What to Know About Hyaluronic Acid Fillers


Marijke Vroomen Durning, RN    

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For generations, researchers have been looking for ways to slow human aging: the modern variation of searching for the fountain of youth. And although we’ve not yet found a miracle to erase laugh lines and plump thinning lips, there are many products and procedures available that can help people look younger. On the very temporary side, there are daily skin creams you can buy off the shelf; on the more permanent side, there’s surgery. There is another option, though, which isn’t as invasive as surgery: soft tissue fillers, called cosmetic, or dermal, fillers. These fillers are injected just below the skin to temporarily reduce wrinkles and give the skin a smoother appearance. Some people call the process “a liquid facelift.”

Cosmetic fillers can be synthetic (man-made) or natural. One popular type of cosmetic filler is a hyaluronic acid filler. Hyaluronic acid is a natural substance, although some synthetic forms have been developed. It’s a type of sugar, or polysaccharide, already found in your body in your soft connective tissue, such as the tendons, and other tissues, like cartilage. For many years, hyaluronic acid was used to treat painful conditions, such as osteoarthritis, before it was approved for cosmetic use as a dermal filler. Hyaluronic acid has a well-established, favorable safety profile.

How Hyaluronic Acid Reduces Wrinkles

If you combine hyaluronic acid with water, a gel forms. This gel is injected under the skin, providing a smooth appearance to the skin above the injection area. Your skin will eventually return to its previous condition as your body absorbs the filler over time. The procedure is generally done in a doctor’s office or clinic, and allows you to return to your regular activities after the procedure is over.

There are several hyaluronic acid filler brands available in the United States, and each brand has different specific applications. Softer fillers are best for delicate areas like lips, and thicker fillers play a role in smoothing wrinkles around the eyes. The Food and Drug Administration (FDA) has approved several brands to date:

  • Captique

  • Esthélis

  • Elevess

  • Hylaform

  • Juvéderm

  • Perlane

  • Prevelle

  • Puragen

  • Restylane

How Long Do Hyaluronic Acid Fillers Last?

The effect from hyaluronic acid fillers is immediate and it lasts from 6 to 18 months. Some manufacturers claim that their products work for up to three years, although they say that you need a couple of touch-ups—once at 4.5 or 9 months after the initial injection and again at 18 months. Hyaluronic acid fillers can be dissolved at any point; to do so, your doctor will inject the area with an enzyme that breaks the filler down.

Risks and Side Effects Associated with Hyaluronic Acid Fillers

All medical treatments, including cosmetic fillers, have some risks or side effects. The FDA recommends that you don’t have hyaluronic acid filler injections if you have an allergy to the product or any substances in the product, or to lidocaine, the local anesthetic usually combined with the filler. The FDA also says you should avoid using fillers if you have a history of any type of severe allergy, if you scar easily or if you have a bleeding disorder. If you have active pimples, rashes, infection, or any other type of skin problem in the area to be injected, you should delay filler injections until the problem has cleared up.

Side effects to hyaluronic acid fillers usually show up shortly after the injection, although there have been times when the side effects appeared later. If you do have any side effects, they usually go away within a couple of weeks. Some people do experience side effects for up to a few months, though. 

According to the FDA, the most common side effects that may occur include:

  • Bruising around the injection area

  • Redness

  • Swelling

  • Pain

  • Itching

Some people have reported other, less common side effects, such as:

  • Changes in skin color around the injection area

  • Lumps and bumps

  • Infections

If the filler is injected into a blood vessel, especially close to the eye, there is the risk of blurry vision, or partial or complete vision loss to the eye.

Doing Your Research

Cosmetic fillers like hyaluronic acid are quite popular and effective for many people. If you’re interested in this procedure, protect yourself by doing your homework beforehand. The FDA has issued the following recommendations to ensure the safest and best possible results:

  • Cosmetic fillers should be performed by a dermatologist or plastic surgeon.

  • The doctor performing the procedure should be trained for the particular filler being used.

  • Discuss with your doctor the risks associated with the injections, where he or she will do the actual injections, and the result you can reasonably expect following the procedure.

  • Read the information regarding the particular product that your doctor will be using for your procedure. If you don’t understand the labeling or any warnings, discuss this with your doctor.

In addition to these recommendations, the FDA advises that people seek immediate medical attention if they develop symptoms like unusual pain, vision changes, a white appearance of skin near the injection site, or any signs of a stroke (including sudden difficulty speaking, numbness or weakness in the face, arms, or legs, difficulty walking, face drooping, severe headache, dizziness, or confusion) during or shortly after the procedure.

It’s important to remember that a cosmetic filler injection is a medical procedure, even if it is for cosmetic reasons. You are protecting your health by doing your research and, along with your doctor, choosing the filler that is right for you.

PHYSICIAN CONTRIBUTOR Close up of woman receiving injection in lips

Advances in Cosmetic Fillers

Dr. David Harvey talks about the latest opportunities for brightening up lips and aging gracefully with cosmetic fillers.
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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Feb 9, 2018

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Medical References

  1. What are hyaluronic acid injections? American Society of Plastic Surgeons. http://www.plasticsurgery.org/cosmetic-procedures/dermal-fillers-hyaluronic-acid.html
  2. Soft Tissue Fillers (Dermal Fillers). U.S. Food and Drug Administration. http://www.fda.gov/medicaldevices/productsandmedicalprocedures/cosmeticdevices/wrinklefillers/defaul...
  3. Filling in Wrinkles Safely. U.S. Food and Drug Administration. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm049349.htm
  4. Dayan SH, Bassichis BA. Facial Dermal Fillers: Selection of Appropriate Products and Techniques. Aesthetic Surg J 2008;28:335–347.