Filler precautions: Things you must know before the procedure

Before getting fillers, the first thing you need to know can be summarized into one key point. The most widely used hyaluronic acid (HA) filler can be dissolved with an agent called hyaluronidase if a problem arises, and the core of safety is whether the hospital can prevent and respond to "vascular occlusion," which is the most dreaded though rare complication. Most of the other precautions stem from this point.

Fillers are procedures that fill volume in sunken areas to naturally refine wrinkles and contours. Although immediate change is its charm, "where, what ingredient, and who" injects it determines the results and safety. Based on frequently asked questions during actual consultations at Onlif Clinic, this article calmly points out the parts that are easy to miss before and after the procedure.

💉 Fillers, they differ starting from their ingredients

Not all fillers are the same. Since the duration and "whether it can be dissolved" completely differ depending on the ingredients, HA fillers are the priority if it is your first procedure or for sensitive areas like under the eyes.

HA tends to have a shorter duration in areas with a lot of movement, such as the lips. CaHA, PLLA, and PCL stimulate collagen and last longer, but they are difficult to reverse if you do not like the results. Permanent fillers such as PMMA are virtually impossible to remove in the event of side effects, so they are not recommended domestically or internationally.

Even the HA fillers used at Onlif have different physical properties, ranging from soft domestic products to premium ones with good shape retention. There are products like Belotero that have good skin adherence to reduce showing through thin areas, and products like Restylane and Juvederm that are strong in shaping contours, so it is right to choose according to the area.

📌 Key Summary: For beginners and sensitive areas, HA fillers are a safe starting point simply because they can be reversed.

⚠️ The most dreaded complication, vascular occlusion

The most serious complication of fillers is vascular occlusion. If a filler blocks a blood vessel, it can lead to skin necrosis, and in severe cases, blindness or cerebral blood vessel involvement. Although the probability of occurrence is rare at less than 1%, the problem is that the damage can be permanent.

In particular, the nose, glabella, forehead, and nasolabial fold areas are close to blood vessels leading to the eyes and brain, and are classified as high-risk areas. According to a 2017 paper, areas of blindness after filler procedures were reported as 60% in the glabella, 25% in the nasolabial folds, and 15% in the nose.

What is crucial at this time is hyaluronidase. If it is an HA filler, it can be dissolved with this agent within a few minutes to dozens of minutes, making it possible to catch the golden hour for an emergency response to vascular occlusion. Therefore, 'whether this hospital always keeps hyaluronidase in stock' becomes a practical standard for distinguishing a safe hospital.

If the following symptoms appear during or immediately after the procedure, you must inform the hospital without delay.

• Severe pain, pale or purple discoloration of the procedure area

• Cold sensation, blisters

• Blurred vision, decreased vision, double vision

📌 Key Summary: Vascular occlusion is rare but fatal. Whether hyaluronidase is stocked and the immediate response system are the measures of safety.

🩹 Common side effects and less common side effects

Bruising, swelling, and tenderness are common reactions. They usually subside within 3 to 14 days, so there is no need to worry excessively. However, if the pain gets worse instead, skin color changes, or vision problems occur, it is not within the range of a common reaction.

There are also less common side effects to be aware of.

• Tyndall effect: A phenomenon where the HA filler looks blue when injected shallowly into thin skin like under the eyes. An error in choosing the injection layer is the main cause, so the skill of the practitioner is significant.

• Delayed inflammatory response: This rarely occurs months to years after the procedure when immunity drops, and is reported to be about 0.06% per year. The cross-linking agent component of HA fillers is also pointed out as the cause.

• Biofilm/Nodule: If bacteria form a film around the filler, it can cause delayed nodules and granulomas in the form of chronic infection.

Most HA fillers contain lidocaine to reduce pain. If you have a history of lidocaine allergy, you must inform us before the procedure.

📌 Key Summary: Bruising and swelling usually improve within 2 weeks. Late-appearing nodules can be prevented by avoiding over-injection and sharing your history.

📋 Before the procedure, what should you prepare and stop taking

Half of the preparation before the procedure is "notification." Please inform us of any medications you are taking, allergies, past filler history, infections, or pregnancy without exception. In particular, what filler you received and where previously is directly related to preventing delayed nodules.

Ingredients that interfere with blood clotting increase the risk of bruising and bleeding.

• Anti-inflammatory painkillers such as aspirin and ibuprofen

• Health functional foods such as Omega-3, Vitamin E, and ginkgo biloba extract

It is recommended to stop taking these ingredients 7 to 14 days before the procedure. However, never stop anticoagulants or antiplatelet agents prescribed by a doctor at your own discretion. You must consult with the prescribing medical staff.

If you are considering lip fillers, you must check your history of cold sores (HSV). The virus can be activated, so if you have a history, taking preventive antiviral medication is considered.

📌 Key Summary: Do not stop prescribed medications arbitrarily, stop health functional foods and anti-inflammatory painkillers 1 to 2 weeks before, and make sure to share previous filler history.

🕐 How is the post-procedure care done

Immediately after the procedure, the volume is visible right away, but it differs from the actual shape due to swelling. Evaluating the final shape is appropriate 1 to 2 weeks later when the swelling goes down. As a rule, you should monitor the progress rather than dissolving it immediately because you do not like it.

Avoid the following for 24 to 48 hours after the procedure.

• Drinking alcohol, strenuous exercise

• Saunas, hot spring baths

• Strong massage

There are also things to take care of by area. After nose fillers, avoid pressure from glasses for 2 weeks; after forehead fillers, refrain from pressing down with a hat for about a month; and after lip fillers, it is good to reduce stimulation with a straw or tongue.

Do not massage arbitrarily at home even if you feel clumping or migration. The position may shift, so it is safe to have it evaluated at the hospital.

📌 Key Summary: Judge the shape after 1 to 2 weeks, refrain from drinking alcohol, saunas, and strenuous exercise for two days, and be careful of pressure on each area.

💡 Fillers and Botox, relationship with other procedures

It is easy to confuse, but fillers and Botox have different principles. Fillers supplement volume to fill sunken areas, and Botox relaxes muscles to alleviate expression wrinkles. Since their purposes are different, they are often performed together or used separately as needed.

If sagging is prominent, fillers alone have limits. In this case, it is natural to consider procedures with a strength in lifting, such as thread lifting, or non-surgical elasticity procedures, such as ultrasound (HIFU) and radiofrequency (RF), together. It is commonly misunderstood that "fillers sag," but in many cases, it is not due to filler migration, but rather a decrease in skin elasticity due to aging.

Onlif aims for a non-surgical approach that restores the skin's inherent balance, rather than incisional plastic surgery. This is why areas requiring volume are designed with fillers, and areas where elasticity is key are designed with lifting lines.

Using a cannula (a blunt-tipped needle) can reduce some of the risk of bruising and blood vessel damage. However, one should not misunderstand that a cannula cannot completely prevent vascular occlusion.

📌 Key Summary: Fillers for volume, Botox for muscle wrinkles, lifting for sagging. It is natural to combine them according to your concerns.

🏥 How should you choose a hospital

Ultimately, safety comes from people and the environment. When choosing a hospital, check the following.

• Whether they use authentic products approved by the Ministry of Food and Drug Safety (MFDS)

• Whether they always keep hyaluronidase in stock in preparation for vascular occlusion

• The skill of the practitioner and experience with approaches for each area

• Infection prevention systems such as disinfection and sterilization

Onlif designs fillers harmoniously by looking at the proportions of the entire face through 1:1 facial analysis, and adheres to the principles of authentic products, precise amounts, and infection prevention systems. Based on the thought that one person cannot do everything well, we operate in a way where each person takes charge of the procedure they do best in their respective field. We aim for natural volume that does not hide your inherent charm, rather than standardized results.

📌 Key Summary: Approved authentic products, hyaluronidase availability, skill, and hygiene. These four are the baseline for choosing a hospital.

❓ Frequently Asked Questions (FAQ)

Does dissolving hyaluronic acid fillers completely return it to its original state?

Injecting hyaluronidase can decompose HA fillers within a few minutes to dozens of minutes. Generally, it returns close to the state before the procedure, but it may vary depending on tissue reaction or individual differences, so a consultation is needed for an accurate judgment.

How long do swelling and bruising last after the procedure?

Bruising, swelling, and tenderness are common reactions and usually subside within 3 to 14 days. However, if the pain gets worse, skin color changes, or vision problems occur, you must inform the hospital immediately.

Why are nose fillers and glabella fillers particularly dangerous?

These two areas are close to blood vessels leading to the eyes and brain, so the risk of blindness and tissue necrosis is relatively high in the event of vascular occlusion. In papers, blindness occurrences are reported as 60% in the glabella and 15% in the nose, classifying them as high-risk areas.

What medications and health functional foods should I stop taking before the procedure?

Anti-inflammatory painkillers such as aspirin and ibuprofen, and Omega-3, Vitamin E, and ginkgo biloba extract increase the risk of bruising, so it is recommended to stop taking them 7 to 14 days before. However, do not stop prescribed anticoagulants arbitrarily and make sure to consult with your prescribing medical staff.

Can I get fillers while pregnant or breastfeeding?

It is not recommended during pregnancy or breastfeeding because there is insufficient safety data. As a rule, you must inform us whether you are pregnant or breastfeeding before the procedure.

What is the reason why under-eye fillers look blue?

If HA filler is injected shallowly into thin skin, the Tyndall effect may occur, where it appears blue due to light scattering. Since the choice of injection layer is often the cause, it can be adjusted with hyaluronidase if necessary.

I have cold sores, can I get lip fillers?

If you have a history of cold sores, the virus can be activated by the procedure, so taking preventive antiviral medication is considered. It is safe to proceed after informing us of your history and consulting.

Why are permanent fillers not recommended?

Permanent fillers like PMMA are virtually impossible to remove even if side effects occur, so they are not recommended domestically or internationally. HA fillers, which can be reversed, are considered a relatively safe option.