Injectable dermal fillers represent a rapidly evolving class of soft-tissue biomaterials whose clinical behavior is determined by their underlying material properties. Despite widespread use in aesthetic medicine, the relationships between structure and behavior that dictate filler performance remain incompletely synthesized across material classes. This review examines the material science foundations of modern dermal fillers, spanning hyaluronic acid formulations, collagen-based materials, and biostimulatory systems, including calcium hydroxylapatite, poly-L-lactic acid, and polycaprolactone. Emphasis is placed on the material parameters that govern filler behavior in vivo, such as polymer chemistry, crosslinking methodology, particulate microstructure, and degradation kinetics. These factors collectively determine key rheological characteristics such as storage modulus (G'), loss modulus (G″), cohesivity, and injectability. In turn, these influence material stability, tissue integration, and resistance to mechanical deformation within dynamic facial environments. Recent advances in formulation strategies, including multiphasic fillers, microspheres, and hybrid systems, illustrate how modification of microstructure can be leveraged to improve durability, biocompatibility, and tissue remodeling potential. This review establishes a mechanistic framework linking filler composition to rheological performance and degradation behavior. As the first part of a 2-part review, the focus here is on the material science and bioengineering principles that inform filler behavior in order to provide the scientific foundation for the clinical decision-making framework explored in Part B.
Weiss et al. (Tue,) studied this question.