely) and brings with it stem cells that regenerate the skin. The disadvantage is that it requires a surgical procedure with liposuction and has a longer recovery period. Fillers with hyaluronic acid are ideal for those seeking results without surgery and with quick recovery.
Fillers versus facelift
The facelift repositions the tissues that have descended over time — it is the definitive solution for sagging. Fillers restore volume. They are different things. It is pointless to "fill" a sagging face with hyaluronic acid hoping it will lift — this only creates more weight on tissues that are already giving way. For real sagging, the facelift is the answer.
Fillers versus biostimulators
Collagen biostimulators (such as Sculptra and Radiesse) are a different category. Instead of restoring volume immediately, they stimulate your body to produce collagen over weeks and months. The result is more gradual and subtle, but potentially more natural on a larger scale. I can combine fillers with hyaluronic acid for immediate results in specific areas, with biostimulators for overall improvement in skin quality and support.
The integrated approach
In my clinic, I practice an integrated approach to facial rejuvenation. I combine different techniques according to the individual needs of each patient. For many, the ideal plan includes botulinum toxin for expression wrinkles, fillers for volume and contour, and skincare for texture and radiance. And when sagging demands it, surgery — whether facelift, blepharoplasty, or lip lift — becomes a fundamental part of the treatment.
My experience and treatment philosophy
With over twenty years of practice in plastic surgery and more than eight thousand surgeries performed, I bring the same technical and aesthetic demands to facial fillers that I apply in theatre. My training with Professor Ivo Pitanguy taught me that every detail matters — and in facial fillers, the details make all the difference between a natural result and an artificial one.
I am a full member of the Brazilian Society of Plastic Surgery (SBCP) and the American Society of Plastic Surgeons (ASPS). I regularly participate in conferences and update courses, keeping up with advances in products and techniques for fillers. This continued education is essential because the field evolves rapidly — new products, new application techniques, and new understandings of facial anatomy emerge constantly.
My philosophy: less is more
I firmly believe that the best filler is one that nobody notices. My goal is not for people to look at you and think "she had fillers." My goal is for them to look and think "she looks great." The difference is subtle, but fundamental.
For this reason, I work with conservative volumes and prefer to divide the treatment into sessions when necessary. It is always easier to add product in a touch-up session than to deal with excess. This gradual approach ensures that the result evolves naturally, respecting the natural proportions of your face.
The plastic surgeon's perspective
A unique advantage I offer my patients is the perspective of a plastic surgeon. I have a deep understanding of facial anatomy — not just superficially, but the deep layers, ligaments, fat compartments, and vascular network. This knowledge allows me to apply fillers with a precision and safety that only surgical training provides. Additionally, I can honestly assess when the filler is sufficient and when a surgical procedure would be more appropriate — such as a rhinoplasty for the nose or a genioplasty for the chin.
Frequently asked questions about facial fillers
Does facial filler hurt?
The discomfort is minimal. I use topical anaesthesia in cream applied thirty minutes before the procedure and, for the lips, I perform local anaesthetic blocking. Additionally, the hyaluronic acid products I use contain lidocaine in their formula, providing progressive anaesthesia during application. Most patients describe the sensation as a slight pressure, not pain.
How long does the effect of the filler last?
It depends on the treated area and the product used. On average, from six to eighteen months. Lips tend to last less (six to twelve months) due to intense movement. Cheeks and jawlines last longer (twelve to eighteen months). I recommend periodic touch-ups to maintain the result without ever "losing" the effect completely.
Does the result look natural?
When performed with the appropriate technique and conservative volumes, yes. My philosophy is "less is more." I prefer to divide the treatment into sessions rather than apply excessive volume all at once. The result should be an enhanced and rejuvenated version of you, not a different person.
Can I dissolve the filler if I don't like it?
Yes, and this is one of the great advantages of hyaluronic acid. The enzyme hyaluronidase dissolves the product quickly and safely. I always keep hyaluronidase available in the clinic. In case of dissatisfaction or any complication, I can reverse the procedure.
What is the difference between filler and Botox?
They are complementary procedures with completely different mechanisms. Botulinum toxin (Botox) relaxes muscles to soften expression lines (forehead, glabella, crow's feet). Fillers restore volume and fill static grooves. The combination of both is one of the most effective strategies for non-surgical facial rejuvenation.
At what age should I start getting fillers?
There is no fixed minimum age. What determines the suitability is the individual need. Young patients may seek fillers for proportion balancing (lips, jawline, chin). From the age of thirty, restoring lost volume due to ageing begins to make sense for many people. An in-person consultation is the best way to assess if and when fillers are recommended for you.
Can fillers replace a facelift?
No. Fillers restore volume; a facelift repositions tissues that have descended with gravity. They are different treatments for different problems. Trying to replace a facelift with excessive filler volumes is a mistake that results in swollen and artificial faces. If there is significant sagging, a facelift is the correct recommendation.
Can I get fillers if I have cold sores?
Yes, but with precautions. If you have a history of cold sores and the filler will be in the lips, I prescribe antiviral prophylaxis (aciclovir or valaciclovir) starting one day before the procedure and continuing for five days. This significantly reduces the risk of virus reactivation.
Do fillers interfere with imaging tests?
Hyaluronic acid may appear in facial magnetic resonance imaging. If you need to undergo facial imaging after fillers, inform the requesting doctor and the radiologist. This avoids confusion in interpreting the results.
How many syringes of hyaluronic acid will I need?
The amount varies greatly depending on the treated areas and the degree of volume loss. For lips, usually one syringe is sufficient. For nasolabial folds, one to two syringes. For a complete facial treatment (malar, grooves, jawline), three to six syringes may be needed, distributed over one or two sessions. I define the exact amount during the consultation after a detailed assessment.
Can I get fillers during pregnancy or breastfeeding?
I do not recommend it. Although there are no studies demonstrating adverse effects of hyaluronic acid during pregnancy or breastfeeding, for precaution and medical ethics, I prefer to wait until after breastfeeding is finished to perform the procedure.
Is it safe to get fillers from any professional?
The safety of fillers directly depends on the professional's qualifications. A deep understanding of facial vascular anatomy is essential to avoid serious complications such as vascular occlusion. Always seek a specialist doctor — preferably a plastic surgeon or dermatologist — with proven training and documented experience. Be wary of prices significantly below the market and professionals who are not doctors performing the procedure.
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Dr. Walter Zamarian Jr.
Plastic Surgeon in Brazil
Rua Engenheiro Omar Rupp, 186
Londrina, PR - Brazil
ZIP 86015-360
Brazil
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