Revitalise Your Look: The Ultimate Guide to Dermal Fillers

Dermal fillers are one of the most important tools we have available. One of the reasons that they continued to grow in popularity over the years is that they can restore many of the key signs of ageing, including restoring volume loss to reduce sagging skin, as well as reducing facial lines and wrinkles. They can even be used to contour the face, camouflage a bump or the nose or correct a receding chin. As well as being very versatile, they are also generally – in the hands of skilled doctors and surgeons – very safe and less risky than traditional surgical options.

Key Takeaways

• Versatile – can treat anything from sagging skin and deep wrinkles to nose bumps and receding chins.
• Safe – the rate of complications in well-qualified and experienced hands is much lower than in surgical alternatives.
• Effective – the results can be a dramatic improvement that still looks natural. Most patients are very happy with the outcome.

What are Dermal Fillers & How Do They Work?

Most modern dermal fillers are made of hyaluronic acid. The hyaluronic acid in dermal fillers is a natural substance that is identical to the hyaluronic acid we have present in our own connective tissues. Because it is identical to our own hyaluronic acid, the risks of an allergic reaction are very low, which means you can have treatment without the need for a test patch first. Although the name dermal filler suggests the material is injected into the dermis (skin), actually, most fillers are injected under the skin – into the facial fat, to restore volume that’s been lost through the ageing process. There are other types of filler materials available, including calcium hydroxylapatite and poly-l-lactic acid (known commercially by names like Radiesse, Harmonica, or Sculptra), although these are less popular except for specific indications.

Types of Dermal Fillers

Hyaluronic acid

Hyaluronic acid is the most commonly use type of filler because it is very versatile and long-lasting. The different types of filler have different characteristics – from thick gels like cement all the way through to thin gels like water in consistency – and everything in between. It’s also popular because, in the event of a complication, it can be dissolved using an enzyme called hyaluronidase.

Calcium hydroxylapatite

Fillers made from calcium hydroxylapatite are popular for different reasons. Radiesse, for example, is a very hard gel that is recommended for creating projection on the chin or jaw bone (although it’s not one we use in our practice). Harmonica, on the other hand, is helpful for stimulating your own collagen production and can be helpful for areas where we want to improve skin quality without using laser-like in the cheek area.

Poly l lactic acid

Poly l lactic acid (PLLA) is available in a couple of commercial preparations. It also works by stimulating your own collagen production, although it has a habit of causing lumps, and so it is best used on non-facial areas like crepe skin on the arms or neck.

Benefits of Dermal Fillers

Dermal fillers are a very effective way to improve many of the aesthetic concerns our patients have about their appearance. In experienced hands, they are both safe and effective and can deliver natural results. In consequence, most of our patients go on to feel better about themselves with improved psychological well-being and reduced social anxiety about their appearance.

Instant Results

The improvements achieved by dermal filler treatments are usually visible immediately following treatment. However, they typically continue to improve over the coming weeks and months as any swelling from the injection procedure settles, the filler integrates with the tissues, and – quite often – the filler retains additional volume from water in its environment. This means that most patients are happy straight away, but even happier as time goes on.

Minimal Recovery Time

Patients can normally resume normal activities immediately after their dermal fillers. Although it is common to experience some swelling and redness from at the injection site, this is usually quite minor and patients get back to normal quite quickly. The exception to this is when we treat the lips. The lips swell more than any other part of the face and if you plan to have this area treated you should expect some visible swelling for at least a few days after treatment.

Long-Lasting Effects

It’s a misconception that fillers only last a few months. In fact, most modern dermal fillers last 18 – 24 months, and sometimes even longer than this.

Natural-Looking Results

Although dermal fillers get a bad rep because of over-done celebrities, when the treatment is performed appropriately with the aim of simply restoring what’s been lost (rather than trying to create something nature never intended), the results are extremely natural and effective.

Non-permanent

The results of dermal fillers are long-lasting but non-permanent, which means they can be adjusted and tweaked further as your face continues to change with age. Before we had dermal fillers, doctors had to restore volume loss using surgical implants. The implants would look great at the start, but as the underlying facial shape continued to deteriorate with age, the implants would look less natural and eventually need to be changed. With dermal fillers, however, we can continue to tweak and adjust easily because the results are not permanent.

Reversible

Most dermal fillers are reversible, which means we can inject another material – an enzyme called hyaluronidase – to dissolve them. This is helpful if you are not satisfied with the appearance of your treatment or if you experience a complication.

Who is suitable for dermal fillers?

Dermal fillers are predominantly used for patients in their 40s, 50s, 60s and 70s to restore lost volume to the face. We can and do treat patients older than this, although the results tend to be more modest into the 80s and beyond. Occasionally, we use dermal filler in younger patients, particularly if they have a bump on their nose or if they have a weak chin that would benefit from moving forward a little.

Dermal Fillers for Cheek Enhancement

One of the most important parts of the face where dermal filler injections are used is the cheek. Loss of volume from the cheek is one of the most significant changes that occurs as part of the facial ageing process. There is a tendency to focus too much on the volume loss from the front – or apple – of the cheek. However, the back of the cheek, in front of the ear, as well as the lower part of the cheek also lose volume too, and to create a natural-looking result, we need to pay attention to all parts of the cheek for a balanced, harmonious look that is natural and attractive.

Addressing the Sagging Jawline with Fillers

The lower jaw – or mandible – also loses a tremendous amount of volume with age, although in this case, it is predominantly from loss of bone. This means there is a less bony projection to hold the overlying skin and soft tissues in place, so they slide forward, contributing to the jowls. To address this, we often use injectable fillers under the jaw to restore the proportions of the bone and reduce one of the underlying causes of sagging jawlines and jowls.

The Cost of Dermal Fillers

The cost of dermal fillers really depends on your own anatomy and how much volume you need. If you are in your 50s, and you haven’t had any procedures in the past, then your face has probably been losing volume for the best part of 30 years, and so it is going to take a bit of work to restore all of that. For patients in their 50s, 10 – 20mls might be required, charged at £300 – £325 per ml, which comes in at £3000 – £6500. You don’t need to do all of that at once: you might do 8-10mls, then come back in a year or two and do another 8-10mls. Or you might do 3 or 4mls at a cost of £900 – £1300 per session and come back and keep doing that every few months until you reach the point of ‘optimal correction’. When your face has been fully restored, and you reach the point of ‘optimal correction’, the costs of maintaining the results tend to diminish. Typically, in the longer term, most of our patients have 1 or 2mls per year, which is enough to keep them going. Ultimately, it’s a personal preference, and it’s our job to work with you to find a treatment plan that suits your goals and your budget.

The Consultation Process for Dermal Fillers

The initial consultation process for treatment with dermal fillers is vital to make sure you achieve the outcome you want. It’s the time when you talk to your doctor about what it is that you don’t like and what you want to achieve. Patients choose to come to our practice because we focus on creating natural-looking outcomes that make our patients look fresh but not frozen. Not all practices are the same: some practices cater to different aesthetic tastes, for example, with prominent lips or sharp chins and cheeks. We prefer looks that are softer and more subtle. There are no right or wrong answers to this, but it is important that both the doctor and the patient use the consultation process to make sure that both are on the same page about what the goal is. A great way of doing this is by looking at before and after examples of previous patients. A previous before and after photo is not a guarantee that you will get the same result, but it is a helpful tool to communicate and give you an idea of the particular doctor or clinic’s style of work.

Dermal Filler Procedure and Aftercare

Facial assessment & mapping

We start with some very clear, detailed clinical photographs of your face so that we can study the proportions and the areas of concern thoroughly. We then utilise this to plan the areas of that face that we want to treat with dermal filler.

Cleansing & anaesthetising

Before your appointment, it is helpful if you come with a clean face and no make-up. Before any dermal filler procedures can take place, it is important that the skin is both clean and disinfected to minimise the chances of complications. Typically, the anaesthetic built into the filler is enough to make the treatment comfortable for most patients. Occasionally, if we are performing filler injections in a very sensitive area – like the lips – we will also use an additional topical anaesthetic cream for maximum comfort.

The dermal filler injection procedure

The injection of dermal fillers into the face usually occurs in a step-wise pattern. We inject a small amount and check that we are achieving the outcome we are expecting before continuing to inject more. We constantly stop and reassess throughout the procedure to make sure we are getting to where we expect to be. When we are doing this, we may ask you to sit up and lie back several times so that we can check in different positions.

Clean-up & recovery

Afterwards, we apply some antiseptic to clean the injection sites. It is common for the injection site to ooze a little blood for a few minutes afterwards, and we will give you some sterile gauze to press on the skin until it stops.

Longevity of Dermal Fillers

In general, when you inject dermal fillers, the results last for a long time. Fillers typically last up to two years, which is when a touch-up is required – although it can be even longer than this. Underestimating how long the fillers last and repeating them too frequently are some of the main reasons people get unnatural results from filler procedures. If you have well-performed filler injections, and you have a good doctor who doesn’t try to encourage you to do repeat treatments too frequently, you should achieve a youthful appearance that looks very natural.

Non-Surgical Facial Rejuvenation with Fillers

Dermal fillers work by restoring volume to the face. That makes they can correct hollows that appear with age, as well as reduce the appearance of deeper wrinkles and folds, like the nose to mouth lines (known as nasolabial folds), or marionette lines. In addition, fillers can be used to improve facial contours, making the face look both more youthful and attractive.

Dermal Fillers vs. Other Cosmetic Procedures

Dermal filler injections are one of the most popular types of cosmetic treatment because they address one of the biggest causes of facial ageing – volume loss. That being said, however, it’s important that we don’t overuse them and recognise that not all signs of ageing are caused by volume loss, which is what traditional plastic surgery – like facelift surgery – still has a role to play in managing the ageing process. Likewise, lasers and muscle relaxing injections are also important to improve the appearance of lines and wrinkles as well as skin quality to achieve a comprehensive rejuvenation. Like with most things in life, moderation is key.

Conclusion

• Summarizing the key points about dermal fillers.
• Encouraging readers to seek professional advice for personalized solutions.

FAQ’s

Are dermal fillers Better than Botox?

Dermal fillers are different from Botox. Botox is a muscle-relaxing drug that is helpful in reducing the appearance of lines on the upper part of the face, especially the forehead, frown lines and crow’s feet. The signs of ageing in the middle and lower part of the face, however, are predominantly caused by loss of volume, which is where dermal fillers are more helpful. To say one is better than the other would be misleading because they both simply do different things, and the best option for you will depend on what your concerns are.

Are dermal filler injections painful?

Most dermal filler injections are very comfortable. Most modern fillers come with some local anaesthetic built into the filler, so they numb as they go, and patients are often surprised at how little discomfort they experience (patients who watch my YouTube videos are always suspicious that we edited the video to miss the patient wincing in pain – but we don’t. It’s just really not that painful!) Some areas of the face are more sensitive – for example, the lips – and so if you plan to have lip fillers, then we would normally use a topical anaesthetic cream to make the procedure more comfortable.

How long do dermal fillers really last?

In general, dermal fillers last a lot longer than most people expect. You can read my full blog article on the question here. There is a misconception that fillers only last a few months. However, if you were to top up your fillers every few months, you would find that it won’t be long until you look over-filled. Most of our patients have a touch-up procedure after 18-24 months. In some cases, dermal fillers may last even longer than this.

What does dermal filler do?

Dermal fillers are gel like substances that are injected under the skin, into the fatty layers of the face, t replace volume that’s been lost through the ageing process. This can reduce the appearance of hollows on the face, smooth wrinkles, or improve facial contours. Although dermal fillers suggest that they are injected into the dermis (i.e. the skin), in fact, most fillers are actually injected below the skin, making ‘soft tissue fillers’ a more accurate terminology.

Are dermal fillers safe?

Most modern types of hyaluronic acid fillers are very safe. The hyaluronic acid in the filler is identical to our body’s own naturally occurring hyaluronic acid, which means that the risk of allergic reaction is very low. The risk of your body rejecting the dermal filler material is believed to be around 1 in 1000. If this happens, it means that the filler may need to be dissolved by injecting an enzyme that breaks down hyaluronic acid.

Is there a downside to fillers?

Of course, there is a downside to fillers. Dermal filler injections are a medical procedure, and like all medical procedures, they have a risk of side effects and complications. However, if you attend a regulated medical clinic and are treated by an appropriately trained medical professional, then the risks of side effects and complications should be low.

What age is best for fillers?

Most people don’t need to worry about volume loss from their face until their late 30s or early 40s. Until this age, most patients are able to get by with less invasive options like sunscreen, gentle lasers and muscle-relaxing injections to keep their skin in good health. If you take good care of your skin, then it will usually be your late 30s or 40s before you really start to notice the signs of volume loss that need to be treated with filler injections. At this age, the volume loss may be subtle, and it might not bother you until much later – in your 50s or even 60s. It is fine to start fillers at a later stage in life if that is when the signs of ageing begin to bother you. You don’t miss the boat by choosing to start later, but you might just need a little extra work to get you to optimal correction if you choose to start later.

What age should you stop getting fillers?

There is no age at which you should stop getting fillers. If the filler is still working for you, and having treatment makes you feel better about yourself, then you are good to keep going for as long as you like. We have many patients in their 80s and beyond who still come to the clinic every year or two for a little touch-up. I once had a patient who told me she was having filler injections as a one-off treat for her 70th birthday. I just treated her again recently for her 80th (and have been seeing her every couple of years in between). If it makes you feel good, then why would you stop?