Debunking Myths on Hyaluronic Acid Injectable Gels in Clinical Practice

Navid Alizadeh, Silvia Caboni, Karl Hasenöhrl, Zbigniew Paul Lorenc, Paula Rosso Millan, Billur Sezgin Kizilok, Fang-Wen Tseng, Lee Walker

Image Credit: © Dusko - stock.adobe.com

Background:

Hyaluronic acid (HA)–based soft-tissue fillers are the most widely used injectables for nonsurgical facial rejuvenation, valued for their reversibility, versatility, and safety profile. Despite widespread use, misconceptions about HA gels have proliferated on social media and in clinical discourse, potentially affecting both healthcare professionals and patients.

Methods:

We conducted a narrative, nonsystematic review of the published literature, supplemented by clinical experience and expert opinion of 8 international specialists in aesthetic medicine. Published studies in English were retrieved from PubMed, with priority given to systematic reviews, meta-analyses, and controlled clinical trials. Evidence grading and quality assessment were applied where available.

Results:

Available evidence indicates that HA gels are biodegradable and temporary, with clinical effects generally lasting 4–18 months depending on product, technique, and patient factors. They are reversible through exogenous hyaluronidase injection. Current HA products cross-linked with 1,4-butanediol diglycidyl ether are not associated with toxicity at clinically used concentrations. The risk of gel migration or facial overfill syndrome is not inherent to the products but linked to inadequate anatomical knowledge, suboptimal injection technique, or inappropriate patient selection and counseling. HA gel treatment has also been associated with biostimulatory effects and improvements in patient quality of life.

Conclusions:

The weight of published evidence does not support common misconceptions about HA injectable gels. However, the evidence base is heterogeneous and includes studies of variable methodological quality. Practitioner education, thorough treatment planning, and shared decision-making between healthcare professionals and patients remain important for the safe and effective use of HA injectables.

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Hyaluronic Acid Fillers: Separating Fact From Fiction

If you've spent any time on social media, you've probably come across a scary story about dermal fillers - gel "migrating" to strange places, faces frozen into a permanent puffy look, or fillers that supposedly never go away. It's no surprise patients come into consultations with questions and, sometimes, real hesitation.

A new international review, co-authored by Dr. Z. Paul Lorenc alongside seven other leading aesthetic physicians and published in Plastic and Reconstructive Surgery – Global Open (July 2026), took a close look at the actual science behind hyaluronic acid (HA) fillers — the most widely used injectable treatment in aesthetic medicine today. Here's what the evidence really shows.

Myth #1: "Fillers are permanent"

HA fillers are designed to be temporary. The hyaluronic acid used in these gels is a naturally occurring substance already found in your skin — it's simply modified so it lasts longer once injected. Over time, the body gradually breaks it down and replaces it with its own tissue. Most patients see results lasting anywhere from several months up to a year and a half, depending on the specific product, where it's placed, and individual factors like metabolism and lifestyle. That's very different from some older filler materials, which really were designed to be permanent or semi-permanent.

Myth #2: "Once it's in, there's no going back"

One of the biggest advantages of HA fillers is that they're reversible. If a patient isn't happy with a result, or in the rare case of a complication, an enzyme called hyaluronidase can be injected to dissolve the gel. This has been documented across hundreds of patients in published case studies, and the effect typically begins within hours.

Myth #3: "Filler travels to other parts of the face"

True migration — filler ending up somewhere far from where it was injected — is uncommon when HA fillers are placed by an experienced, well-trained injector. Most of what patients describe as "migration" is actually normal movement within the treated area, which is usually a sign of injection technique rather than a flaw in the product itself. Choosing an injector who deeply understands facial anatomy is the best safeguard.

Myth #4: "Fillers aren't safe"

The safety data on modern HA fillers is extensive. Manufacturing standards require these products to be highly purified, and regulatory limits on the compounds used to stabilize the gel have been in place for over two decades — with today's technology often testing well below those thresholds. Across thousands of patients studied, the most common side effects were mild and temporary: things like swelling, bruising, or tenderness at the injection site.

Myth #5: "Filler always leads to that overdone, 'pillow face' look"

The overfilled, unnatural appearance sometimes seen on social media isn't caused by the filler itself — it's the result of overuse, poor product choice, or treatment without a thoughtful plan. Interestingly, researchers also point to something called "perception drift," where patients undergoing repeated treatments can gradually lose perspective on how much is actually needed. That's exactly why a thorough consultation, a personalized treatment plan, and honest conversations between patient and provider matter so much — the goal is always a natural, balanced result that enhances your features rather than changing who you are.

The bigger picture

Beyond correcting fine lines and restoring volume, research also shows that HA treatments can stimulate the skin's own collagen production and meaningfully improve how patients feel — with studies showing real gains in confidence and psychological well-being after treatment.

The takeaway from this research is simple: HA fillers, in the hands of a skilled, experienced injector, are a safe, temporary, and reversible tool — and most of the "horror stories" trace back to technique and judgment, not the product itself.

Curious whether HA filler is right for you? Schedule a consultation with Dr. Lorenc to discuss a treatment plan tailored to your goals.