Patients often ask if soft tissue filler injections hurt, and if the area is going to be numbed prior to treatment. The account below will hopefully give you a better idea of what to expect from a filler treatment.

All of the injectable products (ex: Juvederm, Radiesse, Restylane, Sculptra, Voluma) we currently use have a lidocaine mixed in them. This will provide some anesthesia after the product is injected. When doing more advanced injections in the midface, cheeks, perioral region, and chin I prefer not to use local anesthetic injections or topical anesthetic creams prior to the treatment. (But I do use local anesthetic blocks when doing lip augmentation and enhancement treatments.) Injecting local anesthetics into the cheeks or chin can alter the shape or surface contour and thereby interfere with the injection process. In addition, topical anesthetic creams can cause swelling  and color changes in the skin, smoothing out fine surface texture markings, which might otherwise be used to guide treatment. Filler treatments are not painless, but I think you will see from reading below that they can be easily tolerated without anesthetic.

My Treatment

I had some mild hollowing in my temples, mild volume loss and flattening of my upper cheeks, mild hollowing on the sides of my cheeks, fairly deep nasolabial fold creases, and slight volume loss on the sides of my chin. These were treated with Voluma, Juvederm Ultra Plus, and Restylane. The pain during the injection process probably ranged from 0 to 4 (on a 10 point scale).  The more significant pains were very short and intermittent.

Voluma injection into the temples – The sharp poke of the needle, a mild ache with further insertion of the needle, and then a mild (or bit more) pressure sensation with the injection.

Voluma injection of the cheeks – My cheek injections were done with a cannula. A small hole is made in the skin with a needle, and then a longer blunt cannula is inserted through this opening. The use of a cannula involves more pressure sensations than any type of a sharp pain. The sharp poke of the needle was as expected.  Inserting the cannula involved the grasping the skin at the entry site, as well as manipulating the skin as the cannula was advanced. This was done with a fairly firm grip, and the pressure from advancing the cannula varied from mild to moderate aches and pressure sensations to something that resembled a numb feeling. I felt some mild pressure intermittently during the actual injection of the filler.

Juvederm injection of the cheeks – These injections were performed in the posterior cheek and in front of my ear using a needle. There was a little sharp poke of the needle, and this was most sensitive in the cheek skin directly in front of the ear.

Injection of the nasolabial folds – This area was more sensitive and the poke of the needle felt rather sharp.  ,There was relatively little pain with advancement of the needle through the underlying subcutaneous tissue, and minimal pressure sensation with the injection. I have a rather deep nasolabial crease. This requires more superficial treatment to soften the crease in the skin. With the more superficial injection, there was a sharp poke of the needle, some mild or moderate sharp pain with advancement of the needle through the dermis, and then some mild pressure with injection. Additional support to my nasolabial crease was provided with cross-hatching injections. These were performed intradermally, and consisted of numerous short transverse injections perpendicular to the nasolabial crease. These needle pokes were sharp, but I noticed that the faster they were performed, the better. Moving more quickly from one injection to the next, was better than doing them more slowly. These did make my eyes water just a bit. These multiple small injections caused the most bleeding of any of the areas that were treated.

Injection of the chin – The needle pokes were moderately sharp in this region. The injections caused more pressure-related pains because some of the filler was placed deeper in the muscle.

A little bit of Botox Cosmetic in the forehead, frown lines, crow’s feet, and chin completed my treatment.

About 4-5 hours after the injections I noticed a pressure and aching in the temples consistent with a mild to moderate headache. This was intensified by chewing, swallowing or biting down. I took two Excedrin Migraine tablets and after about an hour felt better, but there was still some mild pressure and aching. My face was bit sore to touch and my face felt a little stiff from the (mild) swelling.

Although it was suggested that I try to sleep on my back, and not lay on my face, I did not follow these recommendations. Laying on the side of my face was sore and it took me a while to fall asleep. I’m a side sleeper, and slept that way the entire night.

One Day later

The morning after the treatment, I woke up with the feeling of a mild headache, again from the aching and pressure in the temporal region. Several ibuprofen did make this better. I also had moderate soreness in the chin area and in the sides of my face over the cheekbones. My face looked even, my cheeks were less hollow and I had only minimal swelling in all the areas that were treated. There were some red needle marks along my nasolabial folds. A small bruise and swelling was located on  the right side of my chin. A small lump was present beneath the skin on the side of each cheek, and on the left side of my chin; and some small bumps were present at the needle marks along my nasolabial creases . None of these were particularly visible, but could be felt when rubbing the areas. My anterior chin is flatter, and has a better contour.

I made the mistake of eating raisin bran that morning; the amount of chewing required was quite sore in the temple region. And for lunch I had a sandwich with dense chewy bread, and that again was mildly uncomfortable.

By the end of the day the soreness in my  chin and temples was improved. My results looked natural, and if it were not for a few injection marks, and a small bruise, you would never know I had the treatment. My cheeks still felt a bit swollen, and I had some mild discomfort with a full smile, or when I rubbed over the treated areas. All-in-all not too bad, and well worth the improvement. I would still like my anterior cheeks to be a bit fuller, but I can always have more filler placed.

Two Days Later

I woke up with a mild headache again (but that may be due to lack of sleep). I took a few ibuprofen with breakfast and it did not bother me the rest of the day. I experienced a very mild pressure/pain in the temples while eating breakfast; but I did not really notice this while eating at other times later in the day. Sore spots were present in my cheeks (primarily over the cheek bones) when I rubbed over them. My anterior chin still had some deeper soreness when I rubbed over that as well. Intermittently throughout the day I lightly massaged over the bruise on my chin to get it to resolve. Small red marks were present where the filler had been placed superficially into the dermis to support my nasolabial creases; some tiny bumps were present here as well. A very forced smile produced a deep ache in my anterior cheeks. Biting down hard revealed soreness in my temples. When I washed my face before bed, I was still sore over my cheek bones, and I could still feel some minimal underlying irregularities (lumpiness; but it was not visible as such).

Three Days Later

I still had a light purplish bruise on my right anterior chin but it is improving. Some small pink spots are present along my nasolabial creases. If I rubbed firmly over my lateral cheek bones or anterior chin I still had some deep soreness. A big yawn or biting down hard still revealed soreness in my temples. All of these things were signs of the injections, but none of them were limiting; and none had limited me the day before either. The faint beginnings of weakness/relaxation from my Botox treatment were evident if I stood in front of a mirror and checked.

I may leave some additional comments if I feel there is something notable moving forward. I know that any residual soreness I have will resolve over the next few days. I don’t feel that I had any significant down time. The majority of women could have used makeup the first day to conceal any redness or bruises that were present. The discomfort present during the first 24 hours could probably best be described as annoying, but was not limiting.   This follows the typical adage related to taking our normally functioning bodies for granted  … You don’t realize how much you use your facial muscles or rub your face until there is soreness and swelling.

But, would I do it again? You bet.