Short answer
Most dermal filler side effects appear soon after injection and many fade within days to weeks, but serious ones occur. The FDA calls unintended injection into a blood vessel the most concerning risk. Hyaluronic acid filler can be dissolved with the enzyme hyaluronidase. Other materials cannot be dissolved this way, and the FDA's filler page, last updated July 2023, says the safety of long-term repeated use has not been evaluated in a controlled clinical study.
What are the risks of dermal fillers?
Common risks are bruising, redness, swelling, pain, tenderness, itching and rash, and many fade within days to weeks. Less common risks include lumps, infection and allergic reaction. The FDA's most concerning risk is unintended injection into a blood vessel, which is unlikely but can cause tissue death, vision loss or stroke.
The FDA lists nodules or granulomas, infection, open or draining wounds and allergic reaction as less common risks. It lists migration of filler, leakage, hard nodules and severe allergic reaction as rare ones. How often a blocked blood vessel happens is uncertain. A 2024 review cites estimates of impending tissue death after filler treatment of 0.001% in 2013 and 0.009% in 2020. A 2026 review gives 0.1% to 0.3% for intra-arterial injection with tissue death, while its own summary table lists vascular occlusion as under 0.05%, and says most authors think true rates are underestimated because reporting is voluntary.
None of these numbers is a forecast for your own face. The 2026 review also notes that hyaluronic acid dominates case reports because it is used most, not because it is inherently more dangerous. Seek immediate medical attention if you notice unusual pain, vision changes, skin turning white, gray or blue near the injection site, or stroke signs such as sudden trouble speaking or a drooping face.
What is the riskiest place for fillers?
The glabella (the area between the eyebrows), the nose and the forehead are the areas most often reported in cases of filler-related vision loss. A 2020 systematic review of 44 cases found these three areas most often involved after hyaluronic acid filler, and no cases from the chin, jawline or lips. Vessels in these areas connect to the artery that supplies the eye.
A 2022 literature review of 233 cases of filler-related vision loss found that, when filler went into a single area, the nose accounted for 36.5% of cases (65 of 178), the glabella 27.0% (48), the forehead 20.2% (36) and the nasolabial fold 7.3% (13). The 2020 review found that volumes as low as 0.2 mL of hyaluronic acid filler caused complete vision loss, so a small amount is not a safeguard.
The table below comes from a 2026 review. It is a qualitative summary without per-patient rates, and the vision loss reviews above are built from published cases, so none can tell you the odds for one patient. A 2024 review notes there is no accepted, evidence-based standard of care for vision loss from filler, which is why prevention matters. Lips rate moderate in that table, and our lip filler guide covers lip-specific swelling, pain and risks.
| Area | Risk level | Serious outcome listed |
|---|---|---|
| Glabella | Highest | Blindness, tissue death |
| Nose and nasal tip | Very high | Blindness, scarring |
| Forehead | Very high | Blindness |
| Nasolabial fold | High | Stroke, tissue death |
| Tear trough | High | Vision loss, eye movement problems |
| Lips | Moderate | Rare tissue death |
How long do hyaluronic acid fillers last, and do they ever go away?
The FDA says hyaluronic acid filler effects last approximately 6 to 12 months, and a physician quoted by ASPS says the body usually breaks it down in 8 to 18 months. Scans suggest some gel stays longer: in a 2024 MRI study of the mid-face, all 33 patients still had filler at least 2 years after their last injection.
Those figures are averages. The FDA notes that duration depends on the material and the area, and that some hyaluronic acid is chemically modified (cross-linked) to last longer. In the MRI study, 21 patients had gone 2 to 5 years without injections, 12 more than 5 years, and one up to 15 years.
Treat it as a signal, not a rule. The study is small, 24 patients were recruited through referral networks, nine were scanned because of swelling concerns, and products and volumes were poorly recalled or recorded. It reports MRI findings, not how each face looked. Still, a faded result is not proof the gel is gone, and the authors suggest routine top-ups may need to be reconsidered. That is a fair question for your injector before adding more.
What are the long-term side effects of fillers, and do they age you?
Some side effects appear weeks, months or years after injection. A 2020 systematic review found delayed inflammatory reactions at about 1.1% per year in prospective studies, and most retrospective studies reported under 1% over 1 to 5.5 years. The FDA's filler page, last updated July 2023, says the safety of long-term repeated use has not been evaluated in a controlled clinical study, so what years of filler do to an aging face is unproven.
A 2024 review reports delayed-onset nodules, which can be red, warm and tender, at an incidence of 0.5% in one study (1% in a later retrospective study), with a median onset of 4 months. It calls granulomas rare, at 0.01% to 1%. The FDA says nodules or granulomas may need injections, oral antibiotics or surgical removal. A 2026 review adds migration in up to 1% of cases, and a distorted look from excess product, called facial overfilled syndrome.
Nobody can promise either way on aging. The same FDA page adds that safe use together with neuromodulators such as Botox, or with other treatments, has also not been evaluated in a controlled clinical study. ASPS's 2024 report acknowledges the term "filler fatigue" for weariness with hyaluronic acid filler or puffiness from an overfilled face. The problems reviews do document tend to depend on where and how filler is placed, which material is used and, for an overfilled look, how much. Our Botox vs dermal fillers guide covers how the two treatments differ and how they are combined.
Who should avoid dermal fillers?
Delay filler if your skin is inflamed or infected, and tell your provider about bleeding disorders and severe allergies. The FDA says filler safety is unknown during pregnancy, while breastfeeding, under age 22, and in people prone to excessive scarring. Its approvals are for adults 22 or older.
The FDA presents these as conditions to tell your provider about before treatment, not as a complete list of who can be treated. It also advises choosing a provider trained to inject fillers, treating the visit as a medical procedure, not injecting yourself and not buying filler online, where products may be counterfeit or unapproved.
- Active infection or inflammation, such as cysts, pimples, rashes or hives: delay until managed
- A bleeding disorder
- Severe allergies or a history of anaphylaxis
- Allergy to lidocaine, collagen, eggs or animal products, which some fillers contain
- Allergy to bacteria, because some hyaluronic acid is made by bacterial fermentation
How is filler dissolved, and is it okay to dissolve it?
Hyaluronic acid filler is dissolved by injecting hyaluronidase, an enzyme that breaks down hyaluronic acid. Clinicians use it for lumps, overfilling, migration, reactions and blocked blood vessels, and a December 2025 review calls it the treatment of choice for filler complications. It is still an injection with risks, and controlled research on it is limited.
A physician quoted by ASPS in January 2025 said injected hyaluronidase typically dissolves filler almost immediately, with the final result taking up to several days and swelling common. A December 2025 review notes the enzyme has a short half-life of about 2 minutes, so multiple treatments are often needed, particularly with highly cross-linked fillers. ASPS physicians list pain, bruising, bleeding, swelling and allergic reaction as downsides; the December 2025 review estimates allergic reaction to hyaluronidase injections at 0.05% to 0.7%, with most reported side effects coming from eye procedures.
The enzyme spreads through tissue, so it is hard to aim precisely, and one ASPS physician tells patients to treat dissolving as all or nothing. A scoping review searching to May 2022 found 5 randomized trials with 53 subjects, all on filler placed in forearm, upper arm or back skin, and no trials or case-control studies on reversing filler in facial skin. The December 2025 review adds that hyaluronidase use for complications remains off-label in many countries because dosing protocols are not standardized. A 2024 review still describes good results and an acceptable safety profile from clinical experience, while noting limited controlled data. Ask who would dissolve your filler and how they handle reactions.
Which fillers cannot be dissolved?
Fillers made of poly-L-lactic acid, calcium hydroxylapatite and polymethylmethacrylate (PMMA) cannot be dissolved by hyaluronidase. The FDA warns that removing filler may be difficult or impossible, especially non-absorbable fillers and those not made of hyaluronic acid. Injectable silicone is not FDA approved for any aesthetic use.
These materials trade reversibility for duration. The FDA lists calcium hydroxylapatite effects at about 18 months and poly-L-lactic acid effects at up to 2 years. It lists PMMA as its non-absorbable filler material, and says non-absorbable fillers are approved only for nasolabial folds and cheek acne scars. ASPS's 2024 report says non-hyaluronic acid fillers are not as dissolvable but can offer longer-lasting results, and counted 932,861 such procedures.
If something goes wrong with a filler that hyaluronidase cannot dissolve, the FDA says you may need injections, surgery or other interventions, which carry their own risks. A 2026 review found PMMA and silicone fillers disproportionately linked to chronic inflammatory, vascular and deforming complications, and its table rates calcium hydroxylapatite as partly reversible and poly-L-lactic acid, PMMA and silicone as not reversible. Ask for the material by name before treatment, and if you already have filler of unknown type, ask the clinic that placed it for the product record.
How can you lower your risk before getting filler?
Choose a provider trained in facial filler, ask which product goes where and whether it can be dissolved, and agree what happens if something looks wrong. The FDA says filler is a medical procedure, so ask about training and experience injecting the face. A 2026 review ties irreversible injury mainly to injection site, technique and whether the filler is absorbed by the body, not volume alone.
ANEWU's filler page says Dr. Arshia Payman, MD, a board-certified physician specializing in aesthetic medicine, performs every dermal filler treatment. It also says she names the product she recommends for each area at the consultation, treats in stages where appropriate, and reviews the result at a follow-up, and that she will tell you if fillers are the wrong tool for what you want changed.
A free consultation in Buckhead, Cumming or Dawsonville is a good place to ask these questions, and you can book a free consultation through the request form or by calling (470) 567-6415. Our guide on who can legally inject Botox and fillers covers how to check a provider's license. The filler page says to call the office if anything looks or feels unexpected. For the FDA's urgent symptoms, seek immediate medical attention instead of waiting for an appointment.
- Which product goes into each area, and why?
- Can it be dissolved with hyaluronidase, and who would do that?
- What is the plan if I have blanching, severe pain or a vision change?
- When will you check the settled result?
Sources and further reading
- Dermal Fillers (Soft Tissue Fillers) U.S. Food and Drug Administration, content current as of July 2023
- FDA-Approved Dermal Fillers U.S. Food and Drug Administration, content current as of November 2020
- Risks and rewards: What to know about dissolving filler American Society of Plastic Surgeons, January 2025
- 2024 Plastic Surgery Statistics Report (archived copy) American Society of Plastic Surgeons, 2024 data, Internet Archive copy saved June 2025
- Vision Loss Associated with Hyaluronic Acid Fillers: A Systematic Review of Literature Aesthetic Plastic Surgery, 2020
- Visual loss after aesthetic facial filler injection: a literature review on an ophthalmologic issue Arquivos Brasileiros de Oftalmologia, 2022
- Hyaluronic Acid Filler Longevity in the Mid-face: A Review of 33 Magnetic Resonance Imaging Studies Plastic and Reconstructive Surgery Global Open, 2024
- A Systematic Review of the Literature of Delayed Inflammatory Reactions After Hyaluronic Acid Filler Injection to Estimate the Incidence of Delayed Type Hypersensitivity Reaction Aesthetic Surgery Journal, 2020
- Hyaluronidase for Dermal Filler Complications: Review of Applications and Dosage Recommendations JMIR Dermatology, 2024
- Hyaluronidase Use in Aesthetic Medicine: Formulations, Safety, and Clinical Practice Journal of Clinical Medicine, published December 2025 (issue 2026)
- A Scoping Review of Hyaluronidase Use in Managing the Complications of Aesthetic Interventions Aesthetic Plastic Surgery, 2024 (online December 2022)
- Permanent Complications After Dermal Fillers: Risks, Prevention, and Management Strategies Aesthetic Plastic Surgery, June 2026
This article is general information about dental and facial procedures, not a diagnosis or medical advice. Every jaw and every health history is different, so the right plan for you can only be set after an exam and imaging with a surgeon.