Dermal Fillers

Fillers are the mainstay of non-surgical cosmetic facial rejuvenation treatments. They are an extremely effective way of adding volume to deeper layers and hydration to superficial layers of your skin.


Fillers can be permanent non autologous (eg Sculptra, Aquamid) or autologous (eg fat) or temporary (eg Restylane,  Juverderm). Restylane  is the number one selling hyaluronic acid (HA) dermal filler and the most-studied cosmetic filler in the world. Restylane, Juverderm, Belotero are FDA approved, whilst Teosyal & Emervel are CE marked. With these injections, you can achieve natural-looking results in just one visit that deliver long-lasting results of 6 to 18 months.

I prefer using hyaluronic acid fillers, as they are relatively safe, with immediate results and almost no downtime. These fillersare not of animal or human origin, therefore a skin test is not needed and you can have the HA treatments performed immediately. When treating wrinkles or folds, the filler is injected under the skin in tiny amounts with a very thin needle or canula. These injections give natural volume under the wrinkle, which is lifted up and smoothed out. A typical treatment takes about 15 minutes and the results can be seen immediately.


How long will the effects last with HA dermal filler injections?

These fillers are biodegradable which means that they will gradually be absorbed. As the gel breaks down, water takes its place, and when totally absorbed, the HA gel disappears unnoticed from the body. How long a HA treatment holds its effect is very individual. This depends on many factors, such as your age, skin type, lifestyle, and muscle activity, as well as on product injected.

Injectable Wrinkle Fillers

The differences between fillers has to do with thickness cross linkage and longevity. In general, the thicker the filler, the better it will fill creases, but the greater the chance of possible bumps. Bumps are more likely in thinner skin such as the lower eyelids, and crows feet. Fillers can also be used to improve or enhance facial structures.

I prefer to use the dissolvable fillers (eg HA fillers like restylane) for enhancing cheek bones to make them fuller and more defined, to fill in the nasolabial fold, to enhance brow and volumize hollow upper lids and fill in hollows under the eyes (tear trough) that contribute to dark circles.

Toxin vs. Fillers: How To Choose The Best One For You

It is important to understand the difference between Toxin, a muscle relaxer, and Juvederm, Restylane, Collagen, etc. which are fillers. The easiest way to visualize the difference is to think of a crease as a valley between two mountains. Toxin prevents the mountains from being pushed together, and fillers fill in the valley.

In summary, as we get older, our creases also age. They become deeper and deeper, even when we are not frowning, squinting, or using facial muscles.

If creases are only apparent when we squint, only Toxin is needed. If creases are visible at rest, and not made worse by squinting, then fillers are necessary.

If creases are present at rest, and get worse with facial expressions, then Toxin AND Fillers will be necessary.

Side Effects / Risks of Dermal Fillers?

1. Bruise / erythema (redness), pain at the injection point, which is common and lasts a few days. In rare cases bruising can last several months and even be permanent.

2. Overfilling The aesthetic effect of fillers requires judgement. In addition HA fillers absorb water and can swell, so if you put too much in it can simply look wrong. The fillers can be dissolved if overfilled.

3. Lumps The effect can be lumpy if the filler does not spread as desired, or if there is a local area of overfilling. The thinner fillers are less likely to create lumps but do not last as long, whilst the thicker fillers that can be more lumpy but last longer. Lumps can be dissolved with tiny amounts of Hyaluronidase but the risk is that the main body of the filler will also be dissolved.

4. Inflammatory local reactions, nodules, foreign body granulomasto all hyaluronic acid fillers, appearing 1 to 14 days after treatment. The risk is very low (0.02-1%) but possible.

5. Infection the risk is low but more possible with Aquamid particularly. Post treatment bacterial, viral and/or fungal infections can occur which in most cases are easily treatable but in rare cases a permanent scarring in the area can occur.

This can occur early or may be delayed (after many years).

6. Injection into a large blood vessel This catastrophe must be avoided by knowledge of the anatomy and careful injection. This can result in tissue loss & permanent damage & cosmetic disfigurement eg. Blindness after glabellar & nose-lip filler.

7. “Tyndall effect” is abluish effect under the skin, when the filler is injected too superficially, which represents visible hyaluronic acid seen through the translucent epidermis. Fortunately, these bluish cysts are easily corrected by nicking the skin with a small-gauge needle (30 gauge) or No. 11 blade and expressing the superficial, unwanted dermal filler or dissolving them with hyaluronidase.

8. Migration: this can lead to cosmetic disfigurement eg. sausage like swelling under the eye.

9. Allergic /Hypersensitivity Reactions: like itching, swelling are rare.

10. Blindness: extremely rarehas been reported after glabellar & nose-lip filler.