If you've ever noticed someone with a plump, crease-free under-eye area, it's either one of two things: genetics or hyaluronic acid fillers. Topical hyaluronic acid-infused serums and moisturizers deeply hydrate to create volume, plumpness, and firmness, but HA fillers are a way to kick things up a notch (and achieve instant results), whether you're looking to add volume to sunken under-eyes, lips, cheeks, and more. Curious about this treatment? Ahead, dermatologists share everything you need to know about hyaluronic acid fillers.
What Are Hyaluronic Acid Fillers?
According to board-certified dermatologist and dermatologic surgeon Dr. Michelle Henry, hyaluronic acid fillers are a type of temporary dermal fillers designed to reduce the appearance of fine lines and wrinkles. Unlike other anti-aging injections, HA—which is actually a sugar—naturally exists in the skin and is a key component in the skin's ability to retain water for a plump, hydrated complexion.
When hyaluronic acid fillers are injected into the skin, facial plastic surgeon Dr. Phillip R. Langsdon—who is the Immediate Past President of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS)—says that the filler attracts more water. In fact, it can hold up to 1,000 times its weight in water—which ultimately lead to the appearance of naturally plump skin. For this reason, HA fillers are commonly used all over the face.
Langsdon says that HA fillers can be used in the temples, tear troughs, cheekbones, smile lines, lips, chin, and jawline. Henry adds to this, noting that you can get HA injections in your hands, as well, and that the formulation of each filler often influences where it’s most often used. “For example, dynamic fillers like Restylane Lyft that have larger particle sizes are often used in the cheekbones to build volume, whereas fillers with a smaller particle size like Restylane Silk work better for fine lines,” she explains.
NYC-based board-certified dermatologist Dr. Dendy Engelman takes it a step further and notes that certain fillers are FDA-approved for certain uses. Where Juvederm’s Voluma is meant for use in the cheeks and chin, Vollure and Ultra Plus are designed for smile lines, and Volbella is meant for lips.
While each type of HA filler has on-label areas of treatment—meaning the company specifically studied the product for use in the region of the face—Engelman says that many licensed and trained providers often treat off-label. “Off-label means the product was not designed to be used in that location,” she explains. That’s not to say that the results can’t still be favorable, rather it’s that they’re not yet approved to be. With this in mind, when it comes to getting off-label HA fillers, Engleman says it’s essential that you go to a reputable licensed, board-certified, and/or trained physician in order to steer clear of any avoidable adverse effects. “Without a clear understanding of facial anatomy, an untrained professional can nick a blood supply, damage a nerve, and potentially cause irreparable damages,” she warns.
Benefits of Hyaluronic Acid Fillers
- Stimulates collagen production
- Adds volume
- Smoothes texture
- Decreases the appearance of fine lines and wrinkles
- HA exists naturally in the body
- Lasts up to a year
“Hyaluronic acid fillers add volume and decrease wrinkles all in one visit, with results that typically last six months to a year,” Henry says. “HA fillers can stimulate collagen production, which leads to fresher-looking skin, and can be used for preventative reasons, to combat volume loss and fine lines earlier on in the aging process.”
Hyaluronic Acid Fillers vs. Botox
As we mentioned above, a major difference between hyaluronic acid fillers and Botox is that HA exists naturally in the body. Another difference is that Botox and HA approach aging concerns from different angles. “HA fillers like Restylane differ from neurotoxins (like Botox) that ‘freeze’ the muscles to reduce wrinkles because fillers smooth the skin by filling wrinkles and increasing fullness,” Henry explains.
Engelman offers another perspective: Where HA works to temporarily fill areas of volume loss and plump fine lines and wrinkles to make them nearly invisible, Botox temporarily freezes the underlying muscle so that static lines can’t be formed, and thus there’s nothing necessary of filling.
How to Prepare for Hyaluronic Acid Fillers
As with Botox, Henry says that patients looking to get HA fillers should avoid blood thinners and alcohol for about a week prior to treatment. Doing so will reduce the risk of unwanted bruising.
Beyond that, Langsdon says that you should sit down with your provider so that you feel fully educated on the matter, and are thus able to walk into your appointment with realistic expectations of what HA fillers will do for your face (or hands).
What to Expect During an HA Filler Treatment
If you’re not a fan of needles, move along. Hyaluronic acid fillers are injected through a needle or cannula. (But if your injector chooses to use a cannula, they'll still need to use a needle first.) "A cannula has a blunt tip and therefore cannot pierce the skin,” Engelman explains. “So when a physician uses a cannula, they first use a needle to create a point of entry for the cannula.”
In terms of the actual physical sensation associated with injection, you’ll be glad to know that most fillers on the market are pre-mixed with lidocaine, so the area gets relatively numb with little memorable pain during treatment. Henry says that the whole procedure takes about 15 to 30 minutes depending on where the filler is being injected.
Potential Side Effects
Considering HA is found naturally in the body, the risk of adverse side effects is pretty unlikely. That said, as with all facial injections, there’s always the chance of redness, swelling, or slight bruising. “A wonderful element to HA fillers is that they can be adjusted,” Henry exclaims. “A dermatologist can inject additional filler or can dissolve it altogether. In case you don’t love your results, HA fillers are easy to tweak.”
How Much Do They Cost?
As with most facial treatments, hyaluronic acid fillers vary in price based on where you get them (where referring to both your geographical placement and where on your body you receive filler). According to Langsdon, one syringe of HA often starts at $750. “Costs can go up or down depending upon the type of hyaluronic acid filler, manufacturer, area of the nation one lives in, area of the face treated, and the number of syringes needed to restore the area being treated,” he adds.
Following a filler treatment, you should ice the area, drink lots of water, and avoid alcohol for at least 24 hours following treatment. Alcohol is known to exacerbate bruising, so toasting to your new filler directly post-injection could lead to temporarily not-so-favorable results.
Additionally, Langsdon says to steer clear of aspirin and ibuprofen for three days, as those, too, can lead to more severe bruising during the healing process.
If your goal is to cater to areas of volume loss (say, under the eyes) or prevent the appearance of volume loss in the most natural-looking way possible, hyaluronic acid fillers are a great option to help achieve your goals. Since HA is a natural component of the human body, adverse effects are unlikely and the overall process is fairly painless and safe (just be sure to have this treatment done by a board-certified dermatologist or facial plastic surgeon).
Lubart R, Yariv I, Fixler D, Lipovsky A. Topical hyaluronic acid facial cream with new micronized molecule technology effectively penetrates and improves facial skin quality: results from In-vitro, Ex-vivo, and In-vivo (open-label) studies. J Clin Aesthet Dermatol. 2019;12(10):39-44.
Papakonstantinou E, Roth M, Karakiulakis G. Hyaluronic acid: a key molecule in skin aging. Dermatoendocrinol. 2012;4(3):253-258. doi:10.4161/derm.21923
John HE, Price RD. Perspectives in the selection of hyaluronic acid fillers for facial wrinkles and aging skin. Patient Prefer Adherence. 2009;3:225-230. doi:10.2147/ppa.s3183
American Board of Cosmetic Surgery. Injectable fillers guide.
King M. The management of bruising following nonsurgical cosmetic treatment. J Clin Aesthet Dermatol. 2017;10(2):E1-E4.
Haneke E. Managing complications of fillers: rare and not-so-rare. J Cutan Aesthet Surg. 2015;8(4):198-210. doi:10.4103/0974-2077.172191