Skin Deep

FDA warns about not using Expression as a filler

It never ceases to amaze me how some people can take injections so lightly. Yes, they are cosmetic and non-invasive, but these treatments require the training and skill only an experienced dermatologist, plastic surgeon, facial plastic surgeon or oculoplastic surgeon possess. Every week I have at least one patient that comes to me to correct filler injected by an inexperienced or inartistic doctor.

It saddens me that they wasted their time and money, but at least most of them have been treated with hyaluronic acid fillers like Juvéderm, Restylane, Perlane and Voluma, which I can reverse. (Semi-permanent fillers like Radiesse and Sculptra and permanent ones like silicone cannot be corrected.)

We have all heard about “silicone” injections administered by bogus aestheticians and other uncertified providers in the back of a salon or in someone’s home. Shockingly, some doctors are using fillers that are not FDA approved, which means they are illegal and have not been proven to be safe or effective. One example that has caught the eye and scrutiny of the FDA is an injectable product called Expression.

Consisting of hyaluronic acid like many cosmetic fillers, Expression was approved as an “intranasal splint to minimize bleeding and swelling and to prevent adhesions in the septum and nasal cavity.” But some unscrupulous doctors are using it to fill wrinkles because it is cheaper and they make more money. Though it contains hyaluronic acid, Expression is not meant for injection into the skin. Side effects of improper Expression use include swelling, tenderness, firmness, lumps, bumps, bruising, pain, redness, discoloration, itching and the development of hard nodules.

The FDA requires safety and efficacy studies before new drugs and devices are brought to market. I perform many of these Phase3 dermal filler studies in my research center (including those on Juvéderm, Restylane Silk, and Voluma) and they can go on for years to evaluate a product’s safety. Once an injectable filler is approved for use in tissue augmentation, it is often used “off label” in different areas of the face and body. However, injecting a product that is not approved for anything close to wrinkle improvement is risky, negligent and illegal. The FDA just put out a warning about Expression injections and instructed doctors to cease using it for facial wrinkle correction.

This is just another unfortunate example that proves how important it is to select the proper provider for any type of medical or cosmetic treatment. If your doctor has offered you Expression for anti-aging or used it for that matter, I highly suggest you find another doctor. You can email me if you need a help finding a board-certified dermatologist in you’re area, and you can also check

Dr. Leslie Baumann is a board-certified dermatologist, best-selling author and CEO of Baumann Cosmetic & Research Institute in Miami.