Every Question You’ve Ever Asked About Fillers, Answered

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guide to dermal fillers
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Katy Perry uses them to treat her under-eye circles and they’re the secret to Kylie Jenner’s pout, while the likes of Courteney Cox and Khloé Kardashian have admitted to having theirs dissolved. Yes, we’re talking about fillers – the increasingly popular dermal injectables used for everything from jawline definition to younger-looking skin and, of course, pillowy pouts.

But, do you actually know what fillers are, what they can be used for, or the risks involved? They might have become ‘normal’, super accessible, and more affordable than ever, but there’s a lot you need to consider before going under the needle. “Do your research – knowledge is power. Read about what you want to have done and what the alternatives to achieving that are,” advises Dr. Marwa Ali, Resident Aesthetic Doctor at The Wellness Clinic, Harrods. So, on that note, we asked Dr. Ali every question you’ve ever had about fillers so you can get your, well, fill of fillers, right here.

Dr Marwa Ali Botox
Photo: Courtesy of Harrods Wellness

What are fillers?
Fillers are injectables used in aesthetic medicine for rejuvenation (anti-aging) or the beautification of the face and body.

When were they originally developed, and why?
Most people think fillers are relatively new, but they’ve been used for over a century! Austrian Surgeon Robert Gersuny experimented with a soft tissue filler in an attempt to treat facial defects way back in the late 1800s.

Fillers rose to popularity in the 70s, when animal and human collagens were used to treat areas such as nasolabial folds and severe acne scars. These fillers were associated with many complications and their use dropped in the early 2000s due to the arrival of a new and improved alternative, hyaluronic acid (HA). FDA approval of the use of HA fillers completely changed the world of aesthetic medicine. HA is naturally found in the body and is associated with fewer complications than traditional collagen fillers.

The use of fillers has evolved immensely over time and increased use, study, and research have helped with progression and advancement. Fillers are now less painful due to the introduction of lidocaine, and we have a greater understanding of their potential uses, limitations, and how to use them safely in aesthetic medicine. The dermal filler has come a long way and will undoubtedly continue to develop further.

What can fillers be used for?
Fillers can be used for a wide range of purposes. In the face, HA fillers can be injected to artfully reshape and increase the volume of the lips and to perform a “non-surgical nose job”, which reshapes the nose by straightening a crooked bridge, narrowing a wide nose, and lifting a droopy tip without the need for surgery.

Nowadays, very natural-looking results can be achieved with fillers by using them to re-volumize the natural fat pads that disappear with age. The cheeks in the midface are one of the first areas where we lose volume. Fillers in the tear trough can improve the appearance of dark under-eye circles. They can also be skillfully used to contour the face by improving the definition of the cheeks, jawline, and chin. A brow lift can also be achieved by building a brow bone by an experienced injector.

Fillers such as Juvederm volite or profhilo can be used to rejuvenate crepe skin by stimulating collagen production and replenishing the levels of HA that diminishes with age. Biostimulatory fillers such as Ellanse can be used to treat acne scars. Sculptra is biostimulatory filler that can be used to sculpt and contour the body and improve the appearance of cellulite and stretch marks.

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Do they hurt?
Any injectable treatment has the potential to be painful. Some people have a higher pain threshold than others and some areas can be more sensitive. The lips, for example, have the highest density of sensory nerve endings so are generally more painful than the cheeks.

Nevertheless, any potential discomfort can be minimized by the use of a topical local anesthetic cream prior to injecting any fillers. Most fillers also contain anesthetic to further ease any pain during injection. If a patient is extremely sensitive, nerve block injections such as those used when going to the dentist can also be used.

All medical procedures carry potential risks and filler injections are no different. It’s important to be aware of these risks and side effects before embarking on any treatment.

What are the risks?
All medical procedures carry potential risks and filler injections are no different. It’s important to be aware of these risks and side effects before embarking on any treatment. The most common risks are mild and short-lived and include redness, swelling, bruising, and pain at the site of injection – as can be expected with any procedure involving a needle penetrating the skin. If you’re prone to cold sores, lip fillers can trigger one to appear, but preventative measures can be taken to avoid or reduce this risk.

As with anything that penetrates the skin surface, infection is a potential risk, although very uncommon. Measures can be taken to avoid this, e.g. ensuring the area is adequately cleaned and avoiding makeup immediately after.

Another extremely rare complication is the formation of a granuloma. This is a mass of granulation tissue typically produced in response to infection, inflammation or the presence of a foreign substance, and is more likely to occur with injectables that do not biodegrade completely.

More serious consequences, though very rare, include tissue death, blindness, and stroke, which can occur as a result of injecting in or beside a major vessel resulting in comprised blood flow. This is why I always stress that it’s important to be treated by an experienced, medically trained professional.  Although these side effects are very rare, they can happen to even the most experienced injectors!

How long do fillers take to do?
It depends on how many areas are being treated, the volume of fillers being used, and the complexity of the procedure. It can range from 15 minutes to over an hour.

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What’s the aftercare process?
After having fillers, we advise patients to avoid anything that causes increased blood flow to reduce the risk of swelling and bruising, e.g. strenuous exercise, going to a steam room or sauna, etc. Simple measures such as using a cold compress or using homeopathic arnica cream can reduce the risk of swelling or bruising. The patient will then be reviewed after two weeks.

Is there any downtime?
Potential downtime after having fillers depends on a number of things, such as the type of filler, where the patient is being injected, and their response to fillers and needles and susceptibility to bruising and swelling. Most can walk out of the clinic looking untouched!

Certain areas are more susceptible to swelling and bruising than others, such as the lips, which are highly vascular so there’s a higher chance of passing the needle through a very tiny vessel whilst injecting.

How long until I see results?
That depends on where fillers are injected and what for. If they’re used to increase volume such as lips, facial contouring, non-surgical nose job, etc., results are immediate. However, it may take a couple of weeks to allow any potential bruising or swelling to subside and for the filler to fully integrate into the patient’s tissues. That’s why I ask my patients to come back after two weeks to ensure the desired outcome has been achieved.

If the filler is used as a biostimulator to stimulate collagen production, it may take 8-12 weeks to see the maximum benefit as this is how long it takes for the body to produce collagen.

What if I don’t like the effect?
If the filler is made of HA, the most common type, it can be dissolved immediately by an injection of Hyalase. Permanent fillers were associated with a number of compilations such as migration and patients had to undergo surgery to remove them. These fillers are highly unlikely to be used by any practitioner due to the progression and advancements made in the aesthetics industry and the availability of better fillers today.

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How long do fillers last?
This depends on a number of factors. As mentioned, nowadays most practitioners don’t use permanent fillers, therefore they’re gradually broken down and cleared by the body. The length of time they last depends on the density of the molecules, what it’s made up of, the brand, and the patient’s response to it.

For example, HA fillers have a lower density of hyaluronic acid molecules to ensure the soft, fluid, natural appearance of enhanced lips, and generally last around 6-9 months. HA Fillers used to contour the cheeks and jaw are intended to add structure to the face and have a higher density of molecules, so last longer – around 12-24 months.

Moreover, the ability to clear or break down filler differs from person to person and depends on a number of factors including rate of metabolism. Don’t be afraid to ask your injector how long your filler will last, as this may impact the frequency of re-treatment and overall long-term cost!

Who can use fillers?
Most people can have fillers provided they’re over the age of 18 and are consenting adults. People who have a hypersensitivity to fillers or any of its components, are pregnant or breastfeeding, or who are unwell with an active infection, sepsis, a severe autoimmune condition or cancer patients should not use fillers. Suitability will be assessed by your injector during your consultation.

Do they damage the skin?
If used correctly and safely, fillers shouldn’t cause damage to the skin. If used incorrectly, however, skin damage such as scarring may occur. Skin damage from injecting in or around a vessel, compromising blood flow to the skin, can cause skin tissue death. Signs that indicate this has happened are severe pain, blanching or mottling of the skin. You should always contact your injector if you have any concerns.

Never cut corners. You get what you pay for and the importance of experience and knowledge should not be undervalued!

What mistakes do women make with fillers?
It’s important to choose the right practitioner. Do your research and choose a medically trained qualified professional. The injection of fillers is a medical procedure and adequate knowledge of the facial anatomy, potential risks and how to deal with them should anything go wrong is paramount. Therefore, avoid beauticians or technicians no matter how tempting the low cost may be!

Never cut corners. The cost of fillers is high due to a number of reasons – namely the high cost of high-quality fillers. There’s a huge range of different brands available at different prices, and like with everything in life, higher quality fillers cost more. Also, training to be a medically trained professional able to perform cosmetic procedures at a high standard, as well as maintain up-to-date knowledge and having valid medical insurance and a license, do not come cheap. Basically, you get what you pay for and the importance of experience and knowledge should not be undervalued!

When trusting someone with your face, it’s important not to rush anything. Book a consultation to discuss your main concerns and consider your options. Avoid being injected by anyone you feel isn’t on the same page and who you feel is pushy. Don’t ever feel pressured to do anything you don’t feel comfortable with. Take as long as you need, and don’t be afraid to ask questions, even if you think they might sound silly.

It’s important to choose a cosmetic doctor who has a permanent base and is easily reached. You should be able to contact the practice to be seen and reviewed after the procedure. Go slow and don’t do too much too soon! The best natural-looking results are achieved by doing small amounts regularly.

What’s the biggest misconception about fillers?
That everyone who has fillers will look “fake”. Careful selection of the appropriate fillers and artful and safe injection by a medically trained and qualified injector with a good eye will ensure very natural results. The ultimate objective is to look untouched, fresh, well-rested, and younger!

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