Background: Dermal fillers have gained global popularity due to their perceived safety and cosmetic advantages over more invasive procedures. Still, we know little about how hormones are used and how effective or safe they are for people with a variety of gender identities in Pakistan. This study aimed to evaluate the clinical characteristics, aesthetic outcomes, complication rates, and patient satisfaction associated with dermal filler use among individuals seeking aesthetic enhancement in Swat, Pakistan.
Methodology: This case series study involved a combination of retrospective data review and an ongoing observational analysis of 120 patients who had undergone dermal filler treatments. Data collected included patient demographics, such as age and gender, type of filler used, treatment area, reported complications, satisfaction levels (measured on a 5-point scale), and the duration of visible results. Statistical analysis, including chi-square testing, was used to identify significant associations between the type of filler material and the occurrence of complications.
Results: Approximately 21.7% of participants were identified as transgender. Hyaluronic acid was the most commonly used filler (70%), particularly for lip and nasolabial fold enhancements. Complications occurred in 24.2% of cases, most commonly mild bruising or swelling. A significant association was found between hyaluronic acid and complications (p = 0.038). Overall satisfaction was high, with 83.4% of patients expressing contentment with their results. Poly-L-lactic acid provided the longest-lasting outcomes, averaging 14.2 months.
Conclusion: There is minimal risk involved, and dermal fillers yield good results with few side effects. Having a variety of gender identities among staff and selecting proven treatment options has a big effect on results.

Dermal fillers, Aesthetic procedures, Patient satisfaction, Complications, Hyaluronic acid, Transgender health, Facial aesthetics.

Dermal fillers are injected into the skin or its surrounding tissues to add volume, reduce wrinkles, enhance facial features, and rejuvenate older sections of the face. For instance, hyaluronic acid (HA), calcium hydroxylapatite, poly-L-lactic acid, and polymethylmethacrylate are all classified as these agents. [1] It is a field of medicine that focuses on enhancing a person’s appearance through gentle medical procedures.[2]  Safety concerns encompass potential side effects and complications associated with the procedure. Efficacy is measured by how well the fillers enhance your appearance, and long-term effects cover the durability and potential late symptoms of the procedure.[3] As more people become interested in non-surgical enhancements, it is essential to prioritize the long-term safety of dermal fillers.[4]

Dermal filler procedures are increasing at a remarkable rate internationally. Recent data from the International society of aesthetic plastic surgery (ISAPS) shows that over 5 million procedures using fillers were carried out worldwide in 2023, following only botulinum toxin injections as the top non-surgical cosmetic option.[5] The popularity of aesthetic medicine has reached cities such as Karachi, Lahore, and Islamabad in Pakistan, and dermatology clinics are now commonly providing dermal fillers to patients.[6] Increasingly, aesthetic treatments are being used by people of all ages and genders, so it is essential to examine their clinical effects more closely. Furthermore, thanks to greater exposure to social media and shifts in beauty standards, these procedures are now more accepted by a variety of age groups.[7]

Dermal fillers are commonly used, but they still have some risks. Some side effects may occur immediately after injection, including bruising, swelling, or pain. Severe symptoms, such as blocked blood vessels, the development of granulomas, and later swelling, may also occur.[8] Although they are infrequent, these side effects can negatively impact the satisfaction of both patients and doctors with the treatment. Undoubtedly, unstandardized training and irregular practices in certain locations have raised safety concerns, particularly in regions where the practice of aesthetic medicine is not well-regulated. Knowing about these risks enables practitioners and patients to make informed decisions about the best treatment together.[9]

Offering high satisfaction rates is one of the strengths of dermal fillers, which are administered properly by trained professionals. Clinical studies have found that HA-based fillers can provide natural-looking results immediately, with minimal recovery time.[10] Results from fillers can vary due to the products used, their application method, the injection site, and a person’s unique features. All these factors must be considered to gain an accurate view of the success of filler treatments.[11]

Long-term changes resulting from dermal fillers are a topic that researchers are continuing to study. HA fillers break down naturally within 6 to 18 months, but semi-permanent and permanent ones remain in your body for much longer.[12] It raises questions about the tissue’s structure, cell movement, and the risk of late complications after surgery. Also, treating patients several times over a period can cause gradual or unexpected changes, which is why following patients over a long period helps identify these outcomes.[13]

Both patient education and follow-up appointments are key to ensuring long-term safety. Complications from dermal fillers can often be avoided if the treatment is performed properly, the right patients are selected, and post-treatment care is provided.[14] It highlights the importance of working with results supported by scientific research and established guidelines in the field of aesthetic medicine. Additionally, with reversal agents such as hyaluronidase for HA, complications involving these types of fillers can sometimes be managed more effectively; nonetheless, not every filler can be treated in this manner.[15]

Because the medical world is constantly changing and fillers are being used on many different types of patients, it’s vital to thoroughly assess different types of fillers. The purpose of this study is to help fill existing information gaps by closely examining how these drugs affect safety, work, and long-term results. Reviewing evidence can lead to new recommendations for treatment, improved patient information, and higher quality in cosmetic medicine.

To evaluate dermal fillers, this study employed a descriptive case series observational design at Rashid Medical Complex in Swat. Conducted at an outstanding center for skin care, the research examined aesthetic procedures performed from April 2023 to March 2025. People who were 18 or older got dermal filler treatments. The Selection of filler type was based on the individual patient’s aesthetic goals, facial anatomy, and practitioner recommendation following consultation, and all gave their permission before enrolling. Those with only partial records, who needed reconstruction or were pregnant or lactating during surgery, were excluded. The participants were selected through purposive sampling, with 80 drawn from retrospective records and 40 from those who had signed up for the study. By dividing participants into age, gender, type of filler, and treated area groups, comparative validity was maintained. Due to this hybrid approach, the results encompass information on how patients respond both in the short term and in the long term.

Data collection procedure: Both records and ongoing follow-up were reviewed to ensure the study had complete information on dermal filler results. Information from records was collected, highlighting the filler used, the areas treated, any post-treatment issues, and the results seen in the short term. The patients who received treatment during the study were followed monthly at 1, 6, and 12 months post-treatment. To gather data, we used feedback forms completed by patients, along with checklists featuring standard scales for clinicians, as well as photographs for visual records. This study considered age, gender, filler type, the location where the treatment was carried out, and the method of injection as independent variables. The variables examined in the study included success rate (measured by patient satisfaction), surgical complications, and outcomes that lasted for weeks or months. Employing this method enabled me to analyze patient experiences and treatment through both statistical measurements and qualitative observations.

Data analysis procedure: Quantitative data were analyzed using the statistical package for the social sciences (SPSS) version 26. Demographic and clinical features were summed up using means, frequencies, and percentages. Chi-square tests were used to determine the links between the various variables studied. A p-value of <0.05 was considered statistically significant.

Demographic characteristics of participants: More than 40% of patients were in the 26–35 age group, and 18–25 years made up the next largest share, indicating that most patients were young adults. The sample consisted of 58.3% female participants, 20% males, and 21.7% who identified as transgender. The data used for the study were mainly retrospective (66.7%), with approximately a third (33.3%) coming from prospective participants. Having samples from various communities boosted the chances of generalizing the results (Table 1).

Table 1: Demographic characteristics of participants

Approximately 70 percent of procedures used hyaluronic acid, while calcium hydroxylapatite was used about 15 percent of the time, and poly-L-lactic acid in 8.3 percent. Treatment of the lips accounted for approximately 30% of procedures, with nasolabial folds at 28.3% and the cheeks at 23.3%. Only 18.4% of the cases involved changing the chin or jawline. This pattern exemplifies the current trend of accentuating the middle portion of the face and the area around the mouth (Table 2).

Table 2: Clinical characteristics and treatment details

Out of all patients in the study, 75.8% did not experience any complications following dermal filler treatment. In 13.3% of cases, patients experienced mild bruising or swelling, and in another 5.8%, their pain or tenderness persisted for over three days. Some patients experienced delays in inflammation (2.5%), nodule or granuloma formation (1.6%), and one patient had a vascular occlusion (0.8%). The procedure was generally safe, and only a few serious problems were reported (Figure 1).

Figure 1: Immediate and long-term complications

Most patients reported being very happy with the results, and 26.7% indicated satisfaction with the outcome. A neutral answer was reported by 10% of people, suggesting that their moderate-level expectations were met. Just 5% were dissatisfied, and only 1.6% felt very dissatisfied. Most patients, 83.4%, were pleased with the treatment results, which demonstrate both the effectiveness of the treatment and the support provided to patients (Figure 2).

Figure 2: Patient satisfaction ratings (5-Point Likert Scale)

On average, poly-L-lactic acid remained effective for 14.2 months, just ahead of calcium hydroxylapatite at 12.6 months. The average time that hyaluronic acid was used as a filler before being replaced was 9.4 months. The shortest time between appointments was noted for fillers in the “Other” group at 7.8 months. This research demonstrates that the type of filler has a significant impact on the longevity of the composite (Table 3).

Table 3: Duration of aesthetic results by filler type

Hyaluronic acid fillers showed a stronger association with complications in the survey, yet most cases did not experience any problems (p = 0.038). Fewer complications were seen with calcium hydroxylapatite and poly-L-lactic acid; however, these fillers were used less regularly. The results revealed that ‘Other’ fillers were linked to a larger share of complications. All in all, there is variation in risks with fillers, but the most selected filler is regarded as generally secure (Table 4).

Table 4: Association between complications and filler type (Chi-Square test)

The research provides valuable insights into the demographics, safety, satisfaction, and effectiveness of dermal fillers used by patients in Swat, Pakistan. Among the group, there were many more young adults than in any other age group, which aligns with the global trend of millennials opting for non-surgical cosmetic procedures. In urban centers around Europe and North America, rate studies have revealed similar trends, as younger patients are increasingly opting for preventive cosmetic treatments. The researchers included many transgender participants (21.7%) in their study. This group tends to be underserved by cosmetic dermatology studies. Including them in the results highlights the study’s value and points to a continuously changing demographic landscape for South Asian aesthetic surgery.[16]

Since over 70% of our treatments utilize HA, its worldwide popularity is supported, as it is both biocompatible and reversible, and requires fewer resources for removal. Use of these apps is also common in the United States, Brazil, and South Korea. On the other hand, the report noted that HA was the most commonly used filler; however, patients receiving it had a greater chance of complications (p = 0.038). Such results differ from those in Western countries, where the use of HA fillers by trained doctors is commonly reported to cause fewer complications. The complication incidence reported in this study could be due to changes in the practitioners’ skills, the manner in which the injection was performed, or the care provided after the procedure.[17]

Lips, nasolabial folds, and cheeks were the areas most often treated following worldwide patterns. People are now looking for a full, youthful appearance around their mouth and cheeks. Further, chin and jawline treatments accounted for just 18.4% of all cases. This does not align with recent investigations in Western patients, as lower-face reshaping is becoming increasingly popular, primarily among men. Sometimes, the gap in these traditions stems from cultural influences or differences in community preferences for design.[18]

Participants responded positively, with more than 83% declaring themselves either satisfied or very satisfied with the treatment they received. The results found in this study are similar to those found in the UK and the UAE, where most patients rate non-surgical procedures very favorably. This finding indicates that even a small group (6.6%) experienced some slight dissatisfaction, which reminds us to set realistic expectations and conduct comprehensive consultations. Furthermore, an individual’s satisfaction with their appearance depends on social and cultural views of beauty, as well as their psychology, which varies across different groups and should be acknowledged in aesthetic practice.[19,20]

Calcium hydroxylapatite produced the longest-lasting results (lasting 12.6 months), with poly-L-lactic acid lasting even longer (14.2 months) and hyaluronic acid being the shortest at 9.4 months. The findings of pharmacokinetic studies have already demonstrated that poly-L-lactic acid is recognized for its deep and collagen-stimulating properties. Research on long-term cohorts in Europe has found that it continues to work well, yet requires more effort for users to learn to use it effectively. At the same time, the quicker healing time of “Other” fillers and their greater complication rate highlight the importance of careful use when it comes to these less popular or off-brand ones.[21]

Despite a few overall problems (24.2%), cases of vascular blockage underline the need to keep following safety steps. According to the research, the rate of problems from HA fillers was close to 10% in clinics and hospitals under the strict supervision and guidance of well-trained professionals.[22] Even though HA is a popular choice, patients may get very different results from the same product based on where and who performs the injection. While the findings assure that fillers are safe, early detection and management of any potential problems remain of primary importance.

Recommendations
Based on these findings, the study recommends the following:

• Training workshops and certification programs for practitioners should happen regularly to help them perfect their techniques and reduce problems, mainly for parts of the face like the lips and nasolabial folds.
• Creating and spreading well-researched guidelines for choosing fillers, injecting them, and managing issues will help clinics work consistently and safely.
• Doctors and nurses should take the time to discuss the risks, results, and potential duration of the procedure before commencing any treatment.
• Clinics Should Offer Inclusive Services: Because transgender people participated in high numbers in the study, they should be guided to create special services for people with diverse gender identities.
• Creating a local registry enables the monitoring and review of complications, which benefits both quality control and research efforts.
• Future research should include large, multi-center projects over the years to confirm the findings, examine long-term safety, analyze the affordability of these treatments, and assess their social and psychological effects.

The study provides an in-depth examination of how dermal fillers are used, their safety, the duration of the results, and how experienced patients report their experiences with dermal fillers in Swat, Pakistan. According to the study, dermal fillers, primarily injectable hyaluronic acid, are widely used and accepted by many people, with few or no problems, and most patients are very satisfied. Additionally, the analysis suggests that poly-L-lactic acid and calcium hydroxylapatite are effective but are prescribed less frequently. Although complications were not widespread, a noticeable relationship between hyaluronic acid and negative effects shows that proper and careful use is necessary.

Analyzing results from a diverse range of people, many of whom are transgender, means that the findings remain relevant to everyone who might require dermal fillers. On the other hand, the report suggests that improvements are needed in both practitioner training, patient understanding, and clinical approaches, as complication rates and outcomes do not always align. The finding is that how people feel about their results depends on the filler used, where injections are given, how long the effects last, and what they hoped for.

The author would like to express sincere gratitude to Dr. Shah Hussain, Principal and Assistant Professor at Zalan College of Nursing, Swat, for his invaluable supervision, guidance, and support throughout the course of this study.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Rashid Ahmad
Department of Aesthetics
Rashid Medical Complex, Deolai, Swat, Pakistan
Email: rashidphermacist89@gmail.com

Rashid Ahmad was responsible for data collection, data analysis, and the interpretation of results.

Ethical approval was obtained from Rashid Medical Complex, Swat (Ref No: RMC/25/02 E).

The author declares no conflict of interest.

Rashid Ahmad is the guarantor of this study and takes full responsibility for the integrity and accuracy of data analysis.

https://doi.org/10.63096/medtigo3061224

Rashid A. A Comprehensive Evaluation of Dermal Fillers in Aesthetic Medicine: Safety, Efficacy, and Long-Term Outcomes. medtigo J Pharmacol. 2025;2(2):e3061224. doi:10.63096/medtigo3061224 Crossref