When the Patient Makes Their Own Filler
Imagine a patient walks into your clinic and says, "I've been making my own hyaluronic acid in the basement, but I'm sick of doing it—will you take over?" You'd have to pause, because the truth is, you have no idea what's actually in their skin. That kind of uncertainty is a nightmare for any injector. It's a vivid reminder that choosing the right filler—and knowing what's already there—is far more complex than simply picking a brand off a shelf.
We recently gathered data from over 2,100 injectors across 52 countries to understand the global landscape of filler preferences. The results were revealing, and they point to a deeper truth: the decision of which filler to use is rarely based on pure science. Instead, it's shaped by experience, geography, and the subtle trade-offs between safety, longevity, and how the product handles in your hands.
The World's Most Popular Fillers: Who's Using What?
Our survey asked one simple question: "Which is your favorite filler?" The answers came in from every corner of the globe, with the UK contributing 60% of responses. We cut off at 1% popularity to focus on the most significant players. Here's how the breakdown looked:
- Radiesse – the only non-hyaluronic acid filler on the list, starting at the 1% cutoff.
- Versa – 2% of respondents.
- Stylage – 4%.
- Belatero – 6%.
- Teoxane (RHA) – 10%.
- Galderma (Restylane) – 16%.
- Merz (Belotero, Radiesse, etc.) – 17%.
- Then Allergan as a whole took 30%—split into Juvederm Ultra at 10% and the Vycross range at 20%.
So the most popular filler by volume in our survey was the Vycross range from Allergan. But popularity isn't the whole story. When we looked at how much volume each brand was being used per week, some interesting patterns emerged. Versa, for example, was a niche product overall, but the clinics that used it were injecting in huge volumes. That suggests it fills a specific role—perhaps more in the North American market than in Europe, where Allergan dominates.
Volume and Experience: The Big Accounts Stick with Big Brands
It's no surprise that the biggest accounts—those buying 5,000 to 10,000 ml of filler per month—were almost exclusively with the major brands: Allergan, Galderma, Teoxane, and Merz. Is that a rational choice, or is it driven by sales support, familiarity, or cost? Probably a mix of all three. But it highlights a crucial point: the advice you get on forums often comes from people injecting less than 10 ml per month. That doesn't make their advice wrong, but it means their experience is limited to the immediate injection day—how does it feel to push through the syringe, and do the lips look right? The real test is what happens months and years later.
How to Choose a Filler When the Data Is Missing
Ideally, you'd have a table comparing every filler property: cohesivity, G' (elastic modulus), reaction rates, longevity, ease of reversal. You'd pick the safest, most effective, longest-lasting, most predictable product. But we are miles away from that. G' is often quoted as a desirable feature, but we only know what it is in a test tube—in the tissues, the interaction between molecules and the body completely changes the product's behavior. So we fall back on experience. You know that when you inject a certain amount of a particular product, it projects in a way you like. That's not science, but it's real.
If you're thinking about safety, the questions become more concrete. First, is it dissolvable? Can you get it out quickly if needed? Second, does it aspirate well? Some products never let you see blood no matter how long you pull back. Third, how much hyaluronidase does it take to dissolve each filler? We don't have that data. And there's always a trade-off: a product that creates sharp definition usually can't create as much volume, and vice versa. You never get one factor without paying somewhere else.
Then there's the patient's perspective: cost, longevity, and the way the filler settles over time. And for the clinician, the injection experience matters enormously. Some syringes require you to push so hard that nothing comes out, then suddenly the product bursts forward. That unpredictability is intolerable for sculpting—even if the filler were perfect in every other way, you can't use it.
Mixing Fillers: A Practical and Ethical Dilemma
You'll hear different opinions on whether you can mix fillers in the same patient. There's no data to say it's a problem. Most fillers are hyaluronic acid, and even if they're not, the chemical reaction between them is unlikely. So out of first principles, it's probably safe. Some insurance companies recommend waiting a certain number of months, but we know from ultrasound studies that fillers often remain in the skin for three years or more. If you insisted on a clean slate every time, you'd never treat a patient who had previous work. That's not practical for most of us.
The real risk comes when you don't know what's in the patient's skin. If someone has been injecting themselves with powder they bought online—not even medical-grade—you have no idea what you're dealing with. You could get a reactive process that causes permanent nodules months later. In that case, you'd be lost. So it's reasonable to mix products from reputable clinics, but it's a different realm of risk when you're mixing different categories—like Radiesse (calcium hydroxylapatite) or Sculptra (poly-L-lactic acid) with hyaluronic acid. Those reactions can be harder to solve, especially if they cause permanent nodules.
The Vaccine Connection: Why We Need Data on Reactivity
The COVID-19 vaccine brought this issue to the forefront. Three people in the initial vaccine trial had dermal filler reactions, but we had no idea how many others in the trial had filler, what type it was, or their medical history. That's a massive gap in knowledge. So we launched a survey to try to fill it. Our goal is to measure the proportion of different fillers that react when a large number of people are exposed to an inflammatory stimulus (the vaccine) at a set point in time. We need your help—link in the description.
What factors affect reactions to filler? Inflammatory states are the key drivers. Autoimmune disease, allergies, dental work (which causes a temporary bacteremia), viral infections, and yes, vaccines—all can trigger a response. But the filler itself matters too. Short-chain hyaluronic acid is pro-inflammatory, while long-chain is anti-inflammatory. The way the filler is cross-linked (BDDE, Vycross, NASHA technologies) and even the purity of the product (bacterial cell wall remnants) could influence reactivity. It's unlikely we'll find one filler that's 100 times more reactive than another, but small differences matter. We need to tease apart the filler-specific risk from the patient-specific risk.
A Call to Action
If you're an injector, please click the link below and register your interest for the next wave of our survey. The more data we gather, the closer we get to understanding which fillers are safest in the context of vaccine-induced inflammation—and which factors we can control. Together, we can turn anecdote into evidence. Let's build that table of filler characteristics that we all wish existed. Because the next time a patient asks you to inject them, you want to know exactly what's in their skin, and what might happen next.