The FDA’s position is that having filler injected is a medical procedure and should not be thought of as a cosmetic treatment (FDA). A dermal filler is a gel or suspension placed under the skin. It smooths wrinkles and folds, or adds volume to the lips, cheeks, chin and backs of the hands (FDA). So this page gives the published safety data and the Texas rules on who may inject as much room as the materials, the FDA-approved brands and Austin pricing.
The materials
What dermal fillers are made of
Most fillers are temporary, because the body absorbs them over time. Only one product made from a material that remains in the body has FDA approval (FDA). Fillers come in four material types.
Hyaluronic acid (HA) is a sugar that occurs naturally in skin and cartilage. In gel form it holds water and swells, and that swelling fills the treated area. Some HA is chemically cross-linked so it lasts longer. The FDA puts its general duration at about 6–12 months (FDA). Certain products outlast that in certain areas. Among patients followed in the Juvéderm Voluma XC cheek study, 67.1% still had an improvement of 1 point or more at 24 months (Allergan’s Voluma XC directions). An injected enzyme, hyaluronidase, splits hyaluronic acid and so can break HA filler down (Hylenex label).
Calcium hydroxylapatite (CaHA) is the material in Radiesse. It is a mineral that also occurs in teeth and bone, and it is injected as particles in a gel. The FDA gives about 18 months for how long it lasts, and notes that it is visible on x-rays and may hide the tissue underneath (FDA).
Poly-L-lactic acid (PLLA) is the material in Sculptra, a biodegradable man-made polymer. It is injected as a series of treatments over several months. According to the FDA, the effect builds over several weeks and can last up to 2 years (FDA). A 2022 review calls PLLA and CaHA biostimulatory fillers, ones that bring about new collagen through a controlled foreign-body reaction (Haddad 2022 review).
Polymethylmethacrylate (PMMA) is the material in Bellafill. It is made of tiny beads the body never absorbs, suspended in a gel containing collagen from cows (bovine) (FDA). For that reason, the FDA says allergy testing should come first with products made from animal-derived materials, bovine collagen being one example (FDA).
Hyaluronidase acts on hyaluronic acid, so it cannot dissolve CaHA, PLLA or PMMA. Per the FDA, removal can be hard or even impossible, notably for permanent fillers and any filler not made of a material like HA (FDA).
Brands
Filler brands the FDA has approved
Each dermal filler goes through FDA premarket approval (PMA) as its own product, and the approval names the areas and uses it covers (FDA). The dates below are taken from the FDA’s PMA database. Before treatment, ask which product your injector plans to use and what the FDA approved it for.
HA filler families
Juvéderm (Allergan holds the PMA)
- Voluma XC: approved for cheek augmentation in 2013 (FDA approval record). Chin was added in 2020 (FDA approval record) and temples in 2023 (FDA approval record).
- Volbella XC: approved for lips and lines around the mouth in 2016 (FDA approval record). Under-eye hollowing followed in 2021 (FDA approval record).
- Vollure XC: 2017, for facial wrinkles and folds (FDA approval record).
- Volux XC: 2022, for jawline definition (FDA approval record).
- SkinVive: 2023, for smoothness of the skin on the cheeks (FDA approval record).
Restylane (Q-Med AB holds the PMA). The first Restylane was approved in 2003 (FDA approval record). Approvals since then:
- Silk, for lips, 2014 (FDA approval record).
- Lyft, 2015 (FDA approval record), with the back of the hand added in 2018 (FDA approval record) and chin in 2025 (FDA approval record).
- Refyne and Defyne, 2016, for facial wrinkles and folds (FDA approval record).
- Kysse, 2020, for lips (FDA approval record).
- Defyne, 2021, for chin (FDA approval record).
- Contour, 2021, for cheeks (FDA approval record), with temples added in 2026 (FDA approval record).
- Eyelight, 2023, for under-eye hollowing (FDA approval record).
RHA Collection (Teoxane holds the PMA)
- RHA 2, 3 and 4 won approval in 2017 for dynamic facial wrinkles and folds (FDA approval record).
- RHA Redensity came in 2021, for lines around the mouth (FDA approval record).
- RHA 3 was approved for lips in 2023 (FDA approval record).
- In September 2025, RHA 4 and RHA Dynamic Volume were approved for cheek augmentation and midface contour (FDA approval record).
Belotero (Merz holds the PMA). Belotero Balance, approved in 2011, is for facial wrinkles and folds such as nasolabial folds (FDA approval record). Two more followed in 2026: Belotero Volume (+) Lidocaine for the midface in May (FDA approval record) and Belotero Intense (+) Lidocaine for lips in July (FDA approval record).
Evolysse (Symatese holds the PMA). Evolysse Smooth and Evolysse Form, approved February 2025, address dynamic facial wrinkles and folds of moderate to severe degree (FDA approval record).
saypha (Croma-Pharma holds the PMA). saypha MagIQ was approved in September 2025 for facial wrinkles and folds such as nasolabial folds (FDA approval record). saypha ChIQ followed in June 2026, for cheek augmentation and midface volume (FDA approval record).
Non-HA fillers
Radiesse (Merz holds the PMA) is calcium hydroxylapatite. Its 2006 approval covered moderate to severe facial wrinkles and folds (FDA approval record), and it is also approved for people with HIV who have lost facial fat (FDA approval record). The back of the hand came in 2015 (FDA approval record), and Radiesse (+) received approval for jawline contour in 2021 (FDA approval record).
Sculptra (Q-Med AB holds the PMA) is poly-L-lactic acid. It was first approved in 2004, to treat facial fat loss in people with HIV (FDA approval record). Sculptra Aesthetic, approved 2009, is for contour deficiencies in the nasolabial folds and other facial wrinkles, in people whose immune systems are healthy (FDA approval record).
Bellafill is PMMA. Its approvals cover nasolabial folds and, from December 2014, moderate to severe atrophic acne scars of the cheek in patients over 21 (FDA approval record).
Unapproved versions of Juvéderm have been sold in the U.S., online included. The FDA names Juvéderm Ultra 2, 3 and 4 among them and says not to use them (FDA). The FDA also advises against buying filler online, and says no needle-free device is approved to inject dermal filler (FDA).
The appointment
Treatment day and recovery
Your injector places the filler with a needle or a blunt-tip cannula. Voluma XC is one of the fillers that contains lidocaine, a numbing medicine (Allergan’s Voluma XC directions). Ask your provider how long the visit will run and how much swelling to expect.
-
Day one
During the first 24 hours, the label for Juvéderm Voluma XC advises against strenuous exercise and extensive sun or heat exposure. If the area swells, it suggests a brief ice pack (Allergan's Voluma XC directions). Whatever product you receive, follow its own instructions.
-
The weeks after
The FDA states that swelling, bruising and other side effects mostly begin soon after the injection, and many clear within days to weeks (FDA). In the Voluma XC cheek study, reactions at the treatment site lasted 2 to 4 weeks and were mostly mild or moderate. Moderate or severe reactions took a median of 6 days to resolve completely (Allergan's Voluma XC directions).
-
Months to years
The FDA's general figures are about 6–12 months for HA, about 18 months for calcium hydroxylapatite and up to 2 years for poly-L-lactic acid. PMMA is never absorbed (FDA). The FDA also notes that some side effects can appear weeks, months or years after injection (FDA).
Safety
Blocked blood vessels and vision loss
The FDA names accidental injection into a blood vessel as the most concerning risk of dermal fillers. The blockage cuts off blood flow to tissue. The FDA describes the chance as low, but says the consequences can be serious and permanent, and can include tissue death, vision problems up to blindness, and stroke (FDA).
What the data shows
- How often it occurs: The 10-year survey of 370 dermatologists covered about 1.7 million syringes. Needle injection produced 1 occlusion for every 6,410 one-milliliter syringes, and cannula injection 1 for every 40,882. For 85% of the occlusions, there were no long-term effects (Alam 2021 survey).
- Vision-loss reports: A 2024 review counted 365 published cases in which filler was followed by partial or complete loss of vision, reported from September 2018 to March 2023. The group’s two earlier reviews covered 98 cases (2015) and then 48 more (2019) (Doyon 2024 review).
- Injection sites: Across those 365 cases, the nose was the most common site (40.6%), then the forehead (27.7%) and the glabella (19.0%), the area between the brows. In 79.6% of cases the filler was HA (Doyon 2024 review).
- Outcomes: 318 of the cases had a reported outcome. Of these, 6.0% regained full vision, 25.8% improved partly and 68.2% did not recover. Partially preserved vision at onset went along with improvement. No treatment showed a significant association with improvement (Doyon 2024 review).
Warning signs
During or soon after the procedure, the FDA says to get medical help immediately for unusual pain, vision changes, or skin that looks white, gray or blue near where you were injected. The same goes for any sign of stroke: numbness or weakness of the face, arms or legs, sudden trouble speaking, trouble walking, a drooping face, severe headache, dizziness or confusion (FDA).
Hyaluronidase and emergency readiness
If the skin blanches and its normal color does not return, the Voluma XC label directs injectors to follow American Society for Dermatologic Surgery guidelines, hyaluronidase injection among them. The label also urges injectors to keep supplies immediately on hand and to name a local ophthalmologist who could be called for an eye-related event (Allergan’s Voluma XC directions). Dissolving filler with hyaluronidase is off-label. The uses the FDA has approved for it are urography and as an aid to fluid and drug absorption (Hylenex label). Radiesse, Sculptra and Bellafill are not HA, so hyaluronidase has no effect on them.
If you are considering an HA filler, ask the practice whether it stocks hyaluronidase and what it does when a vessel injection is suspected.
Newer research
Bone loss in the chin
A 2020 study compared CT scans of 80 patients who had received HA filler in the chin with scans of 80 matched controls. Chin bone was significantly thinner in the filler group. Patients given 1 mL or more per session showed more bone loss than those given less, while neither the number of injections nor the interval between them made a significant difference. The authors reported no loss in appearance. Their conclusion was that large-volume HA in the chin calls for caution, and that patients should hear about this complication before treatment (Guo 2020 study). The work was a preliminary retrospective study of Asian patients at a single hospital.
Safety
Side effects and cautions
Common risks on the FDA’s list are redness, bruising, swelling, itching, rash, pain and tenderness. Injection into the back of the hand can also make everyday activities difficult (FDA). One product’s label reports these rates:
| Reaction at the treatment site | Share of patients, Voluma XC cheek study (N = 265) |
|---|---|
| Pain | 66.4% |
| Bruising | 77.7% |
| Lumps or bumps | 81.1% |
| Firmness | 82.3% |
| Swelling | 85.7% |
| Tenderness | 92.1% |
Figures are from Allergan’s Voluma XC directions. Rates vary by product and area, so ask to see the label for the product you will receive.
Less common risks named by the FDA include inflammation near the injection site following a dental procedure, a vaccination, or a viral or bacterial illness; nodules or granulomas, which may need injections, oral antibiotics or surgical removal; infection; open or draining wounds; and allergic reaction. Rare risks reported to the FDA are anaphylactic shock, filler migrating away from the injection site, filler leaking or rupturing, permanent hard nodules, and death (FDA).
Pregnancy and breastfeeding. The FDA states that it is unknown whether dermal fillers are safe during pregnancy and breastfeeding (FDA).
Further cautions from the Voluma XC label: do not use it with a history of anaphylaxis or multiple severe allergies, or with an allergy to gram-positive bacterial proteins or to lidocaine. Put treatment off if inflammation or infection is active. Be cautious with immunosuppressive therapy. Aspirin, NSAIDs and warfarin may increase bruising or bleeding (Allergan’s Voluma XC directions).
Cost
What filler costs in Austin
The spa, the product and the number of syringes all affect the price, so ask each practice for its own. The Austin area pages on this site show the national average given here.
According to the American Society of Plastic Surgeons, hyaluronic acid fillers average $715 nationally (ASPS). Plastic surgeons supplied that number, not Austin med spas. With any quote, find out which product is included and how many syringes.
Before you book
Choosing a filler provider
The FDA recommends a licensed health care provider who has experience in dermatology or plastic surgery and is trained to inject fillers. It suggests asking about their training and how much experience they have injecting the face and hands (FDA).
Who is allowed to inject in Texas
Texas classes cosmetic injection as a nonsurgical medical cosmetic procedure (Tex. Admin. Code §169.25). The current Chapter 169 rules from the Texas Medical Board took effect January 9, 2025 (Texas Medical Board). When a physician delegates the injection, the rules require the following:
- Before the procedure, you need a practitioner-patient relationship with a physician, or with a PA or APRN working under that physician’s delegation (Tex. Admin. Code §169.26). People in the industry often say “good faith exam.” The rule never uses that term.
- Whoever injects needs training in the technique, in contraindications, and in recognizing and managing complications (Tex. Admin. Code §169.26).
- For emergency consultation, a physician, PA or APRN must be onsite or immediately available. One or more people trained in basic life support must also be there the whole time you are onsite (Tex. Admin. Code §169.26).
- A written order is needed (Tex. Admin. Code §169.27). The person doing the procedure must additionally sign and date a written protocol (Tex. Admin. Code §169.26).
- The delegating physician’s name and Texas license number have to be posted in every public area and every treatment room (Tex. Admin. Code §169.28).
An esthetician license does not allow filler injection. TDLR states that an esthetician’s facial treatments do not include injectables or fillers, and that filler services have to be provided under a licensed physician’s order and delegation (TDLR).
Texas bills from 2025
- HB 3749 concerns elective intravenous (IV) therapy. It was signed on June 20, 2025 and became effective September 1, 2025 (Texas Legislature Online). The Texas Medical Board’s Chapter 169 rules, covered above, are the ones that apply to filler injection.
- SB 378 dealt with certain practices that are prohibited for a barber or cosmetologist. The Governor vetoed it on June 2, 2025 (Texas Legislature Online).
Verifying credentials
- Physician and PA licenses: search the Texas Medical Board’s Look Up a License page. Confirm that the license is active and look for disciplinary actions.
- Board certification: ask the physician which specialty board gave the certification, then confirm with that board.
- Nurse licenses (RN and APRN): use the Texas Board of Nursing’s license verification.
Questions for your consultation
- Which filler would you recommend for my goals, does the FDA approve it for this area, and why that product?
- Who is the delegating physician, and are their name and license number posted in the office?
- Who will establish the practitioner-patient relationship with me before treatment (often called a good faith exam)?
- Does the practice keep hyaluronidase on site?
- If I develop signs of a blocked blood vessel, such as pain, skin that turns white or blue, or changes in vision, what will you do?
- How often have you performed this procedure yourself?
- Do you have before-and-after photos of your own work to show me?
- Can I read the patient labeling for the product you intend to use?
Red flags
- You cannot identify a delegating physician
- The physician’s name and license number are not posted, which Texas requires (Tex. Admin. Code §169.28)
- Treatment begins without a practitioner-patient relationship (Tex. Admin. Code §169.26)
- An esthetician does the injecting (TDLR)
- The filler was bought online, or is injected with a needle-free device (FDA)
- An HA filler treatment is offered at a practice with no hyaluronidase on site
Treatment Areas