Recent Trend in the Choice of Fillers and Injection Techniques in Asia: A Questionnaire Study Based on Expert Opinion

January 2014 | Volume 13 | Issue 1 | Original Article | 24 | Copyright © January 2014

Soo-Keun Lee MDa and Hei Sung Kim MDb

aMein Skin Clinic, Seoul, Korea
bIncheon St. Mary’s Hospital, Incheon, Korea

BACKGROUND: With recognition of the value of volume enhancement in achieving a more youthful appearance, there has been concomitant explosion in the soft tissue filler market. Given the vast array of filler products and techniques currently available, choosing the right product and technique can be overwhelming to those with little experience.
OBJECTIVE: To evaluate the recent trend in the choice of fillers and injection techniques among leading dermatologists in Asia and offer guidance to those who practice facial fillers.
METHODS: A panel of dermatologists, who are recognized as filler experts and key speakers in Korea were asked to fill out an in-depth questionnaire on fillers in 2012. The results of the 2012 questionnaire are presented and compared with the questionnaire results of the exact same group of doctors in 2011.
RESULTS: Those who participated in the questionnaire study practiced fillers for an average of 10.6 years with an average of 32.8 filler cases per week. Common indications for filler injection were midface augmentation and nose augmentation. Indications that most drastically increased between 2011 and 2012 were midface and forehead augmentation. For the nasolabial folds, the most preferred choice of filler product, needle, injection technique and injection depth was Radiesse®, 27G short needle, Layering technique and the Upper subcutaneous fat layer. For filler rhinoplasty, the preferred choices were Radiesse®, 27G short needle, Linear threading technique and the Mid-deep fatty layer. For dark circles, the favored choices were Esthelis Basic®, 30G short needle, Vertical technique and the SOOF (suborbicularis oculi fat) layer. For forehead augmentation, the most favored choices were Juvederm Voluma®, 23G cannula, Linear threading technique and Fanning and the Supraperiosteal layer. The physicians’ satisfaction score for the nasolabial folds, filler rhinoplasty, dark circles and forehead augmentation was 71.5, 90, 84.5 and 87 respectively.
CONCLUSION: On general, filler experts preferred fillers with relatively high visco-elasticity for the nasolabial folds, nose augmentation and forehead augmentation but chose fillers with low visco-elasticity for dark circles. Linear treading technique (with or without fanning) was universally popular but Vertical injection was considered more useful for dark circles and the nasal tip.

J Drugs Dermatol. 2014;13(1):24-31.


Facial fillers, injectable therapeutic materials for soft tissue augmentation, are ideal for restoring facial volume and contour.1 With recognition of its value, as well as the ease of office procedures offering minimal downtime and predictable results, filler injection has become one of the most commonly performed cosmetic procedures in Asia. It is currently a mainstream in dermatologic surgery next to botulinum toxin injection.
Generally, Asians including Koreans prefer a “Caucasian” look with prominent facial features including big eyes with a double eyelid and a straight and narrow-based nose with certain height. Not surprisingly, the “double-eyelid” surgery and nose augmentation are the most popular items in plastic surgery. Asians also have a wide face, which is rather flat when observed from sideways. To overcome this two-dimensional look, the facial bone contouring surgery has recently been introduced and is becoming increasingly popular. The facial bone contouring surgery is not a simple procedure and is associated with high rate of complication, also applies for other popular plastic surgeries.
For those who want “Caucasian” features without the risk of surgery, filler injection has become an alternative. Naturally, nose augmentation with fillers is very popular and there is increasing demand for mid-face, forehead and chin augmentation, which adds volume and allows the face to be three-dimensional. In addition, filler injection for lower pretarsal augmentation (for a “cute and young” appearance) is also uniquely popular in Asia.
Despite the popularity of filler injection, there is currently no good analytical data on the choice of filler products and injection techniques tailored to each indication. Considering the numerous filler types and brands currently available, deciding which facial filler to use, when to use it and why, can be a complex process. Injection techniques have also advanced opening a new horizon in filler injection,2 but at times can be confusing. In this study, the general opinion of the filler experts on their choice of fillers and injection techniques is presented which hopefully will guide many of those from having prolonged trial error in practicing fillers.