Hyaluronic acid fillers can be dissolved with hyaluronidase. Collagen biostimulators cannot — which is one reason the two are discussed as genuinely different treatments rather than interchangeable ones.
Overview
Only where volume has genuinely gone
Where volume has genuinely been lost, replacing it works. Where it has not, filler is the wrong tool and usually makes things worse.
Hyaluronic acid fillers restore volume immediately and predictably, and they are reversible — dissolvable with hyaluronidase if the result is not what either of us wanted. Those two properties make them the safest injectable in aesthetic medicine when they are used for the right indication.
The right indication is loss of structure: fat compartments that have deflated, bone that has receded, a fold that exists because the tissue above it has nothing to sit on. Used there, a small, well-placed volume changes a face quietly.
Used to chase a line that is actually a skin quality problem, or to add projection a face never had, filler produces the look that has made the word slightly embarrassing. We would rather under-treat and see you again than be part of that.
At a glance
- Treatment time30–45 minutes
- AnaestheticTopical; lidocaine is contained in most products
- DowntimeSwelling for 1–3 days; bruising possible for a week
- SessionsOne, with review at 2–4 weeks
- ResultsImmediate; typically last 9–18 months by product and site
- Combines withWrinkle-relaxing injections, bio-stimulation, subcision
How it works
Replace structure, not surface
Hyaluronic acid is a naturally occurring molecule that binds water. In filler form it is crosslinked to control how firm it is and how long it persists, and different products are engineered for different planes: a firm gel deep on bone behaves entirely differently to a soft one placed in the dermis.
Placement is planned in layers. Support goes deep, refinement goes superficial, and the total volume is kept as small as the result allows.
In scar work, a soft hyaluronic acid can be used after subcision to support a released scar floor — but not in the same session as tumescent anaesthesia, which would simply carry it away.
Indications
Suited to
- Mid-face volume loss and flattening
- Deep nasolabial folds and marionette lines
- Temple hollowing
- Jawline and chin definition where structure is genuinely lacking
- Lip hydration and shape, treated conservatively
- Tear trough hollowing in selected patients
- Supporting a scar floor after subcision
In the clinic
Step by step
Assessment
The face is assessed in three dimensions, at rest and in movement, and the pattern of loss identified. Sometimes the conclusion is that filler is not what you need.
Planning and consent
Product, plane and volume are agreed, along with the honest risks — including the rare vascular ones.
Injection
Needle or cannula depending on the site. Most products contain lidocaine, and treatment is comfortable.
Immediately after
Swelling for one to three days; bruising is possible for a week. Avoid heat, alcohol and heavy exercise for 24 hours.
Review at two to four weeks
Assessment once swelling has fully settled, and a small refinement if needed.
Questions
Good to know
If your question is not here, ask it in the enquiry form — Dr Henningsen answers these personally.
Ask a question- Is it reversible?
- How long do they last?
Typically nine to eighteen months depending on the product, the site and how much you move that part of your face.
- What are the serious risks?
Vascular occlusion — filler entering or compressing a blood vessel — is the one that matters. It is rare, and it is why filler should be placed by a doctor who knows the anatomy and keeps hyaluronidase in the room.
- Can filler treat acne scars?
Indirectly and temporarily. A hyaluronic acid can lift a depressed scar, but it does not address the tethering that created it. Subcision plus a biostimulator is the durable version of that idea.
Consultation
Ready to talk about your skin?
Consultations with Dr Henningsen are arranged individually. Tell us what you would like to change and we will come back to you with the options, the honest downtime and the realistic result.