Thinking of getting filler? Stop right there and read this first! We've enlisted Dr Tatiana, founder of Dr Tatiana Aesthetic Clinic, Harley Street, to share the ten things you need to know before getting filler, a procedure designed to minimise the appearance of facial lines and wrinkles. Consider it your filler 411.
1. What is filler?
The most commonly used fillers are made of hyaluronic acid, which is naturally found in the skin. Thanks to its ability to store moisture, hyaluronic acid is responsible for giving skin a plump and hydrated look. Hyaluronic acid fillers are a gel-like substance that creates volume in the skin. Once injected, they begin to integrate into the substance of the skin, attracting water molecules and hydrating the surrounding tissue. Whilst other types of filler exist, they are less popular as they are non-reversible. This is a major disadvantage because these fillers cannot be dissolved in the event of complications.
2. What are they used for?
Fillers were first used to treat facial lines and creases in order to stave off the signs of ageing. More recently, fillers are being used to augment and enhance facial features such as creating sharper cheekbones, more defined jawlines and straighter noses. Fillers can also be used on other parts of the body such as the décolletage, neck and hands to rejuvenate crépey skin.
3. What is the difference between fillers and Botox?
Both are used to rectify or prevent the signs of ageing, but fillers and Botox are quite different. While fillers are typically used to add volume and plump the skin, Botox (which is a brand name for botulinum toxin) temporarily blocks nerve signals in the muscles where it's injected to restrict movement and treat 'expression lines'.
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4. Where are fillers used?
Fillers are a gel-like substance that is injected into different parts of the skin. The depth of injection and consistency of the filler dictates the results that will be achieved: deep injections with firm fillers create volume and shape to the face, mid-depth injections with medium-firm fillers reduce the appearance of creases, superficial injections into the dermis with soft fillers help to smooth out wrinkles, plump and hydrate the skin.
It is also worth nothing that fillers can be injected in different ways: using a needle or a cannula. A cannula is a blunt tube that deposits filler underneath the skin and can be used to treat any part of the face e.g. tear troughs, cheeks, jawline or lips.
5. What about the results?
It’s important to understand that your wishes must dictate the results. If you do not want "fish lips" or "hamster cheeks", you will not have them! It’s important to spend some time discussing with your practitioner to make sure that they understand your aims.
I often see patients that shudder at the thought of looking "fake" and this puts them off ever having filler treatments. In reality, it is practically impossible to "over-do" fillers in a single cautious treatment. Where things can go wrong is when people keep adding filler over numerous sessions until their results look disproportionate and unnatural. You may ask “but why?” and the answer is not simple.
Some people enjoy the process of change, some may have lost the ability to objectively assess their appearance, others may not be clear on where they can draw the line between self-expression and risk to their health. In such cases it has to be the responsibility of the practitioner to guide their patient away from treatments that will give poor aesthetic or clinical results.
The results following a filler treatment will, of course, vary from person to person and the areas treated. It is normal for there to be some swelling and possibly even some bruising for a few days after facial fillers but generally you will see an immediate difference in volume and shape of the treated area. The results tend to improve as the swelling settles and the filler begins to sit more naturally in the skin. This may take around two weeks.
6. What’s the best filler to use?
The best filler to use will depend on the area to be treated. There are some commonly used and well-recognised brands of fillers such as Juvederm, Belotero, Restylane and Teosyal.
There are also many other fillers available and practitioners will often have a tendency to use one particular brand. In the UK, fillers are considered a medical device and hence have few restrictions or regulations. As such, many practitioners will look towards the Food & Drug Administration (FDA) in the United States for guidance on filler use and safety.
In order for fillers to gain FDA approval, the pharmaceutical company must prove safety as well as efficacy. So, if you are looking for a safe and effective filler, start by checking if it is FDA approved for the area you want treated. This information can be found on their website: https://www.fda.gov/
Next, ask your practitioner about their choice of filler. It is very reassuring if your practitioner understands the physical properties of the filler and how it is suited to the area being treated. For example, if treating the tear troughs, one would want a filler that doesn't fluctuate much in volume and hence will not ‘puff up’ with lack of sleep, travel or excess salt; or if treating the lips, one would want a soft and elastic filler that can move smoothly with the natural movement of the lips.
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7. Do your research
Make sure you fully research your practitioner before committing to a dermal filler treatment with them - ask to see before-and-after photographs of real patients and make sure you discuss how realistic your results will be. Ask what product will be used and the reasons for the product choice, how much will be injected, the technique of injection (needle or cannula?), how long the results are likely to last and if there are any risks and side effects. It’s also worth asking about alternatives to filler treatment, as a good practitioner should be able to discuss alternative treatment options with you.
Finally, and importantly, ask what can be done if things go wrong. Can your practitioner treat filler complications? Are they able to dissolve your filler if needed and will they charge you for this?
Make sure you are fully confident and at ease with your chosen clinic. Sometimes seemingly awkward questions about qualifications, training and experience are good ways of sussing out if your practitioner is someone who is able to put you at ease.
8. Less is usually more
When it comes to fillers, less is usually more - subtle and natural. Not only should they be almost invisible to the eye but fillers done correctly shouldn’t feel as though they are there.
Hyaluronic acid fillers integrate with the skin and form part of the natural architecture of the skin. This process takes approximately one month. Once integrated, you will not be able to feel that there is filler in the skin, it will simply feel like your own skin - but plumper! It is always possible to add more filler later and you should never feel pressured to have more than what you are comfortable with.
9. Not the result you wanted? Not the end of the world!
Please keep in mind that filler can take up to two weeks to fully settle, if you're unhappy with your results after this time, make a follow-up appointment with your practitioner. In most cases you can usually have it adjusted or dissolved altogether. Hyaluronic acid fillers are naturally broken down by the skin. On average, this process takes 12 months but it does depend on the filler used and area treated. Areas with little muscular movement or tension such as the tear troughs, temples or jawline tend to last well; whereas areas with more movement or tension such as the lips, nose and cheeks will tend to last less.
10. What are the risks of using fillers over a long period of time?
As hyaluronic acid is a natural substance found in the body, it is accepted by our bodies as being natural - there is no evidence to suggest that long-term use is at all damaging. In fact, long-chains of hyaluronic acid such as those found in fillers are anti-oxidant and anti-inflammatory.
11. For the indecisive: Did you know that it’s possible to test out how you could look with fillers without actually taking the plunge?
You can have a trial injection with saline (salty water) to see what your fillers may look like. For example, your practitioner could inject saline in your lips to show you what the filler may look like. Of course, it’s not entirely accurate and the results will likely be slightly different when using filler, but it can give you an idea of whether the treatment would suit you.