Dermal fillers

Dermal fillers are gel-like substances injected beneath the skin to add volume, smooth lines, and soften creases. Unlike anti-wrinkle injections, which relax the muscles behind expression lines, fillers physically restore or stimulate volume, so results look natural rather than frozen.

What can dermal fillers treat?

As you age, your skin loses collagen, elastin and fat, which can lead to sagging, thinning and a loss of volume. Dermal fillers are commonly used to address:

• thin lips
• hollow or sunken cheeks
• nasolabial folds (the lines running from your nose to the corners of your mouth) and marionette lines (from the mouth corners down to the chin)
• jawline and chin definition
• tear troughs (hollows under the eyes)
• facial asymmetry
• recessed scars

What are the benefits of dermal fillers?

Results are visible straight away, and the treatment is non-surgical, with no incisions or stitches needed. Appointments usually take 30 minutes to an hour, and downtime is minimal, with most people returning to normal activities the same day or the next.

Hyaluronic acid fillers can also be dissolved using an enzyme called hyaluronidase if you're unhappy with the result or a rare complication occurs, which is one reason they're considered a safer option for most people.

Are there different types of dermal filler?

There are several types of dermal filler, each working slightly differently:

• hyaluronic acid (HA): the most commonly used type, a substance that occurs naturally in the body; gives an instant result and generally lasts 6 to 18 months, and can be dissolved with hyaluronidase if needed
• calcium hydroxylapatite (CaHA): stimulates your own collagen production, so results build up over about three months; often used for deeper areas such as the cheeks or jawline, and lasts around 12 to 18 months; cannot be reversed in the same way as HA
• poly-L-lactic acid (PLLA): also stimulates your own collagen gradually, used for deep wrinkles, and can last two years or more
• polymethylmethacrylate (PMMA): contains tiny particles that stay under the skin permanently, making it the longest-lasting option, often used when a more permanent result is wanted
• autologous fat grafting: fat taken from your own body using liposuction, purified, and injected into the face; a more involved process than off-the-shelf fillers

What happens before dermal filler treatment?

You'll have a consultation, ideally with a doctor, nurse prescriber or dermatologist. They'll examine your face, discuss what you'd like to achieve, and may mark your face or take photos to help plan the treatment. They'll recommend a suitable filler and talk through the possible side effects and recovery.

You'll be asked about your medical history, including any medications, allergies, a history of bruising or bleeding after similar procedures, neurological problems, or skin conditions. Dermal fillers aren't usually recommended if you're pregnant or breastfeeding, have an active skin infection in the area to be treated, have certain autoimmune conditions, or take certain medications.

What happens during dermal filler treatment?

1. Your skin is cleaned, and a numbing cream may be applied and left to take effect.
2. The filler is injected using either a fine needle or a blunt-tipped cannula, which tends to cause less bruising.
3. The needle may pinch or sting, though most people don't find it very painful.
4. Your practitioner moulds the filler into position for a smooth, even result.
5. The whole appointment usually takes 30 minutes to an hour, depending on the area and how much is being treated.

What does recovery look like?

You'll usually see results straight away, though the final, settled look becomes clearer once any initial swelling has gone down, typically after about two weeks. Redness, swelling and tenderness at the injection sites are normal for the first few days, and bruising is possible, particularly around the lips or under the eyes; an ice pack can help with any pain or swelling.

Most people return to work or normal activities the same day or the day after. You'll usually be advised to avoid alcohol, strenuous exercise, and extreme heat, such as saunas or hot showers, for 24 to 48 hours, and sleeping with your head slightly raised on the first night can help manage any swelling.

How long results last depends on the type of filler and the area treated, ranging from around 6 months up to several years.

What are the risks and complications?

As with any cosmetic procedure, dermal fillers carry some risks, though serious complications are rare. These include:

• an asymmetrical appearance
• bleeding, bruising, redness, pain and swelling
• damage to the skin, which can cause scarring
• infection, which can rarely lead to tissue damage in severe cases
• lumps or bumps under the skin
• numbness
• acne-like pimples, rash or itching
• vascular occlusion, a rare but serious complication where the filler blocks a blood vessel