Dermal fillers: a patient guide to hyaluronic acid

How long dermal fillers last, by area

You see a change straight away. Swelling exaggerates it for the first days, so the real result is the one you see at two to three weeks.

After that, the gel is gradually absorbed. How quickly depends on the product, the area, the amount and how much the area moves. The studies give an idea:

• Lips. In a meta-analysis, 91% still had fuller lips at two months, 74% at six months and 46% at one year ^[3].
• Tear trough. A systematic review found that the effect lasted 8 to 12 months ^[4].
• Cheeks. In a randomised trial with a firm volumising gel, 85.6% had improved at six months and nearly half kept the correction for 24 months ^[2].

As a general rule, deep areas of support such as the cheeks, chin and jawline hold longer than areas that move constantly, such as the lips. Many people keep their result with a smaller top-up rather than starting again from nothing.

What to expect, realistically

• A fresher, more rested face, with better support and softer folds.
• Changes that are measured and in proportion, not a different face.
• Some swelling, and possibly a bruise, for a few days.
• A review at two to three weeks to decide whether a small adjustment is needed.

Fillers do not lift heavy, loose skin, and they do not replace a facelift when there is a lot of laxity. If that is your situation, a good doctor will say so.

Risks, and who should not have them

Most side effects are expected and short-lived: tenderness, swelling, redness and bruising at the injection points. They settle on their own within days.

Less often there can be lumps, irregularities, a bluish tinge under thin skin or an infection. An expert consensus led by Spanish doctors classifies these complications by when they appear, from the first hours to months later, and sets out how to treat each one ^[7]. Lumps can appear late. In one clinic's six-year follow-up of 673 treatments, delayed inflammatory lumps occurred in about 1%, on average 144 days after the injection ^[8].

The most serious complication is vascular occlusion: filler entering or pressing on a blood vessel and cutting off blood supply to the skin. Across 290,307 injections in one group of clinics, serious complications occurred in 0.0041%, and most vascular cases followed injections in the forehead ^[5]. Rare does not mean impossible. That is why the consensus recommends emergency protocols with the right agents ready in the clinic ^[7].

Loss of vision is exceptional. In a systematic review, it was nearly always immediate, and the nose, the area between the brows and the forehead were the areas most often involved. No cases were reported from the lips, chin or jawline ^[6]. Volumes as small as 0.2 ml have been enough to cause it, which is why technique and anatomy matter even with small amounts ^[6].

Permanent fillers. Some products, such as liquid silicone and certain synthetic gels, are not absorbed. They cannot be dissolved, and reactions to them can appear years later and may need surgery to remove. We do not recommend them.

Who should not have fillers: anyone pregnant or breastfeeding, with an active infection or cold sore in the area, an uncontrolled autoimmune condition, a known allergy to a component, or a previous severe reaction to filler. Blood thinners and bleeding disorders need to be discussed first: do not stop any medicine on your own.

Why a doctor and a healthcare setting matter in Spain

In Spain, dermal fillers are a medical procedure. A doctor indicates them and is responsible for them, and they are given in a licensed healthcare centre, not a beauty salon or a hotel room. Whether you are looking for dermal fillers in Marbella, Malaga or anywhere else on the Costa del Sol, check that the clinic has a healthcare registration number, that a registered doctor treats you, and that you are told the product name and batch number.

Ask what would happen if a complication occurred, and whether the enzyme that dissolves hyaluronic acid is kept on site. If you are here for the season, plan treatment so the review falls before you fly home.

How we approach it at Rejuvelook

At our clinic in Fuengirola, a doctor sees you first for a medical consultation of your face as a whole. If dermal fillers suit you, we explain which areas we would treat, which type of hyaluronic acid we suggest and why, and what change is reasonable. We work with conservative amounts, record the product and batch in your notes and review the result once it has settled. We do not use permanent fillers. If a filler is not what your face needs, we will tell you. We see patients in English or Spanish.