As we age, our skin loses elasticity and supporting collagen from beneath the surface. Dermal fillers like Restylane® and Juvederm can plump out lines and can rejuvenate our faces beautifully.

I use non-permanent gel fillers like Restylane®, Perlane, Voluma, Teosyal and Juvederm. They are all Hyaluronic acid (HA) fillers. HA is a natural polysaccharide that exists in all living organisms. The HA in dermal fillers is produced biosynthetically through bacterial fermentation, so it is biocompatible with the skin and there is no risk of transmitting disease. The gel is able to integrate with the adjacent tissues, allowing passage of oxygen and nutrients. These fillers are characterised by the fact that their HA molecules are cross linked, which makes them long lasting - but not permanent. Exactly how long a treatment lasts is quite individual: it depends on age, skin type and muscle activity as well as the injection technique. The HA gel particles are absorbed slowly and water takes their place. When totally absorbed, the gel disappears unnoticed from the body. If these fillers do cause a problem, or a patient does not like them, they can be dissolved.

Radiesse is slightly different. It is a part HA and Calcium containing filler that I also find useful. It cannot, however, be dissolved.

Sculptra is another type of injectable treatment that is difficult to categorise: It is more a volumising agent than a filler, but incredibly useful.

How long do HA fillers last?

Clinical trials indicate that Restylane® is effective for 9 months to a year for the treatment of wrinkles and for around six months for lip augmentation. It lasts less time in areas subject to muscle movement.

Which areas does it treat best?

This substance is a cosmetic “polyfilla” and has a range of uses, including lip sculpture, filling lines, scars and folds. It is used to particularly good effect in the nose-mouth (nasiolabial lines). These are often the first sign of ageing. It is also useful in smile lines, frown lines and sometimes crows-feet, although it is often advisable to combine dermal filler with the use of Botox in these areas of very active expression. The very careful use of dermal fillers has a role to play in the treatment of under eye hollowing or dark circles. Dermal fillers can be used to augment lips or cheeks and to fill out some scars. Some catwalk models even choose to use it as a cushioning pad in the ball of the foot!

Treatment times average 45 minutes and the results are instantaneous. I use a combination of numbing cream and if necessary, local anaesthetic injections to make the procedure as comfortable as possible. The advent of Lidocaine containing fillers, however, has made the use of dental injections much less necessary.

The down side?

• Some mild bruising may occur. These signs may take 3-5 days to vanish. The corners of the mouth tend to bruise a little more.
• Transient redness, swelling, itching or discomfort. In the case of a lip augmentation, the swelling can sometimes be marked initially and may last a few days.
• Discolouration at the implant site is also possible. Typically, resolution is spontaneous, within one or two days of injection into the skin, and within a week after lip augmentation.
• Temporary palpable lumpiness at the implant site.
  What can go wrong?
• Rarely, infection and possible subsequent scarring.
• Cold sores. If you have a history of cold sores in the treated area, filler injections may cause them to break out again. I will give you a prescription for antiviral tablets that must be taken before and after the treatment.
• Immediate allergic type reactions - Prolonged redness, swelling, itching or hard lumps at the points of injection. Sometimes they can last for several months or longer, but this is extremely unusual.
• Delayed allergic type reactions happen with a reported incidence of 1 in every 20,000 patients. Red lumps may appear underneath the skin many months later and are permanent in a small number of cases. In very rare cases (less than 1 in 15,000 treatments) granuloma (lumpy tissue), superficial necrosis (skin death) and urticaria (red wheals) have been reported. These reactions generally start a few days after treatment, but can appear after 2 to 4 weeks. They are generally reported as mild to moderate and self- limiting, with an average duration of two weeks.
• Blockage of a blood vessel by filler causing skin death or, much more rarely, blindness.

Conditions that will mean you cannot have this treatment with dermal fillers

• Within 3 weeks of Covid 19 vaccination
• Active infection e.g. acne.
• Known allergy to Hyaluronic acid or BDDE.
• Pregnancy and breastfeeding, as there is no research data.

Price of treatment

Cost will depend on the number of syringes needed to create the desired result. A quote will always be given at your initial consultation.

Some examples of procedures and their potential costs are;

One syringe I mL of Restylane® will give a subtle lip enhancement or be sufficient for mild nose - mouth lines are priced at £320. Perlane a denser preparation, more suited to folds and volume restoration is priced at £350 per 1ml syringe, for use in say mild nasiolabial lines. Multiple syringes will be required for larger or deeper areas. For example, a syringe of heavier density Perlane plus another syringe of Restylane®, may be required for more pronounced nose - mouth lines.

My view

Dermal fillers are incredibly useful. They are more uncomfortable during and after procedure than the Botulinum toxins, but numbing within the filler has really changed my practice: most patients now choose not to have dental injections, even for the above lip area. Having lips done is a bit of a daunting procedure for first timers. It is easier with dental local anaesthetic, but of course, this adds temporarily to the feeling of swelling. The results though, are worth it.  Uncomfortably perhaps, patients need to be aware of the very, very rare but devastating complications of skin death and blindness, before embarking on treatment.

Treatment Clinic in Hassocks, Mid Sussex. 07809 415211