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The EV guide to Dermal Fillers

Types of dermal filler, where it can be used and the results you can expect

Dermal fillers were once used purely to soften and plump out lines and folds, however they are now used more globally to sculpt, shape, add fullness and definition and replace lost volume.

Because of their versatility and effectiveness, dermal fillers have become one of the most popular aesthetic treatments, but there are no restrictions in the UK on who can train in, buy or inject fillers so it’s vital to do your research, and speak to a qualified practitioner such as those listed on EV before undergoing a procedure.

Similarly, not all facial fillers are FDA-approved, but in the UK they must have a (relatively easy to obtain) CE mark which means they are fit for purpose as ‘medical devices.’ If/when they are eventually reclassified as prescription medicines which many in the industry are calling for, only registered medical professionals such as doctors, dentists, surgeons and nurse-prescribers will be able to obtain and administer them.

What are dermal fillers made of?
Most use hyaluronic acid gel, a natural substance found in the body. The end result is determined how the hyaluronic acid particles are linked together: different sized particles and densities are better for filling different areas of the face, and it’s common for injectors to mix and match product variants. Popular brands include Restylane, Teoxane, Teosyal, Perfectha, Belotero Balance and Juvederm. There’s also the longer-lasting collagen stimulating dermal fillers made from polycaprolactone, calcium hydroxylapatite, polyalkylimide, polylactic acid or polymethyl-methacrylate microspheres (PMMA). These give a subtle, yet tangible result thanks to microscopic spheres suspended in a carrier gel—the gel is absorbed by the body but not before the spheres have jump-started collagen production where the gel has been inserted. At the time of writing, not all collagen stimulating fillers are FDA-approved. Popular brands include Ellanse, which uses polycaprolactone, a bioabsorbable substance that’s also used in surgical stitches, and Sculptra.

Where can they be used?
Dermal fillers are used as a whole to freshen, fill, sculpt, add definition and revolumise where there has been loss of volume due to the natural process of ageing, including under the eyes (tear troughs), nose-to-mouth lines (nasolabial folds), marionette lines, cheeks, temples, jawline (pre-jowl folds) and chin. They can also be used in the lips (lip fillers), on the nose (non surgical rhinoplasty), to rejuvenate aged or weather-beaten hands and treat vulvo-vaginal disorders.

Does having dermal fillers hurt?
Everyone’s pain threshold is different, but the popularity of this treatment proves that the benefits are worth a few minutes of feeling uncomfortable. There are two ways of injecting dermal fillers – through a sharp needle or a cannula, which is like a blunt needle. This sounds worse than it is, as a cannula can make its way effectively through the layers of the skin and is actually gentler on skin tissues. The procedure is relatively quick, but you may want to request some numbing cream for sensitive areas such as under the eyes or around the nose. Your practitioner may also massage the product around a bit when it’s in place to ensure it looks the way it should.  

What results can I expect?
Results are immediate and noticeable. When administered by an experienced practitioner who has a good eye for aesthetics, facial symmetry can be improved by adding filler into the chin, hollow temples can be filled out and jawlines can be sharpened and defined; you will need a firmer filler for the jawline and one that’s more fluid for around the eyes. With collagen stimulating fillers you can also expect a fresher look, as your skin’s collagen will be boosted over a period of time.

How long will dermal fillers last?
Between three months and four years, depending on the density and formulation of the product used. With collagen stimulating fillers, you’ll see the difference immediately but maximum effects take a few months to fully kick in – this is the time it takes for fresh collagen to be produced.

Are there any side effects?
Common and temporary side effects include bruising, redness and swelling at and around the injection site – unfortunately there’s no way of predicting if you will be prone to a reaction. Lumps under the skin can also form if the filler has been badly placed or positioned and not smoothed into shape by the practitioner afterwards: this is why it’s essential to put yourself in the hands of a qualified and experienced practitioner who knows what to do in the event of a problem. There is also the slim chance that your filler will move away from the intended treatment area over time. If you are unhappy with the results, you can have a hyaluronic acid-based filler dissolved with a solution called Hyalase.