Welcome to Ask a Beauty Editor, our new column in which Sarah Jacoby, SELF’s senior health and beauty editor, goes on the hunt to find the science-backed answers to all of your skin-care questions. You can ask Sarah a question at email@example.com.
Hi, can you talk to me about the safety of dermal fillers? I’m in my mid-thirties and my friends have started to use these products. I’m intrigued (because… vanity) but I’m also a bit freaked out at the idea of literally injecting chemicals or toxins or whatever into my face. I recognize that not all fillers are the same so this is a tough question. But I’m beginning to think about it.
So, I guess my question is: Where can someone even begin? How can you know what’s safe in the long-term?
—Filler Me In
Dermal fillers can be used for all sorts of cosmetic reasons—minimizing the look of fine lines, reducing under-eye hollowness, filling in depressed acne scars—and have a surprisingly long history in dermatology. But they’re also needles that inject stuff into your face and make you look different, so I feel you. And, yeah, they aren’t for everyone.
“People definitely have a lot of questions about this because they’re always afraid about whether or not they’re ready to start,” Jenny Hu, M.D. associate professor of dermatology (clinician educator), Keck School of Medicine of USC tells SELF.
There are a few main things to know about soft tissue fillers, she says. The first is that there are, as you noted, a bunch of different kinds, including non-permanent (Juvederm, Restylane, Belotero Balance), semi-permanent (Radiesse, Sculptra), and permanent (Aquamid, Bellafill). The second thing to know is the type that’s by far the most common these days—especially for beginners like yourself—is hyaluronic acid fillers, which are non-permanent and have been safely used for decades.
Semi-permanent and permanent fillers are not made of hyaluronic acid, and usually act on other bodily processes, like stimulating your own collagen production, Dr. Hu explains. They may take a few treatments to see the results, but the plus is that they last longer than non-permanent fillers. However, that does mean that they’re much harder to undo if you don’t like the way they turned out. Your exact treatment plan should be tailored to your specific face and concerns, in consultation with your dermatologist, but just know that non-permanent fillers are typically recommended for newbies.
Hyaluronic acid is a compound already found naturally in the human body, SELF explained recently. So, in general, the risks with hyaluronic acid fillers are pretty low since it’s something that your body is already well acquainted with. “These types of fillers are very safe and also reversible with an injection of an enzyme called hyaluronidase,” Dr. Hu says.
If you don’t like the way your fillers turned out (or you do have any rare complications), you can have them removed. If there’s no health risk and you simply aren’t a fan of your face with fillers, you can also just wait because they’ll naturally dissolve on their own over a period of six months to two years. Unfortunately, yes, that does mean that if you like them, you’ll have to get them re-done regularly.
In general, getting hyaluronic acid fillers is a simple, safe process. But there are some known possible side effects of the procedure, including some potentially serious ones. So, as always, it’s crucial to go to a board-certified dermatologist or cosmetic surgeon who fully understands the anatomy of the face and what they’re doing to it.
The most worrying side effects would be hitting the wrong part of the face (especially blood vessels) or having an allergic reaction. Much more commonly, though, people experience more minor and temporary things like swelling, bruising, and bleeding in the injection area, Dr. Hu says.
If you are going to have an adverse reaction to a hyaluronic acid filler, you’ll probably know in the first few days or months. But in the long-term, there are some known potential issues, mainly the effects of chronic inflammation related to having a foreign body in the skin. Inflammation is a natural reaction to having any foreign thing in the skin and, in the case of fillers, usually subsides in the first few days of the injection. If it doesn’t, though, that inflammation can lead to the development of granulomas, which are masses of immune cells. That said, because hyaluronic acid is technically not foreign to the body, there’s some controversy over exactly how or why this happens after fillers.
Another thing that might make you nervous but (usually) shouldn’t is that some practitioners use fillers in an off-label way. For instance, a filler may be approved to fill in the nasolabial folds (those folds of skin that go from your nose to the corners of your mouth), but some doctors may also use it on other parts of the face, like the temples, the nose, or the lips. That’s not necessarily a red flag, Dr. Hu explains, but it is yet another reason to be sure that you’re totally comfortable with whoever is doing your fillers.
And know that being nervous the first time you go is totally normal! It may be reassuring to know that Dr. Hu’s policy is to err on the side of undertreating a patient their first time so they aren’t shocked with a change that may be more dramatic than they’re ready for. As SELF wrote previously, you can probably expect to pay a few hundred dollars for your fillers, depending on the type of filler and how much your dermatologist uses. For lip fillers, for instance, a syringe can cost upwards of $600.
Ultimately, you should feel totally empowered to ask questions and let your doctor know if you have any concerns. You certainly don’t have to get fillers at any point in your life. But you also shouldn’t let those anxieties keep you from investigating a procedure you might get a lot out of.
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