What are HA fillers

Hylauronic acid (HA) fillers, also known as soft tissue fillers, do much more than simply smooth wrinkles. They enhance facial contours by adding volume to the lips, softening deep creases and folds, and filling in under-eye hollows, commonly referred to as tear troughs.

These injectables can also restore fullness to the cheeks and temples, minimize the visibility of pitted acne scars, sculpt the jawline, and improve the definition of a weak chin. Some individuals even opt for nonsurgical nose reshaping using fillers to refine their profile.

For those noticing early signs of age-related volume loss, a "liquid facelift" that combines fillers with a neuromodulator such as Botox can create a rejuvenated look, potentially postponing the need for more invasive procedures like facial fat transfer.

While dermal fillers offer noticeable improvements, they do not produce the same dramatic transformation as a surgical facelift. Their effects are more subtle and temporary.

Among the various filler ingredients, hyaluronic acid remains the most widely used due to its ability to be easily dissolved if adjustments are needed. Other FDA-approved options include calcium hydroxylapatite (Radiesse), poly-L-lactic acid (Sculptra), and nonabsorbable polymethyl methacrylate microspheres (PMMA or Bellafill), each offering distinct benefits depending on the treatment goals.

How much do HA fillers cost

In the USA, fillers will typically cost between $400USD and $1000USD per syringe (1ml.) How many syringes you need will depend on the area bring treated and what your goals are. fillers are also priced according to their viscosity and brand. The cost of fillers in Australia is usually between $400AUD and $800AUD with the same variable factors as above.

In Mexico, the price is usually less than in the USA, with prices per syringe being between $250USD - $750USD and in Turkey between $200USD-$800USD per syringe.

How are filler treatments performed

Before undergoing a filler treatment, you and your provider will discuss your aesthetic goals and determine the most suitable type of filler to achieve your desired results. This conversation is also an opportunity to review potential risks and get a personalized cost estimate, ensuring there are no surprises when it's time to pay.

Once the details are finalized, the treatment begins with the injector cleansing the area and applying a numbing cream if necessary, though most fillers already contain lidocaine for comfort. The filler is then slowly injected using either a needle or a blunt-tipped cannula, with the injector carefully massaging the area to ensure even distribution before proceeding with additional injections.

For those receiving filler for the first time, particularly in the lips or cheeks, the provider may take a conservative approach, recommending a follow-up appointment after any initial swelling subsides to assess the results and decide if additional volume is needed. If Sculptra is being used, a series of treatments over several months may be required as collagen gradually develops.

Although each individual injection takes only seconds, the overall procedure can last an hour or longer if multiple areas are being treated. Immediate improvements in volume and smoothness will be noticeable, but swelling or minor bruising can occur. To ease discomfort, the injector may provide a small ice pack for gentle application.

Different types of fillers

Hyaluronic acid remains the most widely used filler ingredient, offering numerous options tailored to different facial areas.

Juvéderm fillers vary in viscosity and ability to lift, addressing specific concerns:

• Juvéderm XC smooths smile lines, including nasolabial folds, marionette lines, and creases around the mouth, with effects lasting up to a year.

• Juvéderm Ultra XC provides lip enhancement, maintaining volume for about a year.

• Juvéderm Volbella XC delivers subtle lip fullness and reduces vertical lip lines for up to a year. It can also improve under-eye hollows.

• Juvéderm Voluma XC is designed to contour the cheeks and enhance the chin, with results lasting up to two years.

• Juvéderm Vollure XC effectively softens nasolabial folds and can provide an improvement for up to 18 months.

• Juvéderm Volux is FDA-approved for restoring lost facial definition and can last up to a year.

Restylane offers another extensive range of hyaluronic acid fillers:

• Restylane Silk enhances lip volume and refines fine lines around the mouth, with effects lasting up to a year.

• Restylane Refyne provides a natural softening effect for nasolabial folds and marionette lines, maintaining results for up to a year.

• Restylane Defyne is ideal for deeper wrinkles and folds, as well as chin augmentation, with improvements lasting about a year.

• Restylane Lyft, previously known as Perlane, restores volume in the cheeks and hands. It is also used off-label for nonsurgical nose contouring, with results lasting 10 to 18 months.

• Restylane Kysse enhances lip fullness and smooths fine lines, maintaining effects for up to a year.

• Restylane Contour, a more structured option compared to Lyft, corrects midface volume loss to restore definition and balance in the cheeks.

• Restylane Eyelight is FDA-approved for treating dark circles and hollows under the eyes, offering results lasting up to 18 months with reportedly minimal swelling.

The RHA Collection, known as Teosyal in Europe, is a newer line of hyaluronic acid fillers designed to replicate natural HA movement and provide a highly realistic appearance.

• RHA fillers typically last 15 months or longer.

• RHA 2 is FDA-approved for moderate folds and works well for lip augmentation and fine lines.

• RHA 3 is a firmer formulation suited for moderate to severe folds, such as nasolabial creases.

• RHA 4, the densest option, is injected into the deep dermis to correct severe wrinkles and marionette lines. It also enhances chin and jawline definition.

• Redensity, the latest RHA filler with FDA approval, is specifically formulated for fine lip lines (smoker’s lines or barcode lines) and is proven to last up to 52 weeks.

Belotero fillers, particularly Belotero Balance, feature a thinner consistency ideal for delicate facial areas, including under the eyes.

• This filler is also effective for refining fine lines on the face and neck, such as lip lines, cheek creases, and horizontal neck wrinkles.

• Results typically last around six months.

How to prepare for HA fillers

To help minimize bruising and swelling after filler injections, certain precautions should be taken in the days leading up to the procedure. A week prior, it is advised to avoid medications that thin the blood, such as aspirin, Motrin, ibuprofen, and Aleve, as well as supplements like St. John’s Wort, Gingko biloba, primrose oil, garlic, ginseng, and vitamin E.

Two days before the treatment, steer clear of topical products containing tretinoin (Retin-A), retinol, retinoids, glycolic acid, or other anti-aging ingredients. Hair removal methods such as waxing, bleaching, tweezing, or depilatory creams should also be avoided during this time. Taking Arnica montana before the procedure is optional but can help reduce bruising.

In the 24 hours leading up to the injections, it is best to refrain from consuming alcohol. If you have a history of facial cold sores, the injections may trigger an outbreak, so it is important to notify your provider beforehand. Additionally, dermal fillers should not be used if you are pregnant or breastfeeding, have allergies to any ingredients, or suffer from neurological disorders. Discussing any concerns with your provider ahead of time ensures a safe and effective treatment experience.

What are the risks and possible side effects of getting HA fillers

Dermal filler treatments are generally safe when performed by a skilled provider, though they do carry some risks and potential side effects.

Common side effects include redness, bruising, asymmetry, and the formation of small lumps at the injection site. To reduce the likelihood of bruising, it’s best to avoid blood-thinning medications like aspirin, as well as certain supplements such as high-dose vitamin E, ginkgo biloba, and garlic, for at least one to two weeks before treatment.

Hyaluronic acid fillers have the potential to shift from their original placement. Longer-lasting fillers and those administered in large amounts at once are more prone to this issue. To ensure stability over time, injections should be performed at the correct depth and distributed in small, controlled amounts rather than large doses.

Some individuals may experience allergic reactions, particularly with fillers made from bovine collagen. Other delayed side effects can include inflammatory reactions occurring months or even years later, as well as granulomas, which are firm nodules beneath the skin.

A serious complication known as vascular occlusion occurs when filler is accidentally injected into a blood vessel, potentially leading to tissue damage, blindness, or even stroke if not addressed promptly. If considering hyaluronic acid fillers, it’s essential to choose a highly experienced injector who understands facial anatomy and keeps hyaluronidase readily available for emergency dissolving.

Fillers should not be administered if there is an active infection on or near the intended treatment area, as this could worsen the condition or lead to further complications.

Some practitioners offer permanent fillers using silicone injections, applying a microdroplet technique to layer small amounts of silicone oil. However, this method carries significant risks that should be carefully researched before proceeding.

Additionally, perception drift—a gradual shift in one’s perception of facial proportions over time—can occur with repeated filler treatments, potentially leading to an exaggerated or unnatural appearance. Being mindful of this risk can help ensure balanced and natural-looking results.

How long do HA fillers last

The duration of fillers varies significantly, ranging from six months to several years, depending on the type used, the amount administered, and how quickly the body processes the product. Some HA fillers can remain effective for up to 18 months, while Bellafill is known to last around five years or possibly even longer.

Individuals with faster metabolisms may notice their filler breaking down more quickly. However, with repeated treatments, longevity tends to increase and results often last longer after multiple sessions.

Interestingly, recent research suggests that filler persistence is more complex than originally thought. Imaging studies have demonstrated that HA fillers may remain detectable on MRI and ultrasound for a decade or more post-injection. Certain facial areas, such as the under-eye region, appear to retain filler longer than others.

How long is recovery from HA fillers

There’s no required recovery time after the procedure but bruising and swelling at the injection site are common, so you might prefer to take a break from social events while your skin settles. These effects typically fade within a few days, though in some cases, they can take a couple of weeks to fully resolve.

Makeup can help conceal bruises but it’s still best to schedule your treatment well in advance of any important occasions. To minimize swelling, avoid exposure to the sun and heat, intense physical activity, and alcohol for at least 24 hours post-treatment. Some doctors also suggest using arnica gel or cream, which may help ease discomfort and reduce swelling.

Long term effects of HA fillers

When applied correctly, facial fillers do not lead to permanent changes or lasting complications. However, excessive use, often due to misguided attempts at facial lifting, can create a range of unwanted effects.

Though serious long-term issues with dermal fillers are uncommon, an overabundance of HA filler can alter facial contours, sometimes resulting in an unnatural or exaggerated appearance. Because hyaluronic acid attracts and retains moisture, excessive amounts may cause the face to appear overly puffy, swollen, or doughy.

Large quantities of filler in the cheeks or lips can interfere with natural muscle movement, potentially reshaping the eyes, especially during facial expressions, altering mouth function, and even affecting speech clarity. Overuse near the eye area can also obstruct lymphatic drainage, leading to prolonged puffiness or under-eye bags.

To prevent complications from overfilling, it's best to select a provider who takes a conservative approach and avoids routine filler top-ups based solely on a predetermined schedule, as repeated, unnecessary injections contribute to an overfilled look. Additionally, HA fillers have been found to persist longer than originally thought, making it important to avoid layering new filler over older material too frequently.