Dermal fillers: volume, risk, and the signs to know

Faces lose volume with age. Fat pads shrink and shift downward, bone remodels, and the skin that used to be supported by that structure begins to fold. Filler replaces lost volume in specific planes to restore support.

Most fillers used today are hyaluronic acid, a substance the body already makes. They are temporary, and an important practical consequence is that a specific enzyme can dissolve them if a result is unwanted or if a complication occurs. Non-hyaluronic fillers behave differently and cannot be reversed the same way, which is a meaningful distinction at the point of consent.

What fillers do not do is tighten skin, resurface it, or fix pigment. Where laxity rather than volume is the issue, filler used to compensate produces the heavy, overfilled look people recognise and dislike. Recognising which problem is in front of us is most of the skill.

The U.S. Food and Drug Administration documents rare but serious risks with dermal fillers, including unintentional injection into a blood vessel. When that happens, blood supply to an area of tissue can be blocked, which can cause tissue death, vision changes and stroke.

These events are uncommon. They are described here because the time to learn the warning signs is before treatment. Contact the clinic immediately, and seek emergency care if you cannot reach us, if after filler you experience severe or increasing pain out of proportion to the procedure, skin that turns white, mottled, dusky or blue, any change in vision, or drooping and weakness on one side.

Speed matters with vascular complications. Treatment that begins quickly has a materially better outcome than treatment that begins hours later, which is the reason a clinic should give you a way to reach a clinician urgently rather than a voicemail box.

The ordinary effects are far more common and far less alarming: swelling for a few days, bruising, tenderness, and small lumps that usually settle or can be massaged. Delayed nodules can occur weeks or months later and should be assessed rather than ignored.

Duration varies by product, by area and by person, and is commonly measured in months to a couple of years. Areas that move constantly, such as around the mouth, metabolise filler faster than static areas.

Because results are temporary, maintenance is part of the cost rather than an optional extra. We quote by syringe and tell you at consultation roughly what a year looks like, so the decision is made on the real figure.

Chasing a cheaper price per syringe usually means a less experienced injector, a product not intended for the area, or both. This is one of the few aesthetic treatments where the downside of getting it wrong includes vision loss, and it is not the place to shop on price.