Filler FAQs

What are fillers made of?

Most dermal fillers used by dermatologists are made of hyaluronic acid.  This is a substance found normally in our skin.  HA binds to water resulting in plumpness and hydration our body’s tissues.  It is produced and broken down as one of our body’s naturally occurring functions.  HA for injection is derived from bacteria-produced hyaluronic acid that is collected and isolated from any bacterial components.

How long do fillers last?

Hyaluronic acid filler duration of effect is dependent on how much is injected, where it is placed, and sometimes on the particular patient’s unique metabolism.  In general, with full treatment, you can see lasting results up to 18 months in the nasolabial folds, 12 months in the cheeks and cheek wrinkles/folds, 6 months in the back of the hands, 6 months in lips and vertical lip lines.  Regular injections every 6 to 9 months are recommended for “topping-off” in those patients wanting to maintain a “full treatment” result. 

What side effects are possible?

Potential side effects include but are not limited to the following:

• Usually at or near the injection site and may last an average of 7 days, up to 14 days. 
• Swelling and redness. May occur at the injection site and last for up to 7 days.
• Pain at the injection site. Mild, transient (2-3 days) and relieved by Tylenol. 
• Related to the actual injections, is usually mild and transient lasting less than 24 hours.  May be relieved with Tylenol.
• Filler that can be felt under the skin, even if not visible.
• Irregular skin contour, ridging, bumps. Can be easily corrected in follow-up.
• Vasovagal reaction (drop in blood pressure due to stress).
• Allergy or sensitivity to the product (including, very rarely, anaphylaxis).

Serious but rare side effects include but are not limited to the following:

• Delayed onset of infection or inflammatory reaction to the filler
• Recurrence of cold sores (herpes)
• Superficial necrosis (skin breakdown, scabbing) at the injection site
• From Restylane website: “Unintentional injection into a blood vessel could result in serious complications, which may be permanent including, vision abnormalities, blindness, stroke, temporary scabs, or permanent scarring of the skin.”

While no procedure is without risk, that risk can be reduced by choosing an experienced injector with knowledge of relevant anatomy, injection technique, and how to manage side effects. 

What can I do to limit bruising?

Bruising, usually at or near the injection site, may last an average of 7 days, up to 14 days.  Risk of bruising is increased in patients taking aspirin or aspirin-containing products, vitamin E, St. John’s Wort, NSAIDS, i.e., Motrin, Aleve, etc.  Stop these 7 days before treatment, unless directed to take them by your physician.    Silagen Rapid Recovery Kit can be purchased prior to your treatment and can reduce bruising and swelling.  This kit contains pills with arnica and bromelain to start 1 day before and continue 6 days after, and Vitamin K oxide cream to start applying after treatment.   Pulsed-dye laser (available at Core Dermatology) can be used 1-2 days after treatment to resolve bruise in less than half the normal time (no extra charge).

I’ve read the COVID vaccine can cause swelling of filler.  What should know about this?

Delayed inflammatory nodules or swelling can occur, but these events are rare (reported to occur in 0.3% to 4.25% of cases).  Any infection (flu-like illness) or immune trigger (including Covid or other vaccinations), and dental procedures, can cause delayed inflammation resulting firm, red, tender areas where the filler was placed, sometimes even months after filler injection.  These events are usually temporary, but they can be recurrent if new triggers are encountered.  Some cases that do not resolve on their own are managed with oral corticosteroids, dissolution of filler, antibiotics for their anti-inflammatory properties or a combination of these.

Given the rarity of this side effect and likely spontaneous resolution, patients who have had filler can still receive vaccines of any kind. Likewise, patients who have had vaccines can still receive filler.  As a precaution, avoid COVID vaccination or any dental work 2 weeks before or after receiving filler, which may reduce, but not eliminate, the risk.