Since the introduction of dermal fillers to the US market in 1981, a number of advances in composition, production, and application of the products have been made. For years, European clinicians have had access to more fillers than their US counterparts because of different product approval processes. Although the vast majority of these products will not see regular use in the United States, some of today’s most popular fillers were first tested in Europe. This article reviews the characteristics of the ideal filler, how manufacturers have come to satisfy some of those characteristics in products currently approved by the US Food and Drug Administration (FDA), and the characteristics that are still missing from those products. We also review a number of next-generation fillers that may be approved by the FDA in the near future; data and reports from European studies on these products also are presented for review.