Bruising, redness, swelling, pain, tenderness and itching are common. Most of these occur shortly after injection.[1]
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After treatment and risks
FDA puts hyaluronic acid filler effects at about 6 to 12 months, calcium hydroxylapatite at about 18 months and poly-L-lactic acid at up to 2 years. In trials, Juvederm Voluma held 67% responders at 24 months and Restyla
After treatment
Bruising, redness, swelling, pain, tenderness and itching are common. Most of these occur shortly after injection.[1]
Most activities can resume right away. ASPS advises avoiding intense physical activity for 24 to 48 hours to limit swelling and bruising. Treated areas can look overfilled at first.[1]
Most swelling and bruising resolve in a few days to weeks. In the Restylane Eyelight trial, over 63.7% of injection reactions lasted 7 days or less. In the Voluma cheek trial, they lasted 15 to 30 days in 24.6% of subjects.[1][2][3]
A touch-up injection may follow the first treatment. Sculptra is given as up to 4 sessions over 9 weeks, and its effect becomes apparent over several weeks.[1][2][3]
Some side effects appear weeks, months or years after injection. Delayed inflammatory reactions to hyaluronic acid start a median 3 months after injection, with a range of 2 weeks to 12 years.[1][2]
Unusual pain, vision changes, white, gray or blue skin near the injection site, or signs of stroke need immediate medical care.[1][2]
Risks
Filler injected into a blood vessel blocks blood flow and can cause tissue death, blindness or stroke. In a survey of 370 dermatologists covering 1.7 million syringes, occlusion followed 1 in 6,410 needle syringes and 1 in 40,882 cannula syringes. 85% of occlusions left no lasting harm. Nasolabial folds and lips were occluded most often.[1][2]
Published cases of vision loss from filler: 98 by 2015, 48 more by September 2018 and 365 more by March 2023. In the latest review, the nose (40.6%), forehead (27.7%) and glabella (19.0%) were the highest-risk sites, and hyaluronic acid was the filler in 79.6%. Of 318 cases with outcomes, 68.2% had no recovery of vision.[1][2][3]
Hyaluronidase dissolves hyaluronic acid filler. A 2024 review calls for immediate high-dose hyaluronidase for vascular occlusion and blindness, and low or moderate doses for lumps and the Tyndall effect. In blindness cases it was used in 70.1%, but no treatment was significantly linked to recovery of vision.[1][2]
Delayed inflammatory reactions to hyaluronic acid occur about once per 2,000 patients per year of follow-up, in a meta-analysis of 242 studies. Nodules or papules followed 17.2% of Sculptra treatments, against 12.8% on control.[1][2]
FDA lists bruising, redness, swelling, pain, tenderness, itching and rash as common risks. Most occur shortly after injection, and many resolve in a few days to weeks.[1]
FDA warned on October 8, 2021 not to use needle-free devices such as hyaluron pens for fillers. Listed risks include blocked blood vessels, blindness, stroke, infection, scarring and eye damage. FDA-approved fillers are supplied for injection by syringe with a needle or cannula.[1][2]
FDA has warned of counterfeit fillers and of unapproved Juvederm Ultra 2, 3 and 4 sold in the US, including online. Injectable silicone is not approved for any cosmetic use and can cause embolism, stroke and death.[1][2]
Some fillers contain cow collagen, lidocaine or hyaluronic acid made by bacterial fermentation. FDA advises allergy testing before fillers made with animal-derived material. Severe allergic reaction has been reported.[1]
How long results last
FDA puts hyaluronic acid filler effects at about 6 to 12 months, calcium hydroxylapatite at about 18 months and poly-L-lactic acid at up to 2 years. In trials, Juvederm Voluma held 67% responders at 24 months and Restylane Eyelight held results through 12 months. PMMA filler held nasolabial fold correction 5 years after treatment.[1][2][3]