Written by Joy DeRoche, NP. Board-certified Nurse Practitioner and owner of Joyful Beauty NP in Plaistow, NH. Practicing aesthetic medicine since 2015 and former Preceptor who trained injectors for five large med spa chains.
I’ll let you in on something: almost every first-timer sits down in my chair a little nervous. That’s completely normal. I never take it for granted that you’re trusting me with your face.
I’ve been injecting filler since 2015. For years, I also trained other providers as a Preceptor for five large med spa chains. I’ve seen what a great first appointment looks like. I’ve also seen what happens when it’s rushed.
So let’s take the mystery out of it. Here is exactly what happens at a first filler appointment in my office, step by step.
What Dermal Filler Actually Is
Most of the dermal fillers I use are made from hyaluronic acid. Your body already makes this substance. It holds moisture and gives skin its plumpness.
As we age, we lose volume and support in the face. Filler replaces some of that support in a precise, controlled way. It can:
- Restore volume in the cheeks, temples, and under the eyes
- Soften smile lines, marionette lines, and smoker’s lines
- Add shape and hydration to the lips
- Balance the chin and jawline for a more defined profile
Here is something that brings many patients peace of mind. Hyaluronic acid filler can be dissolved with an enzyme called hyaluronidase if needed. That reversibility is one reason I recommend it for first-timers.
Filler is different from Botox and other wrinkle relaxers. Those relax muscles. Filler adds volume and structure. If you’re not sure which one you need, we can figure it out together at your consultation.
Step 1: The Consultation
Before anything else, we talk. I’ll ask about your goals and what you’ve noticed about your face that you’d like to change, or keep.
I’ll also review your health history. This matters. I want to know about:
- Medications and supplements, especially anything that thins the blood
- Allergies
- Past cosmetic treatments, including any filler from another provider
- History of cold sores, if we’re treating the lips
- Upcoming dental work, vaccines, or medical procedures
- Pregnancy or breastfeeding. I don’t treat with filler during either.
Then I look at your whole face, not just the area that bothers you. Sometimes a line around the mouth is really caused by volume loss in the cheek. Treating the cause often gives a softer, more natural result.
I’ll give you an honest assessment of what filler can realistically do. Sometimes the plan is simple. Sometimes I’ll suggest starting with one area and building over time. And occasionally I’ll tell you a different treatment would suit you better. You’ll never be pressured to do anything.
Step 2: Before Your Appointment
I’ll give you specific instructions based on your health history. A few general tips help most people:
- Check in with me about medications and supplements that may increase bruising. Common ones include fish oil, vitamin E, and ibuprofen. Never stop anything prescribed without talking to your doctor first.
- Skip alcohol and heavy workouts the day before and the day of your appointment.
- Come with a clean face if you can. I’ll still cleanse the area thoroughly.
- Eat a normal meal beforehand so you feel your best.
- Plan ahead for events. Give yourself at least two weeks before a wedding, photos, or a big trip.
Step 3: The Treatment
Here is what happens once you’re in the chair:
- Photos. I take before photos so we can compare your results later.
- Mapping. I mark the treatment points and walk you through the plan.
- Cleansing. I clean the skin carefully. This step is important for preventing infection.
- Comfort. Most fillers contain lidocaine, a local numbing medicine. For lips, I usually apply topical numbing cream as well.
- Injecting. I use small, careful amounts. Depending on the area, I may use a fine needle or a blunt-tip cannula.
- Checking. I step back, assess symmetry, and hand you a mirror. We decide together if anything needs refining.
Most patients are surprised by how comfortable it is. Many describe a little pressure or a quick pinch. The injecting itself usually takes 15 to 30 minutes. Plan for about an hour total with your consultation.
A note on safety. The face has a complex network of blood vessels. Safe filler starts with a deep understanding of facial anatomy. I inject slowly, use conservative amounts, and watch your skin closely the entire time. I keep hyaluronidase in the office at every appointment. I know how to use it quickly if it’s ever needed. This is one of the most important questions to ask any injector.
Step 4: Aftercare and What’s Normal
You can go back to most normal activities right away. For the best results, follow these aftercare steps:
- Avoid strenuous exercise, saunas, and hot yoga for 24 to 48 hours.
- Skip alcohol for the first 24 hours to help reduce swelling and bruising.
- Don’t massage or press on the area unless I tell you to.
- Hold off on facials, lasers, and dental cleanings for about two weeks.
- Use a cool compress for short periods if you have swelling.
- Sleep with your head slightly elevated the first night.
Your Recovery Timeline
Here is what most patients experience:
- Day 1 to 3: Some swelling, tenderness, or small bruises are common. Lips usually swell the most. This is temporary.
- Day 4 to 7: Swelling goes down. You start to see a more natural shape.
- Week 2: The filler softens and settles into place. This is when you see your true result.
Results usually last between 6 and 18 months. It depends on the product, the area treated, and your metabolism. Lips tend to last a little shorter. Cheeks and chin often last longer.
Signs to Call Me Right Away
Serious complications are rare, but I want you to know what to watch for. Call me right away if you notice:
- Pain that gets worse instead of better
- Skin that looks white, blotchy, gray, or purple near the treatment area
- A lump that is hot, red, or increasingly painful
- Any change in your vision
I give every patient a way to reach me after their appointment. If something doesn’t look or feel right, call me. That’s what I’m here for.
How to Choose the Right Injector
After years of training other providers, I can tell you the injector matters more than the product. Before you book anywhere, ask:
- What are your medical credentials, and how long have you been injecting?
- Do you keep hyaluronidase on hand?
- Can I see before and after photos of your own patients?
- Do you offer a follow-up visit?
- Will you tell me if I don’t need treatment?
A good injector will welcome every one of these questions. You can see some of my own patients’ results in my posts on chin filler and on Instagram.
First Filler Appointment FAQs
Most patients say it’s much easier than they expected. Most fillers contain lidocaine to numb the area as I work. I also use topical numbing for sensitive areas like the lips.
Not with me. My goal is for you to look refreshed, not changed. I start conservatively. It’s always easy to add more at a follow-up visit.
It depends on your goals and the area. Many first-timers start with one syringe. I’ll recommend an amount at your consultation, and I’ll never push more than you need.
Yes. Most patients return to work right after. If you bruise easily, you may want to schedule before a weekend.
Wait two weeks for the swelling to settle. Then come see me. Small adjustments are usually simple. Hyaluronic acid filler can also be dissolved if needed.
Yes. I like to see first-time filler patients about two weeks after treatment. We check your results together and make sure you’re happy.
Your First Step
You don’t have to decide anything today. Come in, ask all your questions, and see how you feel.
Joyful Beauty NP is located at 155 Main Street in Plaistow, NH. I see patients from Plaistow, Haverhill, Atkinson, Hampstead, and across the Seacoast. Schedule your free consultation or call 978-702-3736, and let’s talk.
This article is for general education and isn’t a substitute for a personal medical consultation. Your treatment plan depends on your own health history and goals.
