Skip to content
Welcome to QueerDoc
Facebook Twitter Instagram Linkedin
Request Appointment
Search
Close
MENU

Plump It Up: Fillers in Gender Affirming Care

  • March 6, 2023

This article and next week’s article on hair are the last ones planned in our series on gender affirming surgeries and procedures. We started with general prep for bottom surgeries in October, wrote about a different surgery or procedure each week, and we’re ending up here: all about using fillers in gender affirming ways. Next week we’ll finish up the series with treatments to encourage or discourage hair growth.

Content advisory: we will use anatomical terms and discuss clinical procedures in this article and this series. External sites that we link to may contain graphic images.

What Are Fillers?

Fillers are injectable substances that add volume to body tissues. Some fillers create volume just by themselves. Some encourage the body to create new collagen. Some do both of these things.

But first, what’s collagen?

Collagen is a protein and one of the main building blocks in the body. It’s like a fiber, and is mainly used by the body to create structure and support within the body. It surrounds organs and holds them in place (fascia,) helps blood to clot (fibrin,) provides structure and elasticity to skin and blood vessels, and helps new cells, especially skin cells, grow. It also forms connective tissues like ligaments and tendons and helps keep cartilage supple and resilient in joints.

A very common application of fillers is to smooth out wrinkles in the face and neck from the inside. Wrinkles form when collagen in the skin starts to wear after repeated use (like smile lines and forehead creases) or from age, or when the body doesn’t replace it as quickly as it once did. All fillers can cause nodules (little bumps) to form where they are injected. Most can be dissolved, removed, or broken up with massage.

What types of fillers are available?

Fillers that add volume:

  • Collagen! Human, cow (bovine,) and pig (porcine) collagen are used to supplement already existing collagen in tissues.
    • Bovine and porcine collagen may re-absorb more slowly than collagen from human cells.
    • May last a few months to up to a year.
    • Some people are allergic to bovine collagen
Collagen dermal filler derived from human collagen (CosmoDerm) used in gender affirming care.
Collagen dermal filler derived from cows (Zyderm) used in gender affirming care.
Collagen dermal filler derived from cows (Zyplast) used in gender affirming care.
Collagen dermal filler derived from pigs (Therafill) used in gender affirming care.
  • Lipofilling! Fat is often used in body contouring, where fat from one part of the body is removed and used to add volume to another part of the body. It can also be used for facial changes.
    • It’s your own tissue, so very low risk of allergic reactions
    • About half of the fat is reabsorbed, and half stays in the new location.
  • Hyaluronic acid (HLA)
    • you already have HLA in your body! It’s found in skin, joint fluid, cartilage, and connective tissue
      • low likelihood of allergic reactions
    • may be particles suspended in a gel or a gel without particles
    • may last up to 18 months
    • has been tested in individuals with darker skin
      • does not cause keloid scar formation, hypersensitivity, or loss of pigmentation (light spots)
      • may cause mild hyperpigmentation (dark spots)
    • reversible with injection of hyaluronidase

Hyaluronic acid  (HLA) fillers used in gender affirming care (Belotero, Elevess, Juvederm, Prevelle Silk, and Revance).

Fillers that encourage the body to create new collagen:

  • LaViv (autologous fibroblasts – a type of collagen that is sourced from your own body)
    • now that’s a mouthful!
    • lasts 6+ months
    • this technique uses a sample of your skin from behind your ear to grow more of your own collagen
    • this biologically-matched collagen is injected and encourages new collagen formation
    • requires punch biopsies followed by three to six months of lab time
    • may require multiple injections spaced three to four weeks apart
    • minimal testing in individuals with darker skin (test group was 92% white)
      • not advised for individuals prone to keloid scarring
    • not recommended for individuals with collagen disorders such as Ehlers-Danlos

Fillers that do both

  • calcium hydroxyapatite (CaHA)
    • semi-permanent (12 – 18 months)
    • synthetic bone microspheres in a cellulose carrier gel
      • new collagen forms around the microspheres
      • the gel is absorbed by the body and the microspherers slowly break down
    • if nodules form, they can be reduced with massage or treatment to reduce new collagen formation
Calcium hydroxyapatite (CaHA) dermal filler used in gender affirming care (Radiesse)
  • polymethyl methacrylate (PMMA)
    • first used as a biocompatible cement
    • microspheres in a bovine collagen base
      • carrier gel is absorbed in 1-3 months
      • microspheres are foundation for new collagen formation
    • requires sensitivity testing
    • mulitple treatments spaced four weeks apart may be needed
    • nodules may be treated with steroids or surgical removal
Polymethylmethacrylate (PMMA) dermal filler used in gender affirming care (Bellafill)
  • Poly-L-lactate acid (PLLA)
    • commonly used in absorbable sutures
    • triggers a response from the body to build collagen in the injected area
    • results can last for several years
    • may require multiple sessions spaced four to eight weeks apart
    • requires massage to the treated area to prevent nodules
      • if nodules form, they can be removed or treated
Poly-L-lactate acid (PLLA) dermal filler used in gender affirming care (Sculptra)
  • silicone
    • is approved to treat retinal bleeds or retinal detachment
    • is not approved for facial injection in the USA
    • causes a local inflammatory response
    • may cause complications years after use
      • surgical removal only

How are these used in gender affirming care?

The charts and images in our facial surgeries and Botox articles may be helpful in visualizing how and where fillers are used. If you are considering facial surgery in the future but want to use fillers in the meanwhile, many surgeons recommend that you get temporary fillers like collagen and HLA or dissolvable ones so that they are not present for your surgery.

For those wishing to soften their face, fillers can be used to:

  • Fill in dips in the forehead to create a smooth rounded contour
  • Add volume to the temples
  • Smooth out the brow line
  • Raise the arch of the eyebrow
  • Enhance cheekbone height and prominence
  • Fill in a chin cleft
  • Soften and round out angles in a squarer chin
  • Increase lip volume
  • Decrease wrinkles around the mouth
  • Increase fullness in any areas that cause dysphoria

For individuals who want to emphasize angles or have a squarer face:

  • Add bulk and height to the brow line
  • Broaden cheekbone width and decrease the prominence of “cheek apples”
  • Broaden the length of the nose
  • Broaden the tip of the nose
  • Add a bump to the nose
  • Emphasise the dip between forehead and nose
  • Emphasize the angle between the base of the nose and the lip
  • Add volume to the lower lip so the upper lip appears smaller
  • Add squareness and prominence to the jaw and chin
  • Add volume to the tracheal area

The When: Prep and Recovery

Fillers can be done in a dermatologist’s (or ophthalmologist’s) office and procedures often take an hour or less. There’s no hospital stay needed. You may be able to have fillers done on the same day as your consultation, and return to your normal activities after your injections, although you’ll likely be advised to stay away from intense activity for the first one to two days.

Swelling, redness, and bruising at the injection sites are common. The site may look like too much product has been added at first, as some of it may reabsorb, and you may have local swelling. Depending on the filler used, you may be advised to massage the area or to leave it alone for a few days. You may experience stinging or burning at the injection site. Cold compresses for a few minutes at a time can help with discomfort and swelling. You may be instructed not to wash the injection site for 24 hours and not to wear any products like moisturizer or makeup for a few days.

The How: Insurance

Most insurance policies will not cover what they deem to be a “cosmetic” procedure. It’’s possible, but unlikely right now, that insurance will cover gender affirming fillers. However, the current WPATH Standards of Care (SOC 8) include lipofilling and lip augmentation in their list of gender affirming surgical procedures (Appendix E.) Your insurance may have already added fillers to their gender dysphoria treatment policies. Depending on your spoons and finances, the prior authorization and approval process might be worth it.

The Who: Finding a Provider

Most dermatologists offer filler procedures. We recommend going to a provider with experience in transgender affriming care, as the techniques and volumes of filler used may differ from cisgender care. Referrals and recommendations from others in your community are invaluable.

The following directories can also help:
WPATH
OutCareHealth
MyTransHealth


Accessed Articles

Lee JC, Lorenc ZP. Synthetic Fillers for Facial Rejuvenation. Clin Plast Surg. 2016 Jul;43(3):497-503. doi: 10.1016/j.cps.2016.03.002. PMID: 27363763.


Theda C. Kontis.Contemporary Review of Injectable Facial Fillers.JAMA Facial Plastic Surgery.Jan 2013.58-64.http://doi.org/10.1001/jamafacial.2013.337


Viscomi B. From Anatomical Modifications to Skin Quality: Case Series of Botulinum Toxin and Facial Fillers for Facial Feminization in Transgender Women. Clin Cosmet Investig Dermatol. 2022 Jul 14;15:1333-1345. doi: 10.2147/CCID.S363882. PMID: 35860607; PMCID: PMC9293247.


De Boulle K, Furuyama N, Heydenrych I, Keaney T, Rivkin A, Wong V, Silberberg M. Considerations for the Use of Minimally Invasive Aesthetic Procedures for Facial Remodeling in Transgender Individuals. Clin Cosmet Investig Dermatol. 2021 May 13;14:513-525. doi: 10.2147/CCID.S304032. PMID: 34012284; PMCID: PMC8128506.

Ascha M, Swanson MA, Massie JP, Evans MW, Chambers C, Ginsberg BA, Gatherwright J, Satterwhite T, Morrison SD, Gougoutas AJ. Nonsurgical Management of Facial Masculinization and Feminization. Aesthet Surg J. 2019 Apr 8;39(5):NP123-NP137. doi: 10.1093/asj/sjy253. PMID: 30383180.

Medical and aesthetic procedural dermatology recommendations for transgender patients undergoing transition
Dhingra, Nikhil et al. Journal of the American Academy of Dermatology, Volume 80, Issue 6, 1712 – 1721

https://www.webmd.com/beauty/collagen-injections#

https://www.realself.com/nonsurgical/collagen-injection

https://my.clevelandclinic.org/health/articles/23089-collagen

LaViv Prescribing Information: https://www.fda.gov/media/80838/download


Stay in Touch With QueerDoc!

*** Disclaimer

This blog is for entertainment, informational, and general educational purposes only and should not be considered to be healthcare advice or medical diagnosis, treatment or prescribing. The Content is not intended to be a substitute for professional medical care. Always seek the advice of your qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Share This Post

More To Explore

Tips and Resources for Doing Advocacy Against Legislative Youth Care Bans

03/25/2023

Telemedicine Prescribing of Controlled Substances- DEA Docket 407 Advocacy Resources

03/25/2023

Taking a Resiliency Break – See Ya On 4/10/23

03/20/2023

An Urgent Letter To Our Florida Families

03/16/2023

Request a free 15-minute introductory
appointment to find out more!

Request Appointment

What our amazing clients say

We are getting a lot of love!

Progress Pride flag colors in a stripe, LGBTQ+, trans flag
I just had an appointment with queerdoc and it was amazing. I was using another telehealth company and queerdoc was much more individualized. The doctor actually took about 4 hours after our initial visit which was about an hour, to give me an individualized treatment plan. Answered all my questions throughout. Explaied why the treatment most likely didn't work the way I wanted it to with the last place I was with. I also like that the actual prescriptions are through whatever pharmacy you want to use, not just you have to pay us this no if and or buts. They also wrote me a letter of support for laser hair removal as hrt won't necessarily "stop" the hair growth. Also I l love that it's a sliding scale so you pay what you can afford within their set prices.
u/lillyABDLmtf
u/lillyABDLmtfReddit
I couldn't have felt happier and I'm finally able to start being the person I've always been meant to be after 27 years. Thanks to Dr. Lin-Fan Wang MD, she helped ease my everything during the process and I highly recommend her and she's accepting new patients. But practices only in certain states and does telehealth for it via ( https://queerdoc.com/ ). Very good service and no gatekeeping (https://www.reddit.com/r/MtF/comments/wn6tb8/can_officially_say_i_started_my_medical/)
Redditor
RedditorReddit
They have Very thorough information. They were very understanding and even found a translator for my guardian. They care and They can help.
Anonymous
AnonymousEmail
Process was super quick, easy, and I felt extremely comfortable. I met with Dr. Wang and after discussing all of my options I had my prescription the same day less than two hours later. Especially in light of certain socio-political difficulties we are currently facing I cannot recommend QueerDoc enough!
Fae
FaeEmail
Hello, my name is Zoey and I'm a psychology undergrad attending the University of Wyoming. I've been receiving care from QueerDoc for the past few months, and it has hands-down been the best experience I've ever had with any organization. Growing up, it always seemed like getting HRT was an unattainable goal for me and it's been like magic to get a prescription without being dragged around by paperwork and red tape.
Zoey
ZoeyQueerDoc Patient
Excellent treatment, thorough information, great experience overall
 Gunnar Gill
Gunnar GillGoogle Reviewer
They can help
Iris Luna
Iris LunaGoogle Reviewer
Dr. Beal is empathetic, knowledgeable, responsive, and enthusiastic about helping their patients. I would recommend them to anyone!
QueerDoc Patient
QueerDoc PatientHealthgrades Reviewer
Crystal is a very good HRT doctor. She provides plenty of options for types of estrogen and T blockers instead of just spiro to suit people's wants and needs. She was very friendly when she talked to me and my family and I felt comfortable communicating with her about everything. Highly recommend her if you want treatment that is more personal and flexible to your needs :)
Miss Mario
Miss MarioHealthgrades Reviewer
I am feeling very hopeful, safe and excited about this option and just want to let you know how grateful I am for your assistance and your research.
QueerDoc Care Navigation Client
QueerDoc Care Navigation ClientMoon
Amazing bedside manor. Doctor bell made me feel heard and seen. I felt entirely comfortable disclosing information that normally I'd be apprehensive about sharing. I've never had a doctor talk smack about capitalism ever, and I truly felt seen when she did that. Thanks for everything doctor.
5 Star Reviewer
5 Star Reviewerat Sharecare.com
Dr. Beal does telehealth visits, which were extremely convenient before this pandemic and are now a necessity. This is especially helpful in that nothing about the appointment process was interrupted or changed by the pandemic. Dr. Beal is friendly, attentive, and well organized. Even between appointments, if I need to get something clarified or resolved, I get a timely response via the secure messaging system attached to the appointment portal. I always feel good about these visits.
QueerDoc Patient
QueerDoc PatientHealthgrades Reviewer
Great Medical services from the safety of your own home!
Reviewer
ReviewerFacebook
Entirely professional, usage of telehealth was convenient for me, and they helped me, and continue to help me figure out a dosage and regime of medications that have massively improved my life. I cannot be more grateful.
QueerDoc Patient
QueerDoc PatientHealthgrades Reviewer
Very warm, welcoming and very attentive to my needs. Gave me choices and a chance to give input with regards my treatment.
QueerDoc Patient
QueerDoc PatientHealthgrades Reviewer
Dr Beal guided me through my gender reaffirming journey in a safe, informed, and compassionate manner.. I just can't thank them enough !!
QueerDoc Patient
QueerDoc PatientHealthgrades Reviewer
I'm so beyond happy someone told me about you. I think I've said this to you before, but I had given in. I had decided I was just going to suppress and hide my true self the rest of my life. I can't believe I held back all these years! Owning who you are and being yourself is one of the best things a person can do! I'm so happy! There are not words to convey it properly other than, thank you.
Philip
PhilipQueerDoc Patient

Support our gender diverse community in our often uphill battle for equitable access to affirming Healthcare.

TransFamily Support Services and QueerDoc have partnered together to create a scholarship fund!

DONATE NOW
QueerDoc Logo
  • (541) 604-8276
  • (352) 553-4934
  • info@queerdoc.com
Get Social With Us
Facebook Twitter Instagram Linkedin
featured IN
WPATH 2023 Badge
Talk to Us

© 2023 QueerDoc • All rights reserved | Cookies

d&d by mobian

Manage Cookie Consent
We use cookies to enhance your browsing experience, serve personalized ads or content, and analyze our traffic. By clicking "Accept", you consent to our use of cookies.
Functional Always active
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
Preferences
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
Statistics
The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
Marketing
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.
Manage options Manage services Manage vendors Read more about these purposes
View preferences
{title} {title} {title}
Main Menu
  • What we do
    • Telemedicine Services
    • Provider Education
    • Organizational Services
  • Who we are
    • Meet the Team
    • Work with Us
  • How It Works
    • Getting Started
    • Before Your Visit
    • All The E
    • All The T
    • All the NB (non-binary, genderqueer, gender fluid…)
    • Self-Injections
    • Patient Forms
  • Pricing
    • Our Pricing
    • Scholarship Based Care
  • Resources
    • Articles
    • Youth Gender Care
    • Gender Expression Resources
    • Gender Affirming Surgery
    • Legal Transition Consult
    • Gender Care Navigation
    • Insurance Dictionary
    • Pharmacies
    • Video Library
    • Virtual Resources
    • Virtual Communities and Support Groups
    • State Based LGBTQ+ Resources
  • Portal
Open toolbar Accessibility Tools

Accessibility Tools

  • Increase TextIncrease Text
  • Decrease TextDecrease Text
  • GrayscaleGrayscale
  • High ContrastHigh Contrast
  • Negative ContrastNegative Contrast
  • Light BackgroundLight Background
  • Links UnderlineLinks Underline
  • Readable FontReadable Font
  • Reset Reset