Dermal filler myths:
six common claims, checked against the evidence

Myth 1: "Hyaluronic acid filler is gone within a year"

Hyaluronic acid filler often stays in the tissue for longer than the visible effect lasts. A 2024 review of magnetic resonance imaging in 33 patients who had received hyaluronic acid filler in the mid-face found filler still present in every one of them, including 21 who had not been injected for two to five years and 12 for more than five years, with one patient showing filler about fifteen years later. A 2026 systematic review of 24 studies and 1,410 patients reached a similar conclusion from a different angle: persistence varied with the product's manufacturing technology, the movement of the area and the anatomy, and was commonly measured at a year or two rather than months.

Neither study says filler lasts forever, and the persistence measured on a scan is not the same as the look you notice. What they show is that "it has worn off" and "it has gone" are different statements. That is why Dr Sin Yong scans earlier filler with ultrasound, where the history is unclear, before anything new is added. The materials and how each behaves are explained on dermal fillers Singapore.

Myth 2: "Regular top-ups keep filler looking natural"

Topping up on a fixed timetable is one of the commonest routes to an overfilled face. If filler persists in the tissue for years, as the imaging studies above suggest, then adding more every few months because the original "should" have worn off layers new product over old. The authors of the 2024 MRI review drew exactly this conclusion, calling for refilling protocols to be reconsidered. The heavy, wide, puffy look that results is described as pillow face or facial overfilled syndrome.

A natural result comes from asking what is missing before asking what to add: structure before volume, bone before soft tissue, and a plan for the whole face rather than a count of syringes. Dr Sin Yong prefers energy-based treatment for many concerns that injectables are used for, FSX Laser for the skin and the VF Lift for lifting and hollow areas, because it adds no product to accumulate. Where too much is already present, the options are on pillow face treatment, and the worry itself is discussed on will filler make me look fake.

“Most of the filler problems I see are not one bad injection. They are years of reasonable-sounding top-ups on top of filler that never left.”

Dr Sin YongOn filler that has not gone

Myth 3: "Filler stretches the skin and makes it sag later"

There is no good evidence that appropriately placed filler makes skin sag when it fades. The idea is intuitive, a balloon stretched and then deflated, but the tissue studies point elsewhere. A 2007 study injected cross-linked hyaluronic acid into sun-damaged forearm skin of 11 older volunteers and took biopsies at four and thirteen weeks: compared with saline, the filler-injected skin showed new collagen deposited around the filler, with fibroblasts that looked mechanically stretched and active. The authors suggested the stretch itself switches fibroblasts on.

That is laboratory evidence in forearm skin, not proof of a better-looking face, and it is not a reason to inject more. The real version of the worry is overfilling: large volumes in the wrong layer can make the face heavier and, in the midface and under the eyes, add weight to tissue that is already descending. The answer is restraint and correct placement, and, where sagging is the main problem, a lifting treatment rather than filler. The distinction is set out on lifting without fillers.

Myth 4: "Any filler can be dissolved if you don't like it"

Hyaluronic acid is the filler that can be dissolved, with an enzyme called hyaluronidase. A 2021 guideline on the safe use of hyaluronidase in aesthetic medicine sets out how it is used both for elective correction of unwanted hyaluronic acid and, at higher doses, in emergencies such as blockage of a blood vessel. That reversibility is one reason hyaluronic acid is the usual first choice in areas where it matters, such as the lips and tear trough.

Calcium hydroxylapatite (Radiesse), polycaprolactone (Ellansé) and poly-L-lactic acid (Sculptra) cannot be dissolved, because hyaluronidase acts on hyaluronic acid and nothing else. So the material is chosen before the product, and non-dissolvable materials are placed conservatively. Where unwanted non-hyaluronic acid product is present, Dr Sin Yong treats it with the Sculpting mode of Time Freeze Laser LCLR®, without an incision. How dissolving works, and when it does not, is on hyaluronidase and filler dissolving.

Myth 5: "Blindness from filler is just a scare story"

Vision loss after filler is rare, but it is real, and it is the reason filler is a medical procedure. A 2024 review updated the published cases and identified 365 new cases of partial or complete vision loss after filler injection reported between 2018 and 2023. The highest-risk sites were the nose, the forehead and the glabella, the area between the brows, and most cases involved hyaluronic acid. Of the cases that reported outcomes, most had no recovery of vision. The authors described it as rare but disastrous and stressed prevention and preparedness.

That is why the nose is treated with particular care here, with a fine needle placed on the bone, why hyaluronidase is kept in the room wherever hyaluronic acid is injected, and why the warning signs are explained before treatment: skin turning white, grey or dusky, severe pain, and any change in vision or a drooping lid. Those signs are an emergency, as set out on filler warning signs.

Myth 6: "If there's no lump in the first week, there won't be one"

Filler side effects come in early and delayed types, and some appear months or years after injection. A 2024 review of the non-vascular adverse effects of dermal fillers grouped them by timing: early effects such as swelling, bruising, redness and asymmetry, and delayed ones such as nodules, granulomas, migration and infection. Delayed inflammatory swelling can be triggered by an illness, a dental procedure or a vaccination, often in filler that had been quiet for a long time.

So a lump, swelling or change in shape that appears long after filler is worth having examined rather than massaged or ignored, and so is filler that seems to have moved. Ultrasound shows what is there and where it sits, which decides whether it is dissolved, treated or left. The causes are explained on delayed filler reactions and filler migration. A firm lump that stays, from any product, is covered under lump after filler.