The cosmetic filler industry has evolved substantially over the last 30 years. The market is characterized by multiple fillers and a competitive dynamic among major aesthetics companies. Marketing in the United States and Europe has been different owing to regulatory constraints. Differences have led to more rapid growth in the European market. The US market has evolved owing to growth of major companies with multiple product portfolios and leverage in consumer promotion and aesthetics office marketing owing to scale. The evolution of the filler market will include new materials, injection techniques, and facilitation devices, and new areas of injection.