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The Ultimate Guide to Fillers

About fillers

What are fillers?

Dermal fillers (including face fillers and lip fillers) are substances injected into your face or hands to add volume and definition. They are also used to fill deep folds and wrinkles.

Fillers can be temporary (eg hyaluronic acid or collagen fillers) or permanent (eg silicone and PMMA fillers).

What are the benefits of fillers?

Fillers are used to shape and rejuvenate the skin on your face, lips or hands. They fill in lines, plump out sagging skin and improve the definition of your features. The overall effect should be one of a subtle rejuvenation and enhancing your natural beauty.

What are fillers made of?

In the UK, fillers are usually made of hyaluronic acid, a naturally occurring substance which helps the skin retain water and supports collagen and elastin fibres. Often, they include a local anaesthetic (lidocaine) to reduce discomfort from the injection.

Other types of fillers are also available including collagen fillers, fillers made from your own body fat and synthetic materials such as silicone and PMMA.

When were fillers first used?

Dermal fillers were first used in the 1970s. These were collagen fillers made from collagen extracted from animals (such as cows) and, in later years, human collagen.

In the early 2000s, hyaluronic acid fillers were developed. As this substance is naturally occurring in the body it’s far less likely to cause the allergic reactions which were relatively common with animal collagen injections. The ease of removing hyaluronic acid fillers has also contributed to their popularity.

What colour are fillers?

Fillers are transparent.

Are fillers vegetarian or vegan?

The most common form of dermal fillers, hyaluronic acid, may be vegan, as some are made from plant extracts or artificially synthesized. You should check the brand your practitioner is using for further information.

Collagen fillers are not vegan as these are made from animal collagen.

Most synthetically generated fillers will be vegan, but you should check the brand in question for full details.

Having said this, all fillers will have been tested on animals at some point, as this is a legal requirement.

Are fillers kosher?

Yes, fillers are not consumed and therefore, strictly speaking, they are kosher.

Since some fillers are made from animal extracts you may prefer to opt for a brand which is made from plants or chemically synthesized. Please note that all fillers in the UK will have been tested on animals at some point, as this is a legal requirement.

What brands of fillers are there?

There are many different brands of fillers available, each with a slightly different blend of ingredients and developed to achieve specific types of results.

We use Juvederm fillers for volumising treatments (for example to fill sunken cheeks) and Restylane for smoothing out wrinkles. Other popular brands in the UK include Belotero, Teosyal and Emervel.

Trustworthy brands are not available for general sale and can only be purchased by specialist clinics and practitioners.

What’s the difference between fillers and botox?

Fillers plump out the skin. Botox reduces the activity of muscles.

So, botox is effective in dealing with wrinkles which are caused by muscles (eg crow’s feet). Fillers are generally used to improve wrinkles which are not caused by muscles (such as marionette lines) and to add volume to sagging skin (such as the cheeks).

The two treatments are commonly used in conjunction with each other to achieve an overall rejuvenated effect.

What’s the difference between fillers and Profhilo?

Profhilo involves injecting hyaluronic acid into the skin, so the basic ingredient is the same as most fillers. However, the purpose is quite different. While dermal fillers are used to target specific areas where you want to add volume (for example to plump up sunken cheeks or reduce the depth of a wrinkle), Profhilo disperses through your skin to give you an overall hydrating and fine-line-reducing effect.

Find out more about how Profhilo and dermal fillers differ.

What it’s like to have filler treatment

What should I ask before I have fillers?

There are a few things you should check before you go ahead with your treatment:

  • Find out the name of your practitioner and look up their qualifications and experience. Ensure that they are accredited by appropriate medical and aesthetic registers.
  • Check what brand they use (make sure it isn’t one that’s available online to the general public). Make sure that the product they use has the appropriate branding on the box.
  • Find out how many treatments they expect you to need for the outcome you want and the cost of the treatments.
  • Ask what they will do to minimise pain or discomfort during the treatment.
  • Ask about any risks or side effects of the treatment.
  • Find out whether you will have a follow up appointment.
  • Ask what they will do if something goes wrong or if you’re not happy with the results.
  • Ask what aftercare is recommended.

If you are in any doubt about the safety of your treatment or the abilities of the practitioner, do not proceed with treatment.

What should I expect to be asked in the consultation?

Your practitioner should ask you for details of your medical history and any medication you are taking. They should discuss the outcome you’re looking for and why you want to have fillers, to ensure that the treatment is the right choice for you.

If they don’t believe that fillers are right for you, then they should explain why and, if appropriate, discuss alternatives.

How much filler do I need?

This can vary from as little as 1ml of filler, depending on the area to be treated, the product being used and the outcome you desire.

How much do fillers cost?

You should expect to pay from £300 for filler injections. Your treatment may be significantly more than this depending on the type of filler, the amount of filler used and the area/s to be treated.

How long should a filler treatment take?

This will depend on the area/s being treated. It will usually take from 45 minutes to 1 hour for the whole appointment, including the consultation before your treatment.

Do fillers work straight away?

Yes, although you won’t see the full benefit for a few days (up to ten days for lip fillers) as you’ll need to wait for any swelling to subside.

Can I have botox and fillers at the same time?

Botox and fillers work really well together as they combine to give you a completely rejuvenated effect.

There’s no medical reason why you can’t have both your botox and filler treatments at the same time. However, your practitioner may advise you to have botox first, wait a couple of weeks to assess the results, and then carry out the filler treatment. This ensures that the fillers are only used to improve wrinkles which the botox hasn’t resolved.

Can I have fillers at the same time as other treatments?

In some cases, yes. For example, your practitioner may agree that it is appropriate to have botox, Profhilo, laser treatment or CACI at the same time as your filler. When combining fillers with other treatments you will generally have the fillers last. This ensures that the movements, pressures or frequencies used in some other treatments (eg CACI) don’t interfere with the settling of your fillers.

However, in the case of other treatments, such as chemical peels, your practitioner will recommend that you have at least a week’s gap pre- or post-treatment.

Do filler injections hurt?

Most face and hand filler treatments include anaesthetic in the filler itself, so there is rarely any discomfort. For lip filler injections the area should first be numbed using a local anaesthetic as your lips are very sensitive to pain.

Will I be sore after my filler treatment?

You might be a little sore, but this will settle down within a week.

Will I have bruises from my filler treatment?

A small amount of swelling or bruising is possible, however your practitioner should take steps to minimise this. For example, by using a local anaesthetic for lip fillers and, when appropriate, administering facial fillers using a cannula (a very thin plastic tube) instead of a traditional syringe.

Any swelling should generally settle within 24 hours and bruising should be gone within ten days.

What are the side effects of having fillers?

Normal side effects include small amounts of swelling, bruising, redness and soreness. Most of these will subside after a couple of days and be gone within ten. If you are still experiencing problems after ten days you should contact your practitioner for advice.

Will I feel ill after having fillers?

No, you shouldn’t feel ill. You may feel a little tender in the areas which have been injected, but that is all. If you feel unwell, particularly if you have a temperature, you should contact your practitioner and, if appropriate, your GP for advice.

What precautions should I take after having fillers?

Lip fillers, in particular, are prone to swelling after treatment, so you may find that a cold compress helps to reduce the swelling and discomfort.

If you wish to wear make up straight after treatment then you should only use mineral based cosmetics. You can wear your normal make up from the day after treatment.

Avoid excessive exercise for six hours after your treatment.

Don’t consume vitamin E supplements, alcohol or aspirin for 24 hours after your treatment.

Don’t use a sun bed for 24 hours after treatment and wait 72 hours before having a facial, facial massage or sauna.

Are fillers permanent?

Hyaluronic acid based dermal fillers are not permanent. Eventually the ingredients will be absorbed by the body. This is a gradual process, so they won’t suddenly disappear overnight.

Some practitioners do still offer permanent fillers, although there are many disadvantages to them, including:

  • The danger of not liking them and not being able to do anything about it.
  • An increased risk of side effects.
  • The fact that, as your face shape naturally changes with age, you cannot adapt the filler to suit. This can lead to your features appearing very unnatural ten years down the line.

How long do fillers last?

Hyaluronic acid fillers last from six to twelve months. Exactly how long will depend on the type of filler used and where it’s injected. Collagen fillers will last for longer, up to eighteen months.

Can fillers be removed?

Yes, non-permanent fillers can be removed.

With hyaluronic acid fillers (such as Juvederm and Restylane) this is a relatively simple procedure involving injections of the enzyme hyaluronidase, which will partially or completely dissolve the filler.

Other types of non-permanent fillers (such as collagen) are much more difficult to remove. Steroid injections may help and additional injections of filler can be used to improve the overall effect (for example if you have a lopsided result). In extreme cases they can be surgically removed. But, on the whole, the only realistic option is to wait for them to naturally dissipate.

What should I do if I’m not happy with my filler treatment?

So long as you felt that your treatment was administered safely, you should speak to your practitioner if you are at all unhappy with the outcome. Often this can be easily resolved by the original practitioner, for example by adding extra filler, massaging the area or dissolving the filler altogether (if it was a hyaluronic acid filler).

If you weren’t happy with how the original treatment was administered or felt at all unsafe in the clinic, then we would recommend visiting an alternative practitioner to resolve any issues. While this may not be the most cost effective route, your safety should be your primary concern. Use a register such as Save Face to ensure that you select an accredited practitioner.

Do fillers melt in hot weather?

No. The weather will have no impact on your fillers.

What are fillers used for?

Where on the face are fillers used?

Theoretically, fillers could be used in any part of the face where volume needs to be added or deep lines filled. They are most commonly used on the lower parts of the face (to counteract the volume lost due to the ageing process) and the lips (to add volume and create better definition).

What wrinkles can fillers treat?

Fillers can be used to fill most lines and wrinkles. However, they are less commonly used on wrinkles which are caused by repeated facial expressions, as they are often best dealt with by botox.

Can fillers help with smokers’ lines / perioral lines?

Smokers’ lines, or perioral lines, can affect anyone whether they smoke or not. The repeated pursing of the lips by smokers does tend to make this a bigger issue for them than for non-smokers.

Facial fillers are effective in filling these lines, particularly if they have become deep. Lip fillers can also help by enhancing the shape of your lips and, as a result, reducing problems such as lipstick bleeding into fine perioral lines.

Can fillers stop me looking grumpy?

With age, facial skin sags and deeper wrinkles form in the lower face. The upshot is that you can start to appear unhappy or grumpy, regardless of your actual mood!

Dermal fillers can help by restoring lost volume to your lower face, lifting your expression and giving you a naturally happier and rejuvenated appearance.

The treatment should help you feel in a good mood too!

Can fillers help with oral commissures?

Oral commissures are the corners of your mouth. As your skin loses fullness with age, your oral commissures can sag and, as a result, turn downwards. Wrinkles can develop, extending your laughter lines. Dermal fillers can be used to restore the lost volume and lift the oral commissures back up.

Can fillers help with marionette lines?

Marionette lines are wrinkles which extend vertically from the corners of your mouth and down your chin. If you imagine the joint in a marionette puppet which allows the mouth to open and close, these are your marionette lines!

Dermal fillers as a marionette lines treatment can be very effective in returning volume to these areas of your skin and reducing the appearance of marionette lines.

Can fillers help with nasolabial folds?

Your nasolabial fold runs from the top of your nostrils down to the corners of your mouth. As your skin loses volume with age these lines can deepen into permanent folds in the skin. Facial fillers are effective in re-volumising the skin in this area to reduce the appearance of the nasolabial folds.

What are tear trough fillers?

With age, fat pads reduce in the tear trough area under the eyes and, as a result, the skin can start to sag. This causes deep lines to appear, extending from the inner corner of the eye along the top of the cheek.

Dermal filler injections into the tear trough can restore lost volume to the area and, when hyaluronic acid fillers are used, they will also hydrate the area, reducing the appearance of dark circles.

Can you use fillers in your upper face?

Generally speaking, botox is best to improve wrinkles on the upper face, as they are the result of repeated expressions. However, dermal fillers can also be used in this area instead of, or to complement, botox treatment. The vertical lines which appear between your eyes as you age, in particular, can become very deep and may require facial fillers to reduce the folds.

Can fillers help with scarring?

Yes, dermal fillers can help to improve the appearance of indented scars (including acne scars) by pushing up the skin at the base of the scar to make it more flush with the natural surface of your skin.

An added benefit of using hyaluronic acid based dermal fillers is that they will hydrate the skin over your scar, helping to further improve the appearance.

While primarily used for facial scars, there’s no reason that fillers shouldn’t be used for scarring elsewhere on the body.

Find out more about dermal fillers for scars.

Can lip fillers give me a better cupid’s bow?

Yes, lip fillers are an excellent way to better define the shape of your lips, including your cupid’s bow (the dip at the centre top of your upper lip). Not only can this give your lips a more attractive shape, but it also stops the problem of lipstick bleeding into the skin above the bow.

Can lip fillers help with thin lips from ageing?

Lips will naturally thin as you age and lip fillers are an excellent way of restoring lost volume.

Can fillers be used on hands?

The skin on your hands ages in the same way as the skin on your face – gradually losing volume and gaining fine lines. Dermal fillers are effective in returning plumpness to the skin on the back of your hands and smoothing out the lines.

Will people know that I’ve had fillers?

This really depends on the outcome you’re looking for. Fillers can be used subtly to create a very natural appearance – friends will notice you look great, but they won’t realise why!

Alternatively, fillers can be used to make a bigger statement. This has become a more common request with the lip fillers in particular.

Having fillers in the UK

What regulations control filler treatments?

Fillers on sale in the UK have to have a CE mark, however this only means that they adhere to certain manufacturing standards. It says nothing about their efficacy. Currently there are no other regulations in place.

Who can carry out filler treatments?

There are currently no regulations in the UK controlling who can carry out dermal filler treatments.

We would strongly recommend that you only allow a fully trained and experienced healthcare professional (a doctor, nurse or dentist) to administer the injections. While expert filler treatments are safe, in the hands of someone who is not both medically and aesthetically trained, they can be very dangerous.

Do I need to have a prescription for fillers?

No, a prescription is not required for most dermal fillers. However, no reputable brands are available on the open market, they can only be purchased by suitably accredited clinics and practitioners.

How old do I have to be to have fillers?

There are no age restrictions for having fillers. However, a reputable practitioner will not treat anyone who they feel is too young or not suitable for any other reason.

Where fillers are used to improve facial disfigurations, such as scars, it may be permissible to have the treatment at a young age, so long as the appropriate parental/guardian approvals are obtained.

How do I find a safe and high quality filler practitioner?

The Save Face register is an accreditation process for aesthetic practitioners, including those who administer fillers. This independent body is recognised by the Government, The Department of Health and NHS England. Using a Save Face accredited practitioner and clinic gives you assurances that your treatment will be safe, appropriate and effective. Find out more about Save Face.

Safe use of fillers

Are fillers safe?

Yes, so long as they are administered by a suitably trained, qualified and experienced medical practitioner.

You also need to ensure that you have told your practitioner about your medical history and any ongoing conditions or medications you are taking, so they can check the treatment is right for you.

Can I have fillers if I’m pregnant?

No. You shouldn’t have any injectable treatments such as fillers if you are pregnant. The risks are not known and, therefore, no reputable practitioner will treat a pregnant woman.

Can I have fillers if I’m breast feeding?

No. It is not known whether there is any potential risk in having fillers when you are breast feeding, therefore you should not have the treatment.

Can I have fillers if I have an infection?

If you have a skin infection near the area to be treated, you will not be able to have dermal fillers until it’s cleared up.

You may be able to have lip fillers if you have a cold sore; you practitioner will be able to advise you further.

If you have a cold or any other illness, you should tell your practitioner. They can then judge whether treatment will be safe for you.

Can I have fillers if I’m diabetic?

Yes, this shouldn’t be a problem. However, it’s important to inform your practitioner of your condition and any medication you are taking, prior to your filler treatment.

Can I have fillers if I’m on antibiotics?

If these are for a skin infection in the area to be treated or if they are for an ear, sinus, nose, throat or dental infection, then you are unlikely to be suitable for fillers until the infection has fully cleared up.

If you are on antibiotics for another reason, you should discuss this with your practitioner before your treatment to ascertain if you can go ahead.

Can lip fillers cause cold sores?

If you already suffer from cold sores, on rare occasions filler treatment may trigger the virus. Please advise your practitioner before you have treatment if you often have cold sores.

Can you be allergic to fillers?

Yes, it is possible to have an allergic reaction to the ingredients in fillers. If you have any history of allergic reactions, you should discuss this with your practitioner before your treatment.

What are the risks of having fillers?

When fillers are injected by someone who is appropriately qualified, trained and experienced the risks of something going wrong are very low.

However, in inexperienced hands, filler injections can become very dangerous. For example:

  • If the product is contaminated or injected with poor technique this can lead to severe skin reactions. These include rashes, excessive swelling or ulcers.
  • If the person carrying out the treatment doesn’t have a thorough understanding of human anatomy they could inject the filler into a bloodstream and block it, reducing your blood supply. This can lead to skin dying (necrosis) and blindness. If they hit an artery this could trigger a stroke.
  • Poor hygiene can cause infections leading to permanent facial scarring and potentially spread to other parts of your body.

Are there any other reasons I shouldn’t have dermal fillers?

You should discuss any medical conditions you have and any medication you are taking with your practitioner before the treatment goes ahead. You may not be able to have treatment if, for example, you are taking blood thinning medication or have a bleeding disorder.

Can I inject fillers myself?

Dermal fillers and lip fillers are now widely available online. However, it is very dangerous to inject them yourself or allow anyone without the appropriate qualifications and training to administer them for you.

The risks of incorrectly administered filler treatments are numerous. They range from the relatively minor problem of creating a lopsided appearance to the far more serious risks of blindness, skin death (necrosis) and stroke.

Find out more about the risks of “DIY fillers”.