Aesthetic medicine
Hyaluronic acid fillers
Fillers add volume where tissue has lost it or never had it. The effect is temporary, the procedure is elective and the risks are real. This page describes all three without decoration.
What a filler actually changes
With age and with weight loss, the soft tissues of the face lose volume and subcutaneous fat redistributes. Lips thin, their border blurs, and the folds around the mouth become more pronounced. Some of this is tissue; some of it is the underlying bone and the position of the teeth.
Filler addresses the first part. It does not lift loose skin, does not replace surgery and does not correct a dental problem. If perioral support has been lost because of missing teeth or a reduced bite height, the correct answer is restorative dentistry rather than an injection.
Which product we use
We work with hyaluronic acid fillers — a substance that occurs naturally in tissue and binds water. The main reason for this choice is reversibility: hyaluronic acid can be broken down with the enzyme hyaluronidase. That matters not only when an aesthetic result disappoints, but as part of the protocol if a vascular complication occurs.
We do not use permanent or semi-permanent fillers. A product that cannot be removed leaves very few options if tissues change over the years or if the result is not what you expected.
How we approach it
The aim is tissue that looks like tissue, not maximum volume. We work in stages: a smaller amount, assessment at two weeks, and more only if needed. Adding is easy; taking away is harder.
We do not carry out requests we judge disproportionate to your anatomy or likely to produce an unhealthy appearance. That is professional responsibility rather than taste. If we disagree with a request, we will explain why and will not perform the procedure.
We reply within one working day.
What the evidence supports
Hyaluronic acid fillers are widely used and reasonably well described in terms of expected effect and adverse-event profile. The quality of the evidence nonetheless varies by indication and by product, and much of the published work has short follow-up and mixed methods of assessing outcome.
So you will not find a satisfaction percentage here, or a duration figure presented as a rule. How long the effect lasts depends on the area, the product, how mobile the tissue is and individual metabolism. At consultation you will be given a range, and the reason it is a range.
Stages of treatment
How the procedure runs
Usually 30 to 45 minutes, with a review at two weeks.
Consultation and history
We discuss your goal, medical history, medication including anticoagulants, previous procedures and which products were used in them.
Plan and informed consent
You receive written information on the product, the amount, the expected effect, the risks and the cost. Consent is signed before we start.
Preparation and anaesthesia
The area is cleaned and topical anaesthetic applied. Many products also contain a local anaesthetic, which reduces discomfort during placement.
Placing the product
With a needle or a cannula depending on the area. We work in stages and assess as we go, rather than placing the whole amount at once.
Recovery and review
Swelling and bruising are possible in the first days. The final result is judged at the review around two weeks later, once swelling has settled.
Who this is for
Who this suits
- Adults in good general health with a clear, proportionate goal
- Volume loss in the lips or perioral region
- Acceptance that treatment must be repeated to maintain the effect
- Understanding that the result is judged at two weeks, not on the day
Good to know
- Pregnancy and breastfeeding
- Active infection, inflammation or a cold sore in the area
- Bleeding disorders or anticoagulant therapy without coordination with your physician
- A request for volume out of proportion to your anatomy, or a result taken from someone else’s photograph
Good to know
Risks, including the rare serious one
Common and usually transient: swelling, redness, bruising, tenderness and temporary asymmetry in the first days. Schedule treatment at least two weeks before anything that matters to you socially.
Less common: prolonged swelling, visible or palpable nodules, uneven distribution, inflammatory reaction to the product and infection. Several of these can be corrected, including by dissolving the filler with hyaluronidase.
Vascular occlusion is a rare but serious complication in which product compromises the blood supply to an area. It can cause tissue necrosis and, in exceptional cases and in particular facial zones, visual disturbance. This is why the procedure demands knowledge of vascular anatomy, recognition of the early signs and a protocol for emergency management. If after treatment anywhere you develop severe pain, blanching or a mottled skin pattern, contact a doctor immediately.
Nobody can promise you a result. Filler is an elective procedure with a temporary effect, and doing nothing remains an entirely valid option.
Alternatives
What else we will discuss
A dental solution
Where perioral support has been reduced by missing teeth or a lowered bite height, restorative dentistry changes appearance more, and for longer, than filler does.
Botulinum toxin
For dynamic lines caused by muscle movement, filler is not the right instrument. The two are sometimes combined, but with clearly separated indications.
Doing nothing
Always a valid choice for an elective procedure. If the motivation is external pressure or a passing mood, waiting is sensible.
Surgery
Where tissue laxity is pronounced, fillers do not substitute for surgery, and trying to compensate with volume produces an unnatural result.
Meet the dentist
Dr Nevena Karadjova
Dentist · Specialist in Oral Surgery
All implantology and All-on-X surgery of the clinic: implants, bone grafting and sinus lift, oral surgery, aesthetic medicine.
- DMD, Medical University of Varna
- Specialty in Oral Surgery, MU-Varna, 2019
- Assistant, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, MU-Varna, 2016–2019
- Resident, Maxillofacial Surgery Clinic, UMHAT “Sv. Marina”, Varna, until 2017
- 2,000+ implants placed personally
Frequently asked questions
Questions about fillers
With hyaluronic acid fillers, yes. An enzyme called hyaluronidase breaks it down. That is precisely why we do not use permanent products. Dissolving is a separate procedure with its own risks, and it does not always return tissue to exactly its previous state.
The effect is temporary and fades gradually. Duration depends on the area, the product, how mobile the tissue is and individual metabolism. We will not give you a single number, because it would mislead; at consultation you receive a range for the specific area.
That depends on the amount and on respecting your anatomy. We work in stages with small amounts and assess at two weeks. If you decide you want more, adding is straightforward. If you ask for volume we consider disproportionate, we will decline and explain why.
Most reactions are mild and transient. There is a rare but serious complication — vascular occlusion, in which the blood supply to an area is compromised. That is why it matters who performs the procedure, whether they know the vascular anatomy and whether an emergency protocol is in place.
At least two weeks, and three if possible. Swelling and bruising settle within days, but the review and any adjustment happen at day fourteen. Scheduling with a margin is part of getting a result you are happy with. If there is less time than that, we will suggest postponing rather than risking the result.
We do not publish a price, because cost depends on the area and the amount of product required. You receive a written price after consultation, before agreeing to any procedure. It covers the product, the procedure and the review two weeks later. If an adjustment is needed, the terms are set out in the plan beforehand.
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