Filling injections: hyaluronic acid

Principles of filling injections

Injection of fillers. This is a class of injectable medical devices designed to reduce wrinkles and/or modify facial volumes

We use two types of filling products

  • Hyaluronic acid is a resorbable compound, naturally present in the skin and whose presence decreases with age. It is the most widely used product today because it is easy to handle and has an excellent tolerance. We most often use the brands Juvederm® by Allergan and Emervel® by Galderma. Their duration of action is between 6 and 9 months.

In practice

The most frequently made corrections are:

  • Folds: nasolabial folds, bitterness folds (from the corner of the mouth)
  • Wrinkles and fine lines: forehead, "frown lines", "crow's feet", cheeks, around the mouth
  • Areas that may lack volume: lips, cheekbones, chin, cheeks, valley of tears

An injection session can be performed alone, but can also complement medical rejuvenation techniques such as peels and botulinum toxin injections.

Before the injections

Emla® cream can be applied one hour before the injection, on the areas to be treated. It helps to reduce the painful sensations on the surface.

Course of the injection

The treatment will be performed at the office. Depending on the number of areas to be treated and the extent of the improvements to be made, the injection session can last from 10 to 30 minutes.

After the injection

For the first six hours following the injection, it is best to remain calm, rest and refrain from any violent effort. The immediate aftermath may be marked by the appearance of edema and skin redness, the extent and duration of which vary greatly from one individual to another, but which usually remain very moderate and disappear after one to three days.

More information about dermal fillers

What are the side effects of dermal filler injections?

It should be noted that the first few days, there may be some temporary irregularities due to the inhomogeneous distribution of the edema, or an aspect of hypercorrection (in relief) which will gradually disappear.

A number of reactions can also be observed:

  • Local post-injection reactions: edema, redness, pallor, irregularities, tenderness, itching, bruising. However, these reactions are only temporary.

  • Outbreak of cold sores: in susceptible individuals.

  • Acute or chronic inflammatory reaction: possible after secondary injection in an area that has already been injected with other products, especially non-absorbable products.

However, one must be wary of filling injections (including resorbable hyaluronic acid) in the hollow of the dark circles.
Indeed, the product can diffuse into the fat of the orbit, which is an anatomical area very sensitive to inflammation.
Cases of chronic and difficult to treat peri-ocular inflammation have been described.
I never perform such injections and prefer a surgical treatment through the conjunctiva without scars.

  • Granulomas: although rare, this is the most "classic" complication. They are small indurated nodules, more or less sensitive, perceptible to the touch, sometimes visible and unsightly. They correspond to a localized inflammatory reaction that can evolve in flare-ups. They may appear a few days to a few weeks after the injection. These granulomas are in fact extremely rare with absorbable products. Moreover, they are spontaneously regressive in a few weeks.
    Nevertheless, if they prove to be troublesome, an injection of hyaluronidase enzyme is possible to dissolve the injected hyaluronic acid.

  • Outbreak of cold sores: in susceptible individuals.

  • Acute or chronic inflammatory reaction: possible after secondary injection in an area that has already been injected with other products, especially non-absorbable products.

Can we repeat the filler injections?

Yes, but you should not overuse them. Indeed, although the products are resorbable and of natural origin, they contain chemical stabilizers (BDDE) that can create local inflammation. Uncontrolled repetition of filling injections with multiple practitioners can cause chronic inflammation of the face, giving a red and shiny appearance to the skin.

It is essential to keep a record of the history and traceability of the products injected in a summary booklet or "beauty passport". It is also important to understand that these injections are intended for the first signs of facial aging, often between the ages of 35 and 50. More significant alterations are primarily the responsibility of surgery and it is important not to become addicted to injections.

How to avoid an unnatural look with fillers?

Above all, it is important to avoid overdoing the injections. Indeed, too many procedures or with too much volume can give a "duckbill" appearance to the upper lip or a "puffy" appearance to the cheekbones. It is better to limit oneself to the areas that really need to be filled in without trying to radically modify the volumes of the face.

How much does a filling injection cost?

An injection of hyaluronic acid in the nasolabial folds costs 400 €. The same product in the upper lip costs 300€.

Have a question? Please contact us!

Our contact form

The firm

Docteur Yaël Berdah and Docteur Marc-David Benjoar
Plastic surgeons in Paris France

Make an appointment

Appointment with Dr Berdah
Appointment with Dr Benjoar