May 30, 2023

Filler in Syringes

Though filler is typically associated with wrinkle smoothing and Kardashian-esque lips, it turns out it can be a very useful tool in battling acne scars, too. And, as anyone who struggles with acne knows—as if having acne weren’t bad enough—sometimes the scars it leaves behind are even harder to deal with. We spoke to top dermatologists to get the scoop on everything from the basics (like, what even is filler?) to how it can help acne scars.

What Is Filler? 

First things first: Filler, as New York City-based, board-certified dermatologist Shari Marchbein, MD, explains, is “a generic term used to describe a substance injected into the skin to help add volume and structure.” It typically falls into two main categories: hyaluronic acid–based fillers and biostimulatory fillers. Hyaluronic acid fillers (think Juvederm or Restylane) work much like hyaluronic acid does in topical skincare products—it attracts and holds 1,000 times its weight in water and provides a plumping effect. Biostimulatory fillers, Marchbein explains, “act as the scaffold or building blocks for the body to enhance its own collagen production.” Sculptra and Radiesse are examples, and even though they both help with collagen, they work differently.

How Can It Help Acne Scars?

When it comes to acne scars, Cambridge-based, board-certified dermatologist Ranella Hirsch likes to compare the process to slipcovers on sofas. “Certain types of acne scars yield dead space, and filler can help fill that space and allow the overlying skin to drape more smoothly. An analogy I often use with patients,” she says, “is to think of the skin like a slipcover on a sofa. If the underlying tissue isn’t smooth, or has deficits, the slipcover won’t lay smoothly. By using the soft tissue filler, much like restuffing a flat patch of sofa, the base is smooth and thus the overlying skin (slipcover) is as well.”

Acne scarring is permanent, so while filler cannot undo it, per se, the dermatologists we spoke to all agreed that this is a recommended treatment. However, it’s also important to note that this is an off-label use for filler.

Filler is a generally safe procedure—when done by a qualified practitioner. “When we inject fillers, we replace the lost HA in our body, and since it is a naturally occurring substance, the chance of an allergic reaction is highly unlikely,” says New York City–based, board-certified dermatologist Dendy Engelman, MD, who notes that she has never seen one in over 15 years of injecting. That said, when it is not done by an experienced, qualified injector, there can be serious risks—so it’s key to see a trusted, board-certified physician.

Skilled injectors use a number of different techniques, and choose both their technique and the actual filler used based on the patient’s circumstances and needs. Marchbein typically uses a “microdroplet technique where a very small amount of filler is placed under the scar.” This, she explains, gives “immediate cosmetic improvement with virtually no downtime (although there is some mild swelling, redness, and the potential for bruising).”

The other common technique is subcision, a minimally invasive procedure that punctures the scar to break up the fibrous bands that form the scar tissue, which, Marchbein explains, “works best for rolling or boxcar scars, and should not be used on someone with a sensitivity or allergy to hyaluronic acid filler.”

Is This a Permanent Solution?

“There is some maintenance with repeat injections, typically every 6–12 months,” Marchbein says, though she notes that hyaluronic acid fillers also help stimulate new collagen formation, and so she finds that “patients can often go years between touch-ups after initial correction of their scarring.” Finally, she recommends that patients who undergo filler for acne scarring use products with topical retinoids and peptides, as these further help stimulate collagen.

Is There Any Downtime?

Not really. Filler can cause some bruising and swelling, although this can usually be covered with makeup. But Marchbein advises patients that there may be some minimal downtime following the procedure.