Dermal Fillers



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In the hands of a trained and experienced professional, dermal fillers are an extremely versatile aesthetic treatment. Dr. Nirmal Nathan uses cosmetic fillers to help patients in the Miami, FL area maintain and regain youthful facial contours.


You may hear dermal fillers referred to as skin fillers, soft tissue fillers, wrinkle fillers, or injectable fillers. All these terms refer to gel-type substances precisely placed into various layers of the skin’s structure. Fillers serve a dual purpose. First, they add immediate volume, thus smoothing the surface of skin. Second, because the body recognizes filler as introduction of a foreign body, treatment stimulates production of fresh collagen – a natural healing response. Over time that makes skin thicker and firmer from within.

Fillers generally fall into basic categories based on their primary chemical composition. There are several reputable brands of FDA-approved fillers, and multiple viscosities (thicknesses) within each brand family.

Hyaluronic acid is a compound produced by the human body. Its molecules have the unique ability to bind with water, providing lubrication for joints, structure for eyeballs, and internal hydration for skin. The HA in fillers used by Dr. Nathan, however, does not come from animals. It synthesized from non-animal sources in a sterile, clinical laboratory environment. Since HA occurs naturally, there is very low risk of allergic reaction.

Fillers compounded with HA include the popular brand names Juvéderm, Restylane, and Belotero. Some varieties (Juvéderm Voluma and Restylane Lyft) are deep tissue face fillers with a thick consistency for maximum volumization in cheek areas. Belotero is thinner, ideal for soft, even correction in delicate skin around the mouth.  Juvéderm Volbella, Restylane Refyne and Restylane Silk provide smooth and natural lip augmentation. HA fillers deliver correction right away, and some will also absorb providing additional volumunization. Over time, HA fillers can also promote collagen stimulation. Hyaluronic acid fillers can be infused with lidocaine, a local numbing agent, for more comfortable filler injections. Dr. Nathan has performed thousands of injections, and has unparalleled knowledge of anatomy to ensure your comfort and desired results.

Poly-L-lactic acid is a non-toxic, biodegradable synthetic substance. For many years it has been used in the medical community as dissolving sutures. Polylactic acid is the key component of the Sculptra Aesthetic filler. While Sculptra provides minimal immediate correction, it is a collagen-stimulating powerhouse. With a series of injections (usually three, spaced about a six weeks apart), lines and wrinkles smooth out as collagen builds over a period of several months. Since improvement comes from your body’s own collagen, results last about two years.

Radiesse is a water-based gel filler with an active ingredient: calcium hydroxylapatite. Tiny spheres of calcium add extra volume to this product to fill deep wrinkles, while encouraging collagen remodeling. Since calcium is a natural substance, it is gradually absorbed by the body, but the firm meshwork of new collagen remains, keeping skin taut and smooth. This filler is also approved by the FDA for correction of volume loss in backs of hands.

Collagen fillers are made from purified animal proteins. This technique was widely-used a decade or so ago, but being directly animal-sourced it carried some additional allergy risk. Improved methods of processing bovine collagen have made this type of filler safer, and results are natural-looking. However, the body can metabolize injected collagen rather quickly. With so many terrific synthetic alternatives available today, collagen injections are rarely used by  most reputable injectors.

Bellafill contains PMMA (polymethyl-methacrylate microspheres), a biocompatible material utilized in fabricating surgical implants. PMMA filler is sometimes used to flatten pitted scars. Other options include Aquamid, made with polyalkylimide, and various silicone products that are NOT approved by the FDA.

Fillers continue to evolve, with new formulations providing improved longevity. However, periodic re-treatment is necessary to maintain correction. In some cases, semi-permanent and permanent fillers can be a longer-lasting alternative. However, this is a major commitment that requires careful consideration. Plastic surgeons such as Dr. Nathan are master injectors and uniquely qualified to provide injectable treatments. Their real life experience performing surgery gives them extensive anatomical knowledge and technical skill than non-surgeon injectors cannot provide. If you are seeking longer-term wrinkle correction, or more improvement than may be accomplished with injectable fillers, please talk with Dr. Nathan about the benefits of cosmetic facelift surgery instead.


Some wrinkles occur when skin is pulled together as underlying muscles contract from repeated facial expressions. Those are usually on the top third of the face – forehead, between the eyebrows, and at corners of the eyes. Injectable neuromodulators (Botox, Dysport, and Xeomin) are the appropriate treatment for these dynamic wrinkles.

Most wrinkles on the lower two-thirds of the face are the result of volume loss. Usually beginning in our 30s, we start to lose fat pads. These fat pads (along with muscle and bone mass that is also diminishing) soften facial contours and provide a scaffold for skin.


  • Apples of cheeks begin to disappear
  • Hollows form at temples
  • Planes of the face become more angular and harsh
  • Lips thin and roll inward
  • Skin sags downward, causing jowling and a square facial shape
  • Ends of the mouth pull down
  • Wrinkles form from sides of the nose to corners of the mouth
  • Marionette lines develop from corners of the mouth toward the chin
  • The profile becomes blurred
  • Neck skin looks looser, and contributes to double chin

Dr. Nathan begins with a careful assessment of your skin quality and degree of volume loss. He designs an individualized strategy to address your concerns. Using a combination of the best fillers for face, lip fillers, and under eye filler, he can dramatically improve appearance, without surgery.

Because injectables at The Nathan Clinic are highly customized, the treatment plan varies depending on your specific needs. However, in general terms, a dermal filler injection session takes an hour or less and is well-tolerated. There is little or no downtime, so you may return to work or other activities after your appointment. As discussed above, you see the improvement from many fillers right away, and continued benefit as collagen builds. Depending on the product and area of injection, results last several months to a few years, and are easily maintained with periodic re-treatment.

Dermal fillers also work well with other skin rejuvenation techniques – both minimally-invasive (such as Botox, Kybella, and laser therapies) and surgical.

Dr. Nirmal Nathan is a skilled plastic surgeon in Miami, Florida. He received his medical degree through the Honors Program in Medicine at the University of Miami. Dr. Nathan is among the most sought after plastic surgeons in Miami due to his expansive knowledge, skill and method of treating patients. In his practice, The Nathan Clinic Plastic Surgery and Aesthetics, he provides the excellence that comes from experience.


Today we see a growing trend toward “prejuvenation.” Savvy men and women are choosing to preserve their youthful complexions, rather than waiting until the face ages and taking corrective measures. It starts with sun protection every day, and a good daily skin care regimen. Then, a sensible program of injectable neuromodulators, facial dermal fillers, and lip plumping injections, beginning in their 20s, 30s, or 40s, helps to prevent wrinkles from forming.

Your face is a unique work of art. It deserves the touch of a true artist, experienced in a wide range of dermal fillers. Call The Nathan Clinic in Miami, FL at (305) 530-8880 to consult with Dr. Nathan.


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