Hyaluronic acid and fillers in Valencia

Hyaluronic acid is a molecule naturally present in skin that retains water and contributes to hydration and mechanical properties. Hyaluronic acid in a filler differs from that in a cosmetic serum: fillers are sterile injectable gels, modified (cross-linked) to last longer. Products differ in density and their ability to add volume or integrate into tissue, so a gel designed for lips is not necessarily suitable for cheeks or tear troughs. Most are temporary and biodegradable, although “temporary” does not mean they disappear on an exact date. In Spain, aesthetic fillers are regulated as medical devices and must have CE marking and be used for their intended purpose; products sold as cosmetics must not be injected, and administration requires doctors with specific training.

Suitability is based on anatomical assessment rather than the area’s popular name. The most common uses are:

• Lips: moderate volume enhancement, border definition and correction of asymmetry.
• Nasolabial folds and “marionette lines”: reducing fold depth, sometimes by addressing cheek support first.
• Cheeks and midface: restoring lost volume and projection.
• Chin and jawline: improving projection and definition.
• Tear troughs: a delicate area where filler treats only the hollow rather than pigmentation, and the risk of persistent swelling is higher.

Fillers and botulinum toxin are not interchangeable: fillers add volume; toxin relaxes muscles. They may be combined when both problems coexist, but a movement-related wrinkle should not simply be filled.

After facial assessment and photographs, the skin is cleaned and disinfected — injections are never given through make-up, active acne or infection. Discomfort is managed with cooling, anaesthetic cream or the lidocaine already included in many products. Product is introduced with a needle (more precise) or blunt cannula (distributing across a broader plane); neither completely removes the risk of contacting a vessel, although a cannula reduces it. We use slow, low-pressure injections, small amounts and continuous monitoring of skin colour and sensation. Session length depends on the number of areas. Some results are visible immediately, but initial swelling, redness and bruising prevent full assessment for several days or one to two weeks, particularly in lips and tear troughs.

Duration depends on the product, area, movement and your metabolism. As a guide, lip results last six to twelve months, folds six to twelve, and cheeks or chin may last longer, around twelve to twenty-four months with structural gels. These ranges are not automatic retreatment dates: reinjection should follow examination and assessment of remaining product, as repeating “by calendar” leads to an overfilled appearance. One advantage of hyaluronic acid is that it is reversible: an enzyme, hyaluronidase, dissolves it and is used for overcorrection, asymmetry or, especially, vascular complications. However, reversal is neither exact nor instantaneous, may require several sessions and has its own risks.

What fillers cannot do

Fillers do not replace surgery when there is laxity or excess skin; adding volume to a markedly sagging face may even increase its heavy appearance. They do not remove eyelid bags, localised fat or bone deformity. They do not correct movement-related wrinkles (toxin addresses these), tear-trough pigmentation, texture or telangiectasia. They do not reduce the actual size of a nose or chin: they change proportions by adding volume. Perfect symmetry, a “natural” result, one syringe being enough or needing to use it all cannot be promised: anatomical need determines quantity, rather than packaging. Nor can an exact duration be promised. Hyaluronidase is not a perfect “undo button”: several injections may be needed, and it does not reconstruct anatomy where there is fibrosis or several layered products.

Common effects are mild: pain, redness, swelling, bruising, tenderness or small irregularities, resolving within one or two weeks. Asymmetry, visible or palpable product, a bluish tinge after overly superficial injection, or nodules may develop — some weeks or months later — and we always assess these by ruling out infection first. The serious complication is vascular occlusion: product entering or compressing an artery, cutting off blood supply and potentially causing skin necrosis and, in areas connected to the eye’s circulation, vision loss. It is very uncommon but documented; it can occur with a needle or cannula, and warning signs (severe pain, blanching, mottled or cold skin, visual changes) require immediate action with hyaluronidase. This is why we stock it and have an emergency protocol. Any visual disturbance during or after treatment is an emergency requiring immediate attention.

Contraindications and unsuitable candidates

Treatment should be postponed or avoided with active infection in the area, a herpes outbreak, known allergy to the product or lidocaine, or an uncontrolled clotting disorder. Anticoagulants increase bruising risk but must not be stopped without the prescriber’s advice. Pregnancy and breastfeeding are reasons to postpone elective treatment. Previous fillers should always be identified, especially permanent or unknown products, as these complicate management of any complications. Someone seeking an anatomically impossible result, disproportionate volume or unwilling to accept temporary results and risks is also unsuitable. Darker skin phototypes are not a contraindication, but bruising or inflammation may leave more visible hyperpigmentation.

The doctor’s anatomical knowledge is crucial: facial arteries vary between people and connect with the eye’s circulation, and areas such as the nose, glabella, forehead and inner tear trough carry the greatest risk. At the first consultation, we assess your concern and whether the best option is filler, toxin, an energy-based treatment, a dermatological procedure, surgery or no treatment. We explain the product, purpose, common and serious risks, warning signs and emergency pathway. The clinic has hyaluronidase and a referral protocol. Filler treatment is part of our aesthetic medicine and laser service in Valencia, available in Spanish, English and Italian.

You can meet the medical team before your visit.

As a cosmetic treatment, it is not usually covered by insurance policies and is paid for separately. A registered dermatologist recommends and performs it, and we provide a quote at the assessment consultation before any treatment. You can check our indicative prices on the Fees page.