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.

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.

Hyaluronic acid fillers, as the name suggests, introduce HA artificially into your skin. Hyaluronic acid has the capacity to hold up to 1000 times its weight in water, which gives a naturally plump and youthful appearance to your skin.

Hyaluronic acid fillers can be injected into any visible part of your face, which includes your cheekbones, temples, lips, chin, jawline, and so on. Different formulas of this product are used according to the requirements of each area. For example, to improve your cheekbones, large-sized particles are used to add apparent volume to your face. On the other hand, smaller particles are used to fill in facial wrinkles and lines.

The label of the product tells you where it will be injected. Juvederm Voluma is popularly used on the cheeks and chin, Volbella on your lips, and Ultra Plus and Collude for smile lines.

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.


The two major benefits of hyaluronic acid fillers are:

  • Improve Skin Elasticity: Hyaluronic acid fillers boost collagen production to restore fresh and plum skin and improve its elasticity.
  • Fight The Signs Of Aging: Hyaluronic acid fillers reduce the appearance of wrinkles, fine lines, and skin folds. They smoothen out the skin’s texture, and their effect lasts up to a year.

A hyaluronic acid filler is injected into your skin. Hyaluronic acid, an active ingredient, is normally produced naturally in your body to enhance collagen production and improve skin texture. It is the deficiency of this acid that a filler compensates.

Hyaluronic acid fillers work by simply boosting the collagen production in your skin to smoothen out the lines and wrinkles and make your skin look plump and youthful.

In this process, the doctor or physician first marks the areas where the hyaluronic acid filler is to be injected. They then inject the filler into your skin and follow it up with a mild massage to ensure uniform distribution and to prevent any swelling. The whole process takes anywhere from 15 minutes to an hour, depending on the size and the physiological complexity of the targeted area. The injections also contain a minor dose of lidocaine that numbs the area to prevent discomfort and pain.


Both hyaluronic acid fillers and Botox® injections fight the signs of aging on your skin. The difference lies in how they work. A hyaluronic acid filler injects a chemical into your skin that your body is supposed to naturally produce to make your skin plump, lustrous, and healthy. Botox®, on the other hand, freezes the muscles under your skin in place to smoothen out wrinkles and fine lines and prevent the formation of new ones.

  • Botox® is for fading dynamic wrinkles that form around the mouth, eyes, and between eyebrows. These wrinkles become more prominent as you age, and Botox® helps relax the muscles around the wrinkled areas to prevent any muscle movement that might cause the skin to wrinkle. This process takes a couple of minutes, and the results start showing within two weeks.
  • Hyaluronic acid dermal fillers are for reducing wrinkles on facial skin. However, these fillers are not capable of plumping the skin on other body parts, such as breasts. They are only used on soft facial tissues to fade fine lines, smile lines, wrinkles, etc.

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.”

The common side effects of hyaluronic acid fillers are:

  • Itching
  • Redness
  • Minor pain
  • Lumps
  • Tenderness
  • Swelling
  • Bruising
  • Bleeding

The common side effects subside in one to two weeks.

Some uncommon side effects of hyaluronic acid that may result from inefficiency and mishandling include:

  • Allergic reaction
  • Inflammation
  • Infection
  • Numbness
  • Cysts and blisters
  • Scarring
  • Blindness
  • Discoloration
  • Uneven filler distribution
  • Vascular occlusion


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.

The Takeaway

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).

What is the best hyaluronic acid filler?

Restylane Lyft is the most supportive hyaluronic acid for 5 indications including the face and hands. It offers unique safety, structure and versatility. Juvederm Voluma is used on the cheeks and can potentially last up to 2 years with approximately 6 syringes.

How long does it take for hyaluronic acid fillers to settle?

This filler works naturally, much like the hyaluronic acid your body already produces. Because it works this way, it takes two to three weeks to fully settle into your skin. This means that while you’ll see an immediate improvement, you won’t see your final results right away.