Hyaluronic Acid Filler: What It Is, How It Is Done and What the Risks Are

What is hyaluronic acid filler and how does it work?

Hyaluronic acid is a molecule found naturally in our body that attracts water. It contributes to the skin’s feeling of moisture and fullness. In filler products, this molecule is processed in a laboratory into a gel so that it can stay in the body longer.

When the gel is injected into or under the skin, it creates volume where it is placed. Over time it is gradually broken down by the body and its effect decreases. For this reason, hyaluronic acid fillers are not permanent; repeat treatment may be needed at certain intervals.

An important feature of hyaluronic acid fillers is that they can be dissolved with an enzyme called hyaluronidase. In the case of an unwanted result or certain complications, the doctor can use this enzyme to largely remove the filler. This does not eliminate the risks of the procedure; but it does offer a way to deal with problems.

What is it used for?

• Supporting volume in the cheek and cheekbone area that decreases with age
• Softening pronounced folds such as the nose-to-mouth lines
• Adding lip volume and defining the lip border
• Contour support for the chin and jawline
• Hollows under the eyes (only in suitable people and in experienced hands)
• Improving the appearance of some depressed scars

Which area is treated, how much product is used and of what consistency depend on the person’s facial structure. This decision is made after an examination and the doctor’s assessment.

Who may it be suitable for?

It may be suitable for adults who are in good general health, have realistic expectations and understand that the procedure is temporary. It is important to discuss that the goal is not “to look like someone else” but support that is in harmony with your own facial structure.

Who is it not suitable for, and what needs attention?

• Pregnancy and breastfeeding (safety data for this period are insufficient)
• Active infection, a cold sore, a flare-up of acne or an open wound in the treatment area
• A history of allergic reaction to filler ingredients or to local anaesthetic
• Use of blood-thinning medicines or a bleeding disorder (do not stop your medicine on your own; talk to your doctor)
• A filler of unknown content, or one that has not dissolved, previously injected in the same area
• Intense and persistent worry about your appearance (in this case it is better to talk and have an assessment first)

This list is not complete; tell your doctor about all your health conditions and the medicines you use. Also mention, in full, any herbal products and any aesthetic treatments you have had in the past. Information about previous procedures can directly affect today’s plan.

Who should perform it, and where?

Filler should be injected by a trained doctor who knows facial anatomy well, especially the blood vessels, and who can deal with complications. In Turkey, these matters are regulated by the Ministry of Health; the treatment must be performed by a doctor and in a licensed healthcare facility.

The person performing the treatment must be able to act immediately in an emergency. For this reason, it is reasonable to ask in advance whether hyaluronidase enzyme is available on site and how you can reach the doctor after the procedure.

The product used must be licensed, genuine and within its expiry date. Products bought online or of unknown origin may be counterfeit or contaminated.

Preparing for the procedure

• At the examination, discuss your expectations, previous procedures and medical history.
• Unless your doctor advises otherwise, get information in advance about certain medicines and supplements that may increase the risk of bruising; do not stop your prescription medicines yourself.
• If you have a history of cold sores, tell your doctor, especially before lip treatment.
• Not scheduling the procedure right before an important event allows time for any swelling and bruising.
• Having a clean face without make-up on the day of the procedure makes the treatment easier.
• Read the consent form without rushing and ask about anything you do not understand.

The day of the procedure, step by step

1. The doctor assesses your face and clarifies with you the areas to be treated and the amount; photographs are usually taken for the record.
2. The skin is cleaned with an antiseptic solution.
3. If needed, a numbing cream is applied to the area; many products also contain a small amount of local anaesthetic within the gel.
4. The filler is injected with a fine needle or a cannula. A cannula is a flexible tube with a blunt tip; it may be preferred in some areas. The doctor decides which tool to use depending on the area and technique; no tool reduces the risk to zero.
5. During the treatment, the doctor watches the colour of your skin and your reactions. If you feel sudden, severe or unusual pain, say so immediately.
6. At the end of the procedure, the area may be gently shaped and, if needed, a cold application is used.
7. Before you leave, the area is checked; you are given aftercare advice and information on how to reach the doctor.

After the procedure: the first 24 hours and the first week

Swelling, redness and tenderness in the area are expected in the first hours. With lip treatments, swelling may be more noticeable in the first days. Not pressing on the area, not massaging it and postponing make-up for as long as the doctor recommends are usually advised.

You may be asked to avoid intense exercise, saunas, Turkish baths and very hot environments in the first days. Your doctor may also recommend not lying face down for a while. These recommendations may vary depending on the doctor and the treated area.

Expected side effects

• Swelling and mild oedema
• Bruising (especially around the lips and eyes)
• Redness and tenderness at the injection points
• Slight irregularity that can be felt by touch (usually decreases as the swelling goes down)
• Itching or a feeling of tightness

These symptoms usually decrease within a few days; how long they last varies from person to person. Pain that keeps getting worse, a change in colour or a fever, however, are outside the expected course.

Rare but serious risks: vascular occlusion

The most serious risk of filler is the gel accidentally entering a blood vessel or pressing on a vessel from outside. This is called vascular occlusion. It is rare; but if it is not recognised in time, it can lead to tissue loss in the skin and, very rarely, to loss of vision or a stroke. The area between the eyebrows, the nose and its surroundings, the forehead and the area around the eyes are considered among the higher-risk areas.

When vascular occlusion is recognised quickly, the doctor can carry out various interventions, above all hyaluronidase. That is why it is very important to know the warning signs and to contact the doctor without waiting. For details, see our guide ‘After Fillers: When Is It an Emergency? Vascular Occlusion and Other Warning Signs’.

If you cannot reach your doctor, do not wait; go to the nearest emergency department. Unless your doctor advises it, do not massage the area, do not apply heat or ice, and do not take any medicine on your own.

Other possible problems

• Infection: may show itself through redness, warmth, steadily increasing pain, discharge or fever.
• Nodules and irregularity: lumps that can be felt may form where the filler collects in one spot. Some may appear weeks or months later.
• Delayed swelling: rarely, long after the procedure, swelling may appear in the area following events such as an infection, a vaccination or dental treatment.
• Bluish appearance: gel placed too superficially, especially under the eyes, may look bluish through the skin.
• The filler shifting, or an appearance different from what was expected.

Most of these conditions can be treated; however, the assessment must be made by a doctor. Do not start any medicine or interfere with the area on your own.

About fillers that are not hyaluronic acid

There are also fillers on the market made from substances other than hyaluronic acid, which stay in the body much longer or never dissolve. These products cannot be dissolved with hyaluronidase. In problems such as delayed nodules or granulomas (inflammatory tissue the body forms in response to a foreign substance), treatment may be more difficult and surgery is sometimes needed.

Injecting substances not approved for medical use, such as liquid silicone, for aesthetic purposes can cause serious and long-lasting harm. Always ask which substance will be injected and keep a record of the product information.

When will I see the result, and how long does it last?

The volume effect is visible immediately after the procedure; however, because of swelling, how things look in the first days can be misleading. Your doctor decides when the final appearance should be assessed; this usually means waiting a few weeks.

How long the effect lasts depends on the structure of the product, the treated area, the amount and the person’s metabolism. The effect is not permanent and its duration varies from person to person; in areas that move a lot, such as the lips, it may be shorter.

Realistic expectations: what filler cannot do

• It cannot lift significantly sagging skin; in that case surgery or other methods may be considered.
• On its own, it does not correct skin quality, pigment spots or fine surface wrinkles.
• For wrinkles caused by facial expressions, a different method (botulinum toxin) is usually more suitable.
• Injecting too much can lead to an unnatural look; “more” is not always “better”.
• It does not completely change your face; the aim is to support your existing structure.

Alternatives

This page is for general information. The method that is right for you can only be determined through an examination and a doctor’s assessment.