Understanding Dermal Fillers: Anatomy, Placement, and Natural Outcomes

Vitality Unfiltered Podcast

Host: David J. Bauder, PA-C
 Co-Host: Stephanie Lattimore
 Guest: Alicia Sanderson, MD

In this episode of Vitality Unfiltered, we explore the fundamentals of dermal fillers and how they are used to enhance facial structure, restore volume, and improve overall facial balance.

Dermal fillers—most commonly composed of hyaluronic acid—have become a cornerstone of modern aesthetic medicine. However, achieving natural results requires far more than simply adding volume. The depth of placement, anatomical precision, and treatment goals all play a critical role in determining outcomes.

David J. Bauder, PA-C, founder of Weight Loss & Vitality, along with co-host Stephanie Lattimore and guest Dr. Alicia Sanderson, facial plastic surgeon and otolaryngologist, break down how fillers are used differently across the lips, cheeks, and jawline—and why each area requires a distinct approach.

A central concept discussed in this episode is that filler should support facial structure rather than create excess volume. When used appropriately, dermal fillers can restore youthful proportions and enhance natural features. When used incorrectly, they can disrupt facial harmony.

In This Episode We Discuss

• What dermal fillers are and how they function within facial tissues
 • The difference between structural and superficial filler placement
 • How lip, cheek, and jawline fillers serve different aesthetic goals
 • Why facial anatomy is more important than volume alone
 • The role of fillers in restoring facial balance and proportion
 • Common mistakes that can lead to overfilling or unnatural results
 • How injector technique influences outcomes
 • Why individualized treatment planning is essential
 • The importance of subtle, strategic placement
 • How to achieve natural, long-term aesthetic results

Key Takeaway

Dermal fillers are most effective when used to support facial structure and restore balance—not simply to add volume. Precision, anatomical understanding, and a conservative approach are essential for achieving natural-looking results.

Contact Weight Loss & Vitality

📞 Call: 571-550-9000
 🌐 Visit: https://weightlossandvitality.com

💉 Dermal Fillers: https://www.weightlossandvitality.com/services/dermal-fillers

About Vitality Unfiltered

Vitality Unfiltered is a medical podcast exploring the science of hormones, longevity, metabolism, weight loss, aesthetics, and precision medicine.

Each episode provides clinical insight from healthcare professionals who treat these conditions every day.

Our goal is simple: to help people better understand the biology of their health so they can make informed decisions about wellness, prevention, and long-term vitality.

Disclaimer

This podcast is for educational purposes only and does not constitute medical advice. Listening to this episode does not establish a provider-patient relationship. Always consult a qualified healthcare professional regarding medical concerns, diagnosis, or treatment.

⚠️ Disclaimer
This podcast is for educational purposes only and does not constitute medical advice. Listening to this episode does not establish a provider-patient relationship. Always consult your qualified healthcare professional regarding medical concerns, diagnosis, or treatment.

Transcript

SPEAKER_04 0:00

Vitality.

SPEAKER_03 0:02

Vitality Unfiltered.

SPEAKER_02 0:04

Unfiltered.

SPEAKER_03 0:05

With David Bowder.

SPEAKER_02 0:10

And we're back for another episode of Vitality Unfiltered. Today we will be discussing dermal fillers. Joining me today is Dr. Alicia Sanderson, double board certified head and neck and facial plastic surgeon, and my co-host, nurse practitioner, Stephanie Lattimore. To get started, we want to hit on the different types of dermal fillers, and we'll take it from there. So, Dr. Sanderson, if we could start off in explaining to the audience the different types of dermal fillers when they think about them. There is tons of them, okay? We got different brands, we got every brand has ten different types, right? And you know, like I kind of practice like you when it comes to dermal fillers, and I I have my go-to that I like to use as my general filler. But why don't you break it down for everyone?

SPEAKER_00 0:51

Yeah, absolutely. So yeah, this can be a very confusing aspect. Again, goes back to marketing with a lot of things. So why fillers and filling materials in general? Um as we age, we lose volume in our face. So for a more youthful look, we want to restore volume. I think that um fillers have become very, very popular and also changing the look of the face. So now people, even if they are not losing volume, they may want more volume or want a certain look to the face. So um, way back in the day, we did not have a lot of um off-the-shelf fillers. Um, and when we were noticing that there was loss of volume, we would do fat and fat transfers. So would we actually harvest some fat from a different part of the body and use that fat to fill the to the fill the face? And we got beautiful results. It was unpredictable. Certain areas you would have to overfill because you would lose some fat. You'd have to come back and have another um procedure j done um in there, you would only have maybe anywhere from a 20% to an 80% take of the fat. So it wasn't really predictable.

SPEAKER_02 1:57

Was that the 70s and 80s? When was that?

SPEAKER_00 1:59

When the when was the not that old thousands? I was born in the 70s, so I wasn't transferring fat. I'm right there with you. So um, but thank you for that. Um in general, um, so it used fat, right? So it was unpredictable and it required a procedure, right? You would have to sterily harvest it, and it was very complicated. So then came um dermal fillers, and the most popular dermal filler is hyaluronic acid. So hyaluronic acid is something naturally found in the in the skin. And so then they can recreate it in the lab. A lot of times it's from bacteria, they actually um you know that get the hyaluronic that's um that is created, and they um we can use that naturally in the skin, and then it will um actually plump and fill um the skin. Um so hyaluronic acid is the most popular one out there. Um, very easy to use. It's um an immediate, you know, you can see the results immediately, so you can restore the volume accurately at the same time. Um the nice thing about hyaluronic acid, it is reversible, um, or if you have a complication, you can treat it very quickly. There's um hyaluronidase, um, a bacteria um sorry, uh an enzyme that actually dissolves it. So um if you don't like the filler or it doesn't look right, you can go in and you can dissolve it in there. Um there's other fillers, um calcium hydroxyapatite is um a very um popular filler. Um it's a little bit harder and firmer, so that's something like radius that can be used as a deeper, um uh a deeper, more structural, it has a little bit more um bulk to it. Um sculpture is And that one can't be dissolved.

SPEAKER_02 3:45

It can't be dissolved. Yeah, radiase can't be dissolved.

SPEAKER_00 3:47

It cannot be dissolved. And so then um sculptra is also another very popular. So that's a biostimulant, so it causes your body to create some, you know, scar tissue that gives you volume. Now that was first um FDA approved for um lipodystrophy in HIV patients. So patients with terminal disease back in the day of HIV, where it was not curable and people would um eventually die of AIDS and go through there, but they would lose so much weight and so much fat that you could put this in there. Um initially, when we first started with sculpture, we had a lot of problems with it. With the with the reconstitution, it caused a lot of granulomas, or it, you know, it stimulated your body to produce scar tissue and it would leave abnormal bumps and lumps in places requiring surgical excision. So that was it kind of was not very popular. Over time, they corrected it. So sculpture is really popular now. Lots of people do it. I personally just have not gotten into it. I love the hyaluronic acid, and I love that I can reverse it, right? So my mantra in medicine is do no harm, and I like that in there, but I will, you know, I'm not gonna talk a lot on sculpture, but lots of people use it, they love it, they like the results, and so you know, um, that is an option out there. Um, the bulk of the um fillers that I do are the hyaluronic acid, and there are in different brands will um, you know, different companies will brand them different. You have your Galderma, which does a lot of the Restin projects, you have your um you know um Allergan that does the Juveder and products, you have the RHA, there, I mean there's tons. When you get to Europe where their FDA, um they don't have FDA restrictions like we do, there are just an unlimited number of products. The key to the products has to do with we talk their G prime and their flexibility and their um their bulk. So we they kind of change the products have different properties to them based on where you want to put them. Something like um Voluma or a lift is, you know, Voluma being Juvederm and you know, lift being Restilent. Um, they're heavier products, they're meant to go deeper. So you put them, you know, above the bone or something, you put them deep and they have a lot of volume and they'll, you know, lift things up and they have a lot of presence. You don't want to put a substance like that close to the surface of the skin because then you would see it. Then you have other products that are meant for fine lines, like you're like a bellatero or something like that, where it's or a silk that it's really, you know, like um thin, so you want to treat fine lines with that because when you put it underneath the skin, you don't see it there. Um, some of them are a lot more flexible, so really flexible products you want to put in the lips, right? The lips are moving and they're doing things. So you want something that looks natural and your lips are able to move when you put them in. If you're talking about putting filler underneath the eyes, where that's really thin skin, you want to make sure that you don't have a product that causes a bluish hue or what we call the Tyndall effect underneath the eyes. So there's a whole range of products because we need those products. We, you know, we need to pick and choose what product is right to based on the lines that you're putting in, and you want volume restoration versus flexibility versus you know, um, versus that contour changes.

SPEAKER_02 7:05

Um you brought up sculpture a little uh just a bit ago, uh just recently, the um you know, you said they worked out all the kinks. Yep. And uh there was uh Dr. Somnek here in in Washington, D.C. He had a uh they were they did a clinical study on the Ozimbic face and the use of sculpture. I haven't seen it get released at all. But during that clinical study, weight loss and vitality, we actually helped we helped. You know, like any any any patients that lost any patients that lost a certain amount of percentage of body weight, they were accepted into the clinical study. And they wanted to see how the sculpture would work in that in that specific you know, client base. So we're still waiting on the results on that one, but it's kind of the first one.

SPEAKER_03 7:49

Yeah.

SPEAKER_02 7:49

When when you think about placement of dermal fillers, like superficial and deep. So generally speaking, um the fine lines are gonna always be the ones that are superficial, right? And then when you think about structure and deep, are we putting that right on the bone?

SPEAKER_00 8:05

Depending on where and what you want to do. So um the aging face, we lose volume in our face, we we lose fat. Um our our face is divided into fat pockets, and as the fat pockets start to descend, because we're losing bony support underneath there, we have a lot of ligaments. So the face will get tethered by ligaments. So that's why you look at an aging face, there's all these craters and grooves in there. That changes the contour contour of the face, and the youthful face is smooth without these you know ridges and valleys. So, what you're doing is you're putting the filler into that space to elevate it so it goes with a smooth contour and not, you know, an abnormal abnormal line that catches your eye. So, depending on what you're trying to fix is where you put it. Now, if you have a superficial line and you put this really deep, it's gonna take a lot of product to get you know that high. So you want to kind of balance the the you know the financial aspect of not uh of using the least amount of product to get the best result. So, based on that, you know, like I you have the heavy products, I would, you know, you use things like some of the you know the Juvederm Ultra or the Restilin, I love the refined defines for those kind of medium depth where you're putting it, um, you know, under the eyes. I still will use a little, I still like Rustin L underneath there. Um the RH products, you know, can be used underneath there. Um, but uh some of it is getting as an injector and having been injecting for a long time and using different products, you get a feel to it, right? Some of them, some products will say this is a really heavy product, but it's not as heavy as a Voluma. Well, Voluma is really heavy, but it's really expensive. It's a lot more expensive than some of those. So I have to, you have to kind of you know balance with the patient how much they want to spend on this, how much they want to, you know, put in there, and you know, talking about them, what their goals are, what their their budget is, and where their biggest bang for the buck would be.

SPEAKER_02 10:11

So let's let's get into risks and complications. All right. Let's start off with some risk associated with it, and then some real complications that can occur. All right. Because I think first of all, I think the audience absolutely underneath to understand this. Okay.

SPEAKER_00 10:24

And this is very, very important. Fillers have very high, high risk, right? It's been very popular. Lots of people, you know, inject it and they put it in there, but they have potentially high risks. The anatomy of the face is very, very complicated. Um, you know, there's different textures of skin on the face, you know, the under-eye is very thin, the nose is thin. The blood supply is um, although the face is a very, you know, robust blood supply, there's lots of arteries, and you know, injecting into an artery and getting retrograde flow of things can cause blindness. So injecting in and around the face can cause blindness or loss of um vision, it can cause massive necrosis of the skin, which is death of the skin, because it blocks the um it it blocks the vessel. And more importantly, it when we're talking about injecting and um and having kind of what I call catastrophic um, you know, results where you know you inject into a blood vessel and you ha lose a whole piece of skin or you have necrosis of the skin, um, it's a little bit more complicated than cutting a vessel, right? So I very commonly, you know, when I'm operating, I will see a blood vessel to the lip and I will tie it off and cut it off when I'm resecting a cancer. It's not a big deal, the face has a great blood supply. When you put a filler into that, you actually eject that product into all the tiny little microscopic capillaries. So I can't fix that, right? That's not something that, you know, like if I tie off a vessel, there's another vessel to come in there. It's it can cause significant damage. And understanding what to do immediately when those things happen is important. Some of the the other complications that happen, which are luckily the more common ones as opposed to these catastrophic ones, can be, you know, putting the the filler in the in the wrong place. So you see lumps or bumps. You can get migration of the filler. Like over time, you can put filler in, and as we move our muscles, that filler that stays there moves. I think a common misconception with fillers when they first came out was that they last for a year and then they're gone. Well, we know that depending on where you're putting the filler and what filler you're you're putting in, it can last 10 years. And get, you know, 10 years we can still see fillers. As people start to age and their face starts to descend, all of a sudden you start to see stuff that we had put underneath that muscle or that fat pad that has gone down there. And I think that contributed to a lot of our overfilling, right? First of all, it was like the zealous, you need to do more, more is better, right? Oh, I'm a I had my filler a year ago and now I need to, you know, get more filler. Let's proactively put the filler in because it's gonna go away. Well, when the filler isn't going away and people are, you know, over puffy, and so now the filler is kind of falling out of favor because it was overdone and not done properly. So I think that you still have a role for filler, but it's important to understand the filler, understand how long the filler lasts, to treat the patient, you know, look at the patient. Patients would come back and see me and say, Oh, I need fill more filler underneath my eyes. And I'm like, no, you don't, you look fine, right? But they think it's that time. Um, if you're injecting in and around the eyes, please, please have an experienced injector do that. I mean, it's it's so risky. You're talking about putting products in and around the eye that can cause blindness and perennials. Same thing in the nasal label fold. That's a really high risk area for getting blindness doing that. So it's really important to have a plan and an emergency plan. I know at weight loss and vitality, you know, when I was working here, we have um we have emergency kits. We have an emergency protocol that is available right away because when something happens, you want to jump right on it and you're overwhelmed, you don't know what's going on. We have a clear guideline for it. We have an emergency kit that has the medications that we need to put in and do it and make sure that you have contacts in the community that can help you with that. An ophthalmologist that you could call that, you know, could do it, a facial plastic surgeon who you know can help with those things. But um, there are definitely some significant complications. So you really want to choose, you know, um who puts the filler in, you know, carefully and make sure that they have the experience and they know what to do in case of a bad event. Aaron Ross Powell, yeah.

SPEAKER_02 14:36

I really don't when you think about filler, I really just don't think that this is a cavalier type procedure. And you know, you confidence and cavalier is two different things, right? Like I was telling you, is like I have confidence on injecting dermal fillers. Uh like like you're a surgeon. You have seen every piece of anatomy underneath the face, right?

SPEAKER_00 14:54

Yeah, yeah, yeah.

SPEAKER_02 14:55

And everybody's anatomy is a little different.

SPEAKER_00 14:57

So even you can get fooled. I absolutely 100%.

SPEAKER_02 15:00

Right. So how you know for somebody that has not, you know, like spent years and years and years up underneath the skin, how would we really truly have an appreciation and a three-dimensional look of the anatomy? Now, we know where the basic anatomy is. You know, we know, everyone knows, right? But things move. You know where you know and the confidence that I get from doing fillers is know that I have your phone number. But I mean, I'm not kidding. I mean, it's like if something was to happen, it's like I can pick up the phone and be like, look, like walk me through this, right? And you know, the and and also for all any injectors out there, you know, they go through training. Well, their training will only injector training will only take you so far. Right.

SPEAKER_00 15:38

Injector training, I mean, some of the training programs are only four hours. I mean, you don't understand that. And I always laugh because I'll see people putting up there like, oh, look at me, and I know the anatomy and the vasculature of the face. So the one thing about the face is it's incredibly variable. Like it does not come out in in a predictable way, right? So you talk about the we we have kind of three big um what we call foramen or openings of the face where the the nerves and the vasculars come out, and there's uh a whole bunch of little smaller ones in there. But the just in this one area where the vessels come out, sometimes it comes out as one big vessel, sometimes it comes out in branches, and there's so much variability. We pretty much know in and where it is, but you know, the there's a lot of you know changes that can happen, and I know that as a surgeon. So when I get in there, I'm like, oh look, there's a a variability or not doing it. And so I'm very kind of aware when I'm in and around that area, and I'm very, very careful, and there's definitely things that you can do as an injector to kind of minimize your risk, but nothing's safe. People will say, like, oh, you know, it's a it's if you use a cannula, it's safe. It's safer than it, but you can still puncture a vessel with a cannula. Um they'll talk about well, you aspirate when you inject. Well, the study showed that if you do and you aspirate, you have to hold for something like 30 seconds. Nobody's sitting there for 30 seconds aspirating to not you know, like to not doing it. So we falsely think that we can have safe. Catastrophic complications happen to experienced surgeons. Um it can happen to anybody, uh probably a little less frequently, but it could h I know every time I inject in the face, I think about it. That's why I am we talked about um fillers in the nose, and I am not a fan of filler in the nose, and you can have catastrophic problems with that. You shouldn't be in there, you shouldn't, I don't, I don't support liquid rhinoplastase or anything like that. You need to fix it the the way it is, but you know, there's just such high risk areas, but I know, not that I yeah, I mean I have put it in to revision patients that are just not good candidates for revision. I'm trying to fix a little something. I am so cautious and nervous because I know it could happen to me at any time. And I'm ready though. I'm ready. I know that if that does happen to me, what you know, what am I gonna do? How am I gonna get this you know going in there? So I think it's really important to um to understand that there are complications with this and you know nothing's really free in life, and we we have you know risks that go with it.

SPEAKER_02 18:16

Aaron Ross Powell when you think about dermofiller training, even one of the first one of the first areas that they teach anyone to to do dermofiller is nasal labials. And it's actually one of the higher risk. One of the higher risk areas. It's like you know, it's it's really necrosis and all this stuff, yeah.

SPEAKER_01 18:33

It's really reassuring, Dr. Sanderson, to hear you stress the importance of safety as a new practitioner and a new um provider of injectables, even at your level, how serious you take this and um the understanding of any individual's facial anatomy and where the vessels are, um, having the emergency medications available to you. Um at the end of the day, it's an aesthetic elective procedure that we have to take seriously.

SPEAKER_00 19:02

Yeah. Yeah, absolutely.

SPEAKER_02 19:04

And then I guess we'd just end too is like the last thing I think we should bring up is uh there um I th for the listeners, I think they also should understand where the products are coming from on this. Correct. Because there are a lot of available you know, these products can be or ordered from overseas. They are non-FDA approved. You yes, some of them we just have to be very cautious about where the where when you are getting your product injected into your face, you should know where it's coming from. Is it coming from Galderma? Is it coming from Allergan?

SPEAKER_00 19:36

You know, and and I think that the important part of that is that you need to have um accountability of the the chain, of the supply chain um going through there. And again, lots of people go to Europe and have you know procedures done and it's fine, but like you're expecting that there's a reliable, you know, um accountability, not that these were sit in an area where they weren't temperature controlled or they weren't, you know, like they didn't have those. Um we have a lot of people that will, you know, travel to, you know, like in Mexico or something like that and have procedures or fillers in there. They'll have people, I've had people come back and they're not sure what was injected, because other things it's sometimes it's Gore-Tex, sometimes it's all sorts of sorts of things. I always caution that um people are very careful with your face. I know it sounds like a good deal and it sounds like a bargain, but you know, really uh having a reputable area, because I've seen as a surgeon, I've seen a lot of complications and they're devastating. Our face is how we interact with society, and as you absolutely, as you touched on, these are elective procedures, right? There's no room for errors. If you have a cancer and I'm making you better, you know, you had a cancer and you're okay with that. But when you are there's nothing wrong with you and you look fine and you go in to look a little bit better, and now you have a big defect on your face, it's emotionally devastating. It changes these people's lives. People with, you know, botched facial surgeries are completely devastated because it changes how they interact with society. So be really, really careful with your face.

SPEAKER_02 21:06

Aaron Powell That's great advice.

SPEAKER_01 21:08

That being said, there is a place and role for fillers that can be done safely and beautifully and naturally. Absolutely.

SPEAKER_00 21:14

That's great. Yep, I agree. Yes, thank you. Since we are promoting the use of fillers, I don't want to be the doomsday person. But but I think yes, I I love fillers. I think it has a role, it has a role with facelifts and we're surfacing and you need to do it. Um so I think that they can definitely enhance um patients' appearance.

SPEAKER_02 21:33

Great discussion. Awesome. Thank you both for being here today. If you enjoyed the show, make sure you click below or s hit the subscribe button so you don't miss the next show. Thank you for joining us today on Vitality Unfiltered.

SPEAKER_03 21:45

Thanks for joining us on Vitality Unfiltered with David Bowder.

SPEAKER_04 21:50

Addressing norms, busting myths, and uncovering health realities for a more vibrant life today. For more expert insights and real talk. Make sure to subscribe and join us next time.