Dermal Fillers in Fresno
Dermal fillers are hyaluronic acid gels injected beneath the skin to restore volume the face has lost and to soften folds that show when the face is at rest. At Savage Serenity MedSpa in Fresno, filler is performed by a team of nurse injectors led and trained by Angela Hash, BSN, RN, using RHA and Evolysse hyaluronic acid fillers. This page explains what filler can and cannot do, what the appointment involves, what the studies behind these products say about results and risks, and how pricing works, so you can decide whether a consultation is worth your time.
Dermal fillers at Savage Serenity at a glance
What dermal fillers do
Dermal fillers add volume where the face has lost it. As we age, the fat pads, bone, and collagen that hold the face up thin out, and the skin above them folds, hollows, or drifts downward. Hyaluronic acid is a sugar molecule the body already makes; filler is a purified, cross linked gel of it that holds its shape under the skin and is broken down slowly over time.
Filler and Botox solve different problems. Botox relaxes the muscles that crease the skin when you frown, squint, or raise your brows, so it treats lines that appear with movement. Filler treats the lines and hollows that are there when your face is completely still. Many of our patients use both, and the consultation is where your injector sorts out which line is which. Our Botox in Fresno page explains the other half of that pairing.
How Angela approaches filler
Angela describes her approach as full facial balancing. She looks at the face as a whole and builds a plan that restores balance, supports the way you are naturally aging, and keeps you looking like yourself. In her words, “My goal is never to change someone’s face.”
In practice, that means she often treats a line by treating the area above it. A fold beside the mouth is frequently the result of volume loss in the cheek. Restore the cheek, and the fold softens with less product placed directly in it. It also means she will sometimes recommend less than you came in asking for, or a different area entirely, and she will tell you why. Angela trains the injectors on her team in this approach, so a plan made by Michelle Perkins, RN, or Candice Brantley, NP, is built the same way.
The fillers we use
Savage Serenity carries two hyaluronic acid filler lines, RHA and Evolysse. Your injector chooses the product by the area and the depth it will sit at; a gel firm enough to support the cheek is the wrong gel for a fine line at the lip.
RHA
Evolysse
What happens at your appointment
Consultation
Screening
Numbing
Injection
Check and follow up
Where filler is used at Savage Serenity
Fillers are designed and studied area by area, because each part of the face has its own anatomy and its own risks. The areas below are where we use filler at Savage Serenity, beginning with the ones we treat most.
Cheeks and midface
Smile lines and the folds around the mouth
Lips
We also treat the under eye hollows, the jawline, the chin, and the temples with filler. Each is planned from your own anatomy at the consultation, with the product and the amount chosen for the area, and your injector will discuss with you whether it is appropriate for your face. The risks described further down apply to every area filler is placed.
Under eye hollows. The hollow between the lower lid and the cheek makes people look tired when they are not. It is the most technique sensitive area on the face: the skin is thin and blood vessels sit close to the surface. We are selective about who we treat here, and when the shadow comes from cheek volume loss we recommend cheek filler first.
Jawline. Filler placed along the jaw is intended to define the line of the jaw and soften the dip that forms in front of an early jowl. A firm product is placed along the bone for this area.
Chin. A small amount of filler in the chin is intended to bring a recessed chin forward so the profile reads in proportion with the lips and nose. It is a small change that alters how the whole face reads from the side.
Temples. Filler in the temple is intended to soften the hollow at the sides of the forehead that develops with age and can make the upper face look drawn. A small amount is placed deep, and we treat this area conservatively.
Results and how long they last
Filler results are visible at the appointment. Swelling and tenderness are usual for the first days and can make the area look fuller than the final result; in the RHA studies, most injection site reactions had resolved by day 14. Our guidance is to judge the result at about two to four weeks.
How long the improvement lasts depends on the product, the area, and you. The study figures are the honest ones:
- RHA 3 and RHA 4 for smile lines and folds: more than 78 and 89 percent of people, respectively, still had a meaningful improvement 64 weeks after their first treatment.
- RHA 4 for the cheeks: more than 65 percent of people still had a meaningful improvement 52 weeks after their last treatment.
- Evolysse Smooth for smile lines and folds: 65 percent of people still had at least a one grade improvement at 12 months.
These are study results, and your own result may last a shorter or a longer time. Areas that move more, such as the lips and the folds around the mouth, tend to be retreated sooner than the cheeks. Your injector will tell you what she typically sees and when to plan your next visit.
Risks, side effects, and when to call
Most people have swelling, tenderness or pain, redness, bruising, firmness, small lumps or bumps, or itching at the injection sites. In the RHA and Evolysse studies, most of these were mild and resolved within one to two weeks.
The serious risk with any filler, in any area, is unintentional injection into a blood vessel. The FDA’s patient information for these fillers puts it this way: the chances of this happening are very small, but if it does happen, the complications can be serious, and may be permanent. The complications reported for facial injections include vision problems, blindness, stroke, temporary scabs, and permanent scarring of the skin. Other risks reported with fillers include infection, lumps or nodules that may need treatment, filler moving from where it was placed, and swelling or inflammation at the treatment site that appears weeks or months later, sometimes after an illness, a vaccination, or dental work. The area around the eyes and the temples are where the most serious of these complications, including vision loss, have most often been reported, which is one reason we are conservative in both.
Savage Serenity keeps hyaluronidase, the enzyme that dissolves hyaluronic acid filler, in the treatment room at all times, so a vascular occlusion can be treated the moment it is suspected. Prompt, high dose hyaluronidase is the treatment the American Society for Dermatologic Surgery task force recommends for filler related vascular occlusion.
Call us right away, and if you cannot reach us go to an emergency room, if after treatment you have:
- Changes in your vision.
- Signs of a stroke, including sudden difficulty speaking, numbness or weakness in your face, arms, or legs, difficulty walking, face drooping, severe headache, dizziness, or confusion.
- A white, gray, or blue appearance of the skin near the injection site.
- Unusual pain during or shortly after treatment, or significant pain away from the injection site.
Also call if redness or visible swelling lasts more than a week, or if any side effect appears weeks or months after treatment.
Filler is not for everyone. You should not be treated if you have severe allergies with a history of anaphylaxis or multiple severe allergies, an allergy to gram positive bacterial proteins, an allergy to lidocaine or similar anesthetics, or a bleeding disorder. The fillers we use were studied in adults 22 and older. Treatment is deferred during pregnancy and breastfeeding, and postponed if there is an active breakout, cold sore, or infection at the treatment site.
Before and after your appointment
Before
For the week before treatment, avoid aspirin, ibuprofen and similar anti inflammatories, fish oil, St. John’s Wort, and high dose vitamin E unless a physician has prescribed them, to reduce bruising; a prescribed blood thinner is never stopped without talking to your injector and your prescriber. Plan filler at least two weeks away from dental work and any invasive or surgical procedure. If you have an event, give yourself three to four weeks.
After
Skip makeup for the first 12 hours. For the first 24 hours, or until swelling and redness settle, keep the treated area away from excessive sun, tanning lamps, and extreme heat or cold, including saunas. Wait until the next day for exercise or anything strenuous. Avoid pressing on or massaging the area for three days unless your injector tells you to. You leave with the practice’s written aftercare sheet, which includes its rule on alcohol.
How dermal filler pricing works
Filler is priced per syringe, and the price per syringe depends on the product. Most facial balancing plans use more than one syringe; a subtle cheek refresh might be one or two syringes, and a plan covering the cheeks and the folds around the mouth uses more. During your consultation your injector writes down how many syringes she recommends, which product, and the total, and nothing is injected until you have agreed to it. There is no package you have to buy, and follow up visits are not charged.
Why Fresno patients choose Savage Serenity for filler
A team trained by one injector. Angela Hash, BSN, RN, trains every injector at Savage Serenity in her facial balancing approach. Your filler is performed by Angela, Michelle Perkins, RN, or Candice Brantley, NP, and the injector who examined your face is the one holding the syringe and the one you see at follow up.
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A physician medical director
Dr. Luis Lee is the practice’s medical director and supervising physician. -
Two filler lines, explained plainly
We carry RHA and Evolysse, we tell you what each one is for, and your injector tells you which product is going where on your face and why. -
Reversal on hand
Hyaluronic acid filler can be dissolved with hyaluronidase, and we keep it in the room, both for the rare emergency and for the patient who wants a result adjusted after it settles. -
A face that still looks like you
Every plan here is built around balance and support, with the aim that people notice you look healthy and refreshed, smoother and more like yourself, and cannot say what changed.
Frequently asked questions about dermal fillers in Fresno
It depends on the product, the area, and your own metabolism. In the studies, most people treated with RHA still had a meaningful improvement in their smile lines and folds 64 weeks after the first treatment, most people treated in the cheeks with RHA 4 still did a year after their last treatment, and about two thirds of people treated with Evolysse Smooth still did at 12 months. Lips and the folds around the mouth move more and are usually retreated sooner than the cheeks.
Most people feel pressure and a pinch. Topical numbing cream goes on first, the fillers contain a local anesthetic, and a cannula, where your injector uses one, means fewer entry points. The cheek and lip areas tend to be more sensitive than the folds.
Right away. Filler adds volume the moment it is placed. Swelling for the first several days makes the area look fuller than it will end up, so the settled result is best judged at two to four weeks.
Yes. Hyaluronic acid filler can be broken down with hyaluronidase, an injectable enzyme, partly or completely. This is one reason the practice works with hyaluronic acid products. Dissolving is a medical treatment with its own consultation, and the enzyme itself carries an allergy risk that your injector screens for. Read more in our article on dissolving filler in Fresno.
A cannula is a thin, blunt tipped tube that enters through a single small opening and glides beneath the skin, so filler can be placed along a wider area from one entry point. A needle is sharp and enters at each injection site. Your injector chooses needle or cannula by the area, the depth, and the product; the RHA cheek studies, for example, used a blunt 25 gauge cannula. Every injection carries the vascular risk described above, whichever instrument is used.
Hyaluronic acid filler adds volume at the appointment and is gradually absorbed. Sculptra is poly L lactic acid; it is used for smile lines and other facial folds and for fine lines in the cheeks, works over a series of sessions, and the body may produce new collagen in response to it. The two are sometimes used together in one plan. Our article on hyaluronic acid fillers versus Sculptra and our Sculptra in Fresno page go deeper.
Three to four weeks. Swelling takes a few days to settle, bruising can take up to two weeks to clear, and we like to see the settled result at the two week follow up with time to adjust.
Yes. Botox treats the lines that form with expression and filler treats the lines and hollows present at rest, so they are often planned together. Your injector decides the order and the spacing at your consultation.
Anyone with severe allergies with a history of anaphylaxis or multiple severe allergies, an allergy to gram positive bacterial proteins, an allergy to lidocaine or similar anesthetics, or a bleeding disorder. Treatment is also postponed during pregnancy and breastfeeding, during an active skin infection or cold sore at the site, and within two weeks of dental or surgical procedures. The fillers we use were studied in adults 22 and older; your injector will talk through age with you at your consultation.
Book a dermal filler consultation in Fresno
The consultation is where the plan is made, in writing, before anything is injected. Book online, call (559) 388-8726, or text (559) 780-8773. Savage Serenity MedSpa is at 997 E. Champlain Drive #160, Fresno, CA 93720, open Monday through Friday, 9:00 am to 5:00 pm.
Keep Reading
Sources
U.S. Food and Drug Administration. RHA 2, RHA 3, RHA 4 Instructions for Use (P170002). Approved 10/19/2017. https://www.accessdata.fda.gov/cdrh_docs/pdf17/P170002C.pdf
U.S. Food and Drug Administration. RHA 4 and RHA Dynamic Volume Directions for Use (P170002/S048). Approved 09/18/2025. https://www.accessdata.fda.gov/cdrh_docs/pdf17/P170002S048D.pdf
U.S. Food and Drug Administration. Evolysse Form Patient Information (P240022). Approved 02/13/2025. https://www.accessdata.fda.gov/cdrh_docs/pdf24/P240022D.pdf
U.S. Food and Drug Administration. Summary of Safety and Effectiveness Data, Evolysse Smooth and Evolysse Form (P240022). Approved 02/13/2025. https://www.accessdata.fda.gov/cdrh_docs/pdf24/P240022B.pdf
U.S. Food and Drug Administration. Dermal Fillers (Soft Tissue Fillers). Content current as of 07/06/2023. https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers
American Society for Dermatologic Surgery. Jones DH et al. Preventing and Treating Adverse Events of Injectable Fillers: Evidence-Based Recommendations From the ASDS Multidisciplinary Task Force. Dermatologic Surgery 2021;47(2):214–226. https://www.asds.net/Portals/0/PDF/asdsa/Preventing%20and%20Treating%20Adverse%20Events%20of%20Injectable%20Fillers%20Evidence-Based%20Recs%20From%20ASDS%20Task%20Force%20Article.pdf
American Academy of Dermatology. Fillers: FAQs. Accessed 09/23/2026 (page undated). https://www.aad.org/public/cosmetic/wrinkles/fillers-faqs