Permanent fillers
Silicone and other permanent materials were used widely in the past and are still offered in some places. We would not accept one and cannot think of a reason to.
Faces change. A permanent filler does not, and the problems it causes years later are among the hardest in aesthetic medicine to fix.
How long it lasts
Duration depends on the product, the area and the person.
Hyaluronic acid in the lips, which move constantly, may soften within six to nine months. In the cheeks, chin and jawline, twelve to eighteen months is common.
Calcium hydroxylapatite lasts twelve months or more. Poly-L-lactic acid builds over months and persists for two years or longer.
Individual metabolism matters more than the brochure admits, and some people clear filler quickly for no reason anyone can name.
The practical point is that duration should be described as a range, and a review should be booked rather than a top-up.
Filler added on a schedule, whether or not the face needs it, is how faces end up carrying more than they started with.
Where filler belongs
The honest answer is: in fewer places than it is sold.
Cheeks, temples, chin and jawline are structural areas where a well-chosen gel placed deep restores support. Lips are a matter of taste and a matter of restraint.
The fold beside the nose is treated constantly and is often better addressed by supporting the cheek above it.
The under-eye is the most demanding area on the face and is covered in its own guide.
The nose and the forehead are high-risk areas that belong with a small number of very experienced injectors, if anywhere.
A good injector will sometimes tell you that filler is not the tool for your concern at all.
A crease made by a muscle needs a neuromodulator. Loose skin needs tightening or surgery. Dull skin needs skin treatment.
Filler placed into these problems does not solve them and often makes them look odd.
What can go wrong
The common things are bruising, swelling, tenderness and small lumps. They pass, or they are adjusted at a review. Asymmetry happens and is usually correctable.
Migration, where gel moves from where it was placed to where it was not, is more common in the lips and under the eyes than clinics admit. It is a reason to prefer less product and better placement.
The serious thing is vascular occlusion. Filler injected into a blood vessel, or pressing on one, can block blood flow to an area of skin. Untreated, the skin can die.
In the rarest cases, filler entering the arteries around the nose, glabella or under-eye can reach the eye and cause blindness. This is a known, documented complication of facial filler.
It is rare. It is also the reason that anatomy training, slow injection, aspiration, cannula use in certain areas, and an enzyme kit within arm's reach are not optional extras. Ask about all of them.
Delayed reactions, firm swelling weeks or months after treatment, sometimes after an illness or a vaccination, are uncommon but real with some products. A clinic should know how to recognise and manage them.
Reading an injector
Good injectors share habits. They look at your face from across the room before they come close. They ask you to smile, frown, talk and turn.
They photograph you under the same light every visit. They talk about proportion and support rather than about areas. They under-treat and review.
They say no to something you asked for, at least once.
They can name the product, the depth, the volume and the reason, and they write it all down so that the next injector, if there is one, knows what is in your face.
Poor injectors also share habits: a menu priced by syringe, a recommendation formed before you sat down, a rush to the next room.
A promise about how long it will last. An answer to the enzyme question that involves ordering it.
The consultation
Ask these, and listen for the reasons.
What are you treating, and why is filler the right tool rather than something else? Which product, in which layer, and why that one?
How much, and could we start with less and review? Needle or cannula here, and why?
What is your plan for a vascular event, and is the enzyme in this room? Who will inject me, what is their licence, and where can I check it? What will this look like in a year?
The licence question is answered on public California board websites.
Physicians, registered nurses, nurse practitioners and physician assistants may inject under the arrangements the law sets out. Estheticians may not.
A clinic that is vague about who holds the syringe is a clinic to leave.
Paying for it sensibly
We do not publish prices, because they change and because the cheapest syringe is rarely the best purchase.
We do suggest thinking about filler the way you would think about any other considered expense.
Some readers set money aside in a dedicated account well ahead of a first treatment, and local institutions such as the Los Angeles Federal Credit Union offer the ordinary savings tools for that.
A treatment you have planned and budgeted for is one you can walk away from on the day if the consultation feels wrong.
A treatment on a same-day discount is one you have already half-decided to accept.
One example a reader can measure against these questions is a practice offering Dermal Fillers in Los Angeles alongside thread lifts, laser and skin rejuvenation, where filler can be weighed against the alternatives rather than sold on its own. Run the test on that door and on every other one.
A local note
Larchmont readers ask, reasonably, whether it matters that so many injectors have appeared so quickly around the neighbourhood.
It matters in one way. Density raises the pressure to sell, and selling is the enemy of restraint.
The city's neighbourhood council system, run through EmpowerLA, occasionally hears from residents about new medical-spa openings. It has no say over licensing and cannot help you choose.
The state boards can tell you who is licensed. Only a consultation can tell you who is careful.
The decision
Choose the injector, then the product, then the price, and be prepared to walk out of a consultation that gets the order wrong.
The right injector looks at your face before your wish list, uses a reversible product for a reason they can explain, keeps the enzyme in the room, under-treats and asks you back.
After the basics, the working test is whether the recommendation you receive could only have been made for your face.
