Short- and Long-term Patient Perceptions Relative to HA Filler Volume Retention

Abstract Background The efficacy and longevity of hyaluronic acid (HA) fillers is well supported by previous studies evaluating patient-reported outcomes (PROs). However, the longitudinal relationship between patient perceptions and physical volume retention remains unknown. Objectives To assess the short-term relationship between patient perception and measurable volume loss across facial regions and to evaluate long-term satisfaction and treatment-seeking behavior after filler injection. Methods A prospective study enrolled female patients ages 40–65 who received HA fillers to four facial regions using three different products. FACE-Q surveys and 3D imaging were obtained at baseline, immediately post-injection, and at 2 weeks, 4 weeks, and 3 months. Relative changes in volume and PRO scores were analyzed using univariate methods. A long-term follow-up survey was administered 2–5 years post-treatment. Results A total of 101 patients were included. Discordance between objective volume retention and matched PRO scores was observed in the malar and upper perioral regions, where perceived improvement persisted despite volume loss. The lips showed initial alignment between perception and volume, which diverged over time. The lower perioral region exhibited the most proportional decline in satisfaction to volume loss. FACE-Q psychological function and aging appraisal domains demonstrated greater durability than measured volume. Among 35 long-term respondents, 67% reported increased likelihood to seek additional treatments, while cost was the main barrier among those who did not. Conclusions Patient satisfaction often outlasts objective filler volume in select regions. These results could guide patient–provider discussions on treatment frequency for different facial regions, as perceived benefits may persist beyond measurable correction.