Understanding hyaluronic acid fillers: what to expect

What hyaluronic acid is

Hyaluronic acid is not a foreign substance. It occurs naturally in the body, most abundantly in the skin, where its main role is to bind and hold water. In its natural form the body turns it over quickly, in the skin in less than a day, which is why it cannot simply be injected unaltered.

The fillers used in clinic are cross-linked: the molecules are bonded together into a gel that resists breakdown and stays where it is placed. Gels differ in firmness and cohesion. Softer gels suit fine, superficial work. Firmer gels are placed deeper, where the aim is to support tissue or replace structure that has been lost. Matching gel to layer and area is one of the most consequential decisions in a treatment, and one the patient rarely sees.

Used well, filler can replace some of what facial volume loss takes away, soften certain folds, or bring definition to an area. It does not stop ageing. The rest of the face continues to change around it.

Before anything is injected

Every patient at DROM has an in-person consultation before any treatment is booked. It is a clinical conversation, not a sales one. We look at your face at rest and in movement, ask about previous treatment, including filler that may still be in the tissue, and review your medical history. Some circumstances mean filler should be postponed, such as pregnancy, or infection or inflammation in the area. Others, such as a bleeding disorder or a history of severe allergy, need careful discussion first.

Sometimes the conclusion is that filler is not the answer. What looks like lost volume can turn out to be a question of skin quality, or of laxity that filler is not designed to correct. When that is the case, we will tell you.

The appointment and the days after

A numbing cream may be applied first. Because filler is a gel, its effect is visible straight away, but that is not yet the result. Redness, tenderness, swelling and bruising are common at first and usually settle within days, so the final shape is judged once the tissue has calmed. A follow-up consultation is included for exactly this reason: to see how the filler has settled, and whether anything needs attention.

Risks, stated plainly

Most side effects are mild and short-lived. Less commonly, filler can cause lumps or infection, or move from where it was placed; these may need treatment.

The most serious risk is rare: filler blocking a blood vessel and cutting off the blood supply to the tissue it serves. Without prompt treatment this can damage the skin and, in the gravest cases, cause permanent loss of vision. It is why anatomy matters more than any product, and why the warning signs are worth knowing:

• Skin that turns pale, white or mottled during or after treatment
• Pain that is severe, or that keeps building rather than easing
• Any change in your vision, however brief

Pain is not always present, so colour change matters on its own. Any of these needs urgent medical attention, not a wait-and-see approach.

Hyaluronic acid filler has one particular safety advantage: it can be dissolved. A dissolving enzyme breaks it down, and it is the mainstay of treatment if a blood vessel is compromised. It is also used, less urgently, for misplaced or excess filler, which we cover under unwanted filler. The enzyme has risks of its own, including allergic reaction, so it too is used only after a face-to-face assessment.

How long it lasts

Filler is not permanent. The body breaks it down gradually, and results commonly last somewhere between six and eighteen months, depending on the gel, the amount, the area and the individual. Areas that move a great deal tend to lose it sooner. Imaging studies also suggest that some filler can remain in the tissue for longer than its visible effect.

That persistence is why maintenance should not run to a fixed timetable. Adding filler on top of filler that has not yet gone can build volume gradually, in a way that is hard to notice between appointments. A considered plan is reviewed against your face each time, and sometimes the right decision is to wait.

If you are considering filler, or wondering whether something you had before is still there, the place to start is a conversation. You can book a consultation, and we will begin with your anatomy rather than a syringe.