How long do hyaluronic acid fillers last?
The short answer is several months to numerous years. I have personally seen hyaluronic acid filler last over 10 years. Unfortunately, it is common to hear claims that fillers last 6 to 12 months, and sometimes 1.5 to 2 years. That may cause the impression that the filler will always be completely gone within that period of time, which is a terrible assumption. This type of thinking can lead to having filler treatments too frequently, ending up with unnatural results, and potentially even having unanticipated long-term complications. Having a complete understanding of how long fillers last is important for achieving excellent results both short-term and long-term. This comprehensive article will help explain how long fillers last, and why you may feel your filler treatment lasts shorter or longer than what is typically claimed.
The Scientific Data
Before a filler product can receive FDA approval to be used in the United States, extensive clinical trials have to be performed to confirm the filler is safe and effective. Based on the results of the studies, claims can be made on how long the filler lasts.
Typically, hyaluronic acid fillers are claimed to last 6 to 12 months, but some are claimed to last up to 2 years. Hyaluronic acid fillers are among the most common fillers used at the face and include products such as Juvederm, Restylane, RHA, Versa, and Belotero. However, there are other types of fillers that can be used at the face such as Radiesse and Bellafill. The main component of Radiesse is calcium hydroxylapatite, which makes it relatively thicker and is claimed to last 1 year. Bellafill is marketed to last even longer (5 years) and is often referred to as a semi-permanent filler.
Limitations of the Scientific Data
Clinical trials are often designed to have a maximum time period that subjects are evaluated. As such, we do not know the potential outcomes after the trial ended. For example, if a trial is designed to last 1 year and the data shows the filler lasted for the entire duration of the trial, the manufacturer can claim the filler lasted 1 year, but we do not know the results after that time point.
Many clinical trials evaluate how long fillers last using visual assessment. However, there can still some particles of filler present even if it is not visually obvious. It is very difficult, if not impossible, for the human eye to perceive how much filler is present. It takes a certain amount of filler to be able to start noticing a difference.
Clinical trials are not standardized between various fillers and thus it is difficult to compare them. For example, one study protocol may allow 2 syringes of filler, while another study may limit the treatment to 1 syringe filler. I don’t think it would be surprising that more syringes of filler may visually appear to last longer. Another example would be that one study protocol may allow a touch up after 1 month, while another one may not. Again, I think it is clear that those protocol differences can affect the final result and longevity of the filler.
What Affects How Long Filler Lasts
It is my personal belief that the following factors affect how long filler lasts. It is the combination of all these factors that creates such a large range of how long fillers can last.
The different hyaluronic acid fillers have unique characteristics that affect how long they last.
Each individual metabolizes filler differently.
The amount of filler used affects how long you feel the filler lasts. This goes in hand in hand with the number of treatments performed.
Filler lasts differently at different regions of the face. Filler usually lasts longer at regions of the face that have less movement. For example, filler typically lasts much longer at the under-eye region compared to the lips.
Filler can migrate to other areas1, making it look like it did not last as long at the treated area. Good technique and proper filler selection can significantly reduce the risk of filler migration.
Filler can induce a small degree of collagen formation.2 This may vary depending on multiple factors, such as the depth and technique of injection, as well as the region being treated. The visual effect you are seeing months after filler treatment may partially be due to the additional collagen, as opposed to just the filler material itself.
There is a difference between how long a filler lasts, how long you notice it having effect, and how long you feel it provides enough improvement. Therefore, there is a bit of semantics and subjectivity involved.
Are Longer Lasting Fillers Better?
Longer lasting fillers are not necessarily better. Selecting a filler with the proper characteristics for the area being treated is of great importance. My opinion is that it is better to use a filler that does not last as long, than to significantly increase the risk of long-term swelling, nodules, and migration. Achieving a natural appearing result in a safe way should be the utmost priority.
The following are cases I have seen that help describe the wide variation in how long filler lasts.
Case 1: Under-eye filler lasting 10 years
This case involves a middle-aged woman who presented to my office after having hyaluronic acid filler treatment of the under-eye region about 10 years prior by another physician. She mentions her under eye region was very slightly puffy initially after the treatment, which did not bother her much. However, after several years she noticed worsening of the puffiness. She was confused on whether this was due to the filler because she had been told that the filler will go away on its own within a few months to a year. When I examined her, she had fullness and puffiness at the under-eye region which was very characteristic of filler side effect. I treated the region with hyaluronidase, which helps breakdown and dissolve filler. There was already noticeable improvement by the time she left my office. During her follow up 2 weeks later, there was remarkable reduction of the fullness and puffiness.
Of note, the under-eye region is one of the more advanced areas to treat. Poor technique and improper fillers can drastically increase the risk of problems, such as long-term swelling. Although injecting filler superficially under the skin can achieve superior volumization and wrinkle reduction, it has the highest risk for causing a blue discoloration and long-term swelling. Also, fillers that absorb and attract the most amount of water increase the risk of long-term swelling. Lastly, proper evaluation is critical to ensure you are an appropriate candidate for under eye filler.
Case 2: Lip filler only lasting 2-4 weeks
This case involves a young woman who describes having hyaluronic acid filler treatment by another provider. She felt that the filler only lasted 2-4 weeks. Although it is possible that filler can be fully metabolized in that time period (I never say never in medicine), it is more likely that 1 or more of the following has occurred:
An insufficient amount of filler was used. In this case, the volumization initially noticed is due to swelling.
Not remembering how your lips started. During the swelling phase, you become used to much larger lips. When the swelling resolves, your lips may be bigger than how you first started but you do not fully realize it. Taking standardized photographs before and after treatment will help gauge the amount of change.
Filler migration. There is a possibility that the filler migrated outside the confines of the red part of your lip. Good technique significantly reduces this risk.
I treated her lip with Restylane Refyne, split over two separate sessions. She achieved the volumization she desired for many months and was very happy.
Case 3: Lip filler lasting 6 years
This case involves a young woman who had lip filler (Juvederm) several times with another provider; the last time she had the filler treatment was about 6 years ago. She felt she had asymmetry of the lip, as well as a small lump, since having the filler. Her exam was suspicious of having persistent filler at her lips, which was the cause of the lump. In addition, it had appeared that she had filler above the border of her upper lip due to migration. I performed hyaluronidase treatment to dissolve the filler. The lump resolved, the symmetry improved, and a more normal architecture of the lip was obtained.
Using the right type of filler and excellent technique can drastically reduce the risk of unwanted outcomes.