Aesthetic treatments, or ‘tweakments’, as they’re often called, can be a divisive subject. Whichever side of the fence you sit on, there’s no denying that they’re a growing sector. Dermal fillers - or ‘filler’ as it’s more commonly known – have seen an unprecedented rise in popularity over the last few years. Whether it’s celebrities revealing they have been relying on the treatment for years, experts debunking myths around them or documentaries divulging potential dangers – former Love Islander Olivia Attwood has done just that with her new ITVX series Olivia Attwood: The Price of Perfection, which airs today – filler continues to be a thorny subject.
In the hands of a licensed, medical professional, filler can be a subtly transformative tool. Get it into the wrong hands? You end up with horror stories. There’s a growing movement online of people sharing their experience of filler gone wrong. In Attwood’s series, she exposes the dangerous lengths people go to in the name of aesthetics. The rise of tweakmentsgone wrong is the reason the UK’s £3.6 billion non-surgical cosmetic industry was put under scrutiny at the end of last year. As a result of pressure, the UK government launched the first-ever consultation on treatments, which will be used to shape a new licensing scheme for practitioners and cosmetic businesses which operate in England
According to analysis by University College London, the UK’s injectables market is predicted to reach a value of £11.7 billion by 2026. Worryingly, though, 68% of cosmetic practitioners included in the study, who are currently administering injections such as Botox, are not medical doctors. Despite these figures, the popularity of tweakments shows no signs of slowing down. Arming yourself with the right information, and knowing where to find a medically trained practitioner, is key to tweaking safely. We’ve spoken to three leading doctors to find out everything you need to know about dermal filler treatment.
What is dermal filler?
Dr. Yusra Al-Mukhtar explains, ‘Dermal filler is a gel-like substance that is injected into the facial tissues to restore volume, enhance facial contours, and reduce the appearance of wrinkles and lines.’
Redressing lost volume in hollow or saggy areas of the face is one of the main reasons people turn to filler. Dr. David Jack points out that filler is used to, ‘soften facial creases, reduce the appearance of wrinkles, enhance shallow contours, augment thin lips, improve the appearance of recessed scars (for example from acne), and rejuvenate facial skin.’
What are the different types of filler?
Filler is not a one-face-fits-all situation. ‘They range in thickness of the gels,’ says Dr Wassim J Taktouk. ‘The lighter, more watery textures are used for superficial lines. Thicker gels are used for deeper volume replacement. Most dermal fillers are made of hyaluronic acid. Newer technologies employ resilient hyaluronic acid (RHA). These are gels that stretch and move with the face’s natural movements resulting in natural looking results.’
Dr. Jack says, in addition to HA filler (which is formulated in various densities to match the tissue layer it is injected into), doctors may also administer ‘calcium hydroxylapatite, which is a mineral-like compound found naturally in human bones and is used for deeper lines and volume enhancement. or poly-L-lactic acid, a biodegradable synthetic substance, which is used to stimulate collagen production.’
Where can filler be used on the face and body?
According to the experts, filler can be administered anywhere on the face and body where there has been a loss of volume. The most commonly injected areas include: 'the cheeks, lips, nasolabial folds (lines that run from the nose to the corners of the mouth), marionette lines (lines that run from the corners of the mouth to the chin), and under-eye area. They can also be used on other parts of the body to add volume or enhance contours,’ says Dr. Yusra.
What can you expect from your filler appointment?
Before any tweakments take place, your practitioner should conduct an initial consultation to go through your medical history and check for any allergies. Photographs are taken and often you’ll be asked to provide photographs of yourself when you were younger. A good practitioner should also work to understand why you want the treatment, in order to rule out any red flags. Most practitioners won’t administer filler then and there. ‘We send patients home for a “cooling off” period where they can process the discussion and allow time for further questions – impulse filler is not a good idea,’ says Dr. Wassim.
On the day of the treatment, the area is first cleaned using antiseptic and numbing cream or local anaesthesia may be applied for comfort. The filler is then injected into the targeted area using a fine needle or cannula (longer, blunt ended needles), and then massaged to ensure it is distributed evenly. The procedure usually takes around 30 minutes to an hour, depending on the extent of treatment. ‘Treatment should only be administered after a thorough consultation, facial assessment, an agreement of desired outcome and meticulous planning is conducted,’ adds Dr. Yusra.
She explains further that 'filler treatments typically have minimal downtime, though some patients may experience temporary swelling, redness, or bruising at the injection site, which usually resolve within a few days. The results of filler treatments are normally visible immediately post-procedure. However, it's important to note that there may be some initial swelling or minor adjustments needed, so the final results are fully appreciated at the four-week mark.'
How painful is dermal filler?
This really depends on your pain threshold. Dr. Yusra explains that some patients may feel a slight pinch or stinging sensation during treatment but the discomfort is generally minimal or appeased by numbing cream or anaesthesia. Some dermal fillers also contain a local anaesthetic to minimise pain, which is something you can check ahead of treatment.
How long does filler last?
Depending on the type of filler used and the area being treated, this can vary. ‘Most advanced fillers last over six months up to two years, however, there is some evidence that fillers may last longer than this in some cases. Maintenance treatments are generally needed to sustain results,’ Dr. David explains.
However, Dr. Yusra points out that repeat treatments should only be performed in specific circumstances: ‘It is unlikely you will need top up treatments every year as results can last a very long time. It’s important not to inject unless there is a relapse of your concern to avoid over inflating the tissues, migration of filler beyond the area intended and unnatural distortion to the facial features.’
How to maintain the results of filler
Aftercare is important. It goes without saying that you should follow the instructions provided by your healthcare professional. This may include avoiding excessive sun exposure, refraining from touching or rubbing the treated area, and avoiding strenuous activities for a certain period.
To facilitate the longevity of your treatment, skincare is key. ‘My patients are encouraged to top up hyaluronic acid levels with SkinCeuticals’ H.A.Intensifier Serum. This contains extracts of liquorice and purple rice which block hyaluronic acid degradation,’ Dr. Wassim says.
Generally speaking, 24 hours before and after your treatment you should avoid active skincare like acids and retinols. Make-up shouldn't be worn in the first 24 hours post-treatment, either. Experts also advise against facials, saunas and sun beds two weeks after treatment, as well as drinking alcohol and exercising for three days post-treatment.
How much does dermal filler cost?
The cost depends on the type of filler, the amount being used, the area being treated and the expertise of the healthcare professional. But as a general rule of thumb, more advanced providers will charge higher rates for their services, which can range from several hundred to several thousands of pounds per session.
Are dermal fillers safe to use?
When administered by a qualified medical professional? Yes, absolutely, filler is generally safe. That being said, as with any medical procedure there are some risks, such as bruising, swelling, and asymmetry. Potential complications could include infection, allergic reactions, lumps, filler migration, and in rare cases, vascular occlusion (blockage of blood vessels). The latter complication needs to be recognised and treated immediately to prevent tissue damage.
The good thing to note is that filler is actually reversible, should results not go according to plan. Hyaluronic acid-based fillers can be dissolved with an enzyme called hyaluronidase which breaks down the filler. For other types, the removal process is more complex and may require surgery or other treatments. While hyaluronic acid filler is generally reversible, there may be rare instances (secondary to complications such as a vascular occlusion that can leave scarring if untreated), which can result in patients being unable to return back to normal after filler is removed.
The pros and cons of getting dermal filler
According to Dr. Yusra, the main benefits include ‘restoring volume and youthful contours, reducing the appearance of wrinkles and lines, enhancing facial features, improving acne scars, and providing a more rejuvenated appearance. They can also help to restore skin texture and radiance, and provide a lasting glow. They can help individuals achieve a more refreshed and revitalised look without the need for invasive surgery.’
Doctors such as Dr. Yusra have also noted the positive psychological impact treatments can have on the patients. 'I’ve spent years in clinic researching this alongside a team of psychologists and psychiatrists assessing both motivation for seeking treatment and impact for treatments on patients quality of life. Clinical evidence now proves that injectable treatments can have a profound and positive impact on self perception, self-confidence and self-acceptance. Filler treatments utilised to address and correct a facial concern which may have a psycho-social burden on the patient, most commonly like a bump on the nose, have been proven to have a profound positive psychological impact on individuals by boosting self-confidence and improving their perception of their appearance. In general, people report feeling more youthful, refreshed, and satisfied with their overall look after getting filler and more confident at work and in their personal relationships.'
However, there are some potential dangers to bear in mind. If treatments are not performed correctly or by a medically trained professional, patients can be exposed to infection, asymmetry, overfilling or under-filling, lumps or nodules, vascular complications, and allergic reactions. It is crucial to choose a qualified healthcare professional and discuss the potential risks before proceeding with treatment.
Questions to ask before your filler treatment
Things to familiarise yourself with ahead of treatment include the practitioner's qualifications, experience, the specific type of filler being used, as well as potential side effects and risks, aftercare instructions, and what to expect in terms of results and follow-up treatments. Dr. Yusra adds, ‘not all fillers are the same, and many in the United Kingdom are not regulated and have little to no safety data, so make sure the injectable implant you are having has a robust safety profile. It is essential to have open communication and address any concerns or questions.’
Interestingly, Dr. Wassim reveals, ‘there are over 200 brands of hyaluronic acid [filler] and they are not created equal, my clinic uses Teoxane fillers exclusively.’ As well as Teoxane, top rated brands include Restylane by Galderma, Belotero by Merz, and Juvederm, which are all known to have high safety and a low risk profiles.
The general stance taken by all experts is to go to a medically trained professional; someone with expertise in dermatology or plastic surgery or a healthcare professional with medical qualifications including GMC registration and royal college affiliations.
Luckily, there are resources available for patients to find certified doctors and healthcare professionals for filler treatments, including the Joint Council of Cosmetic Practitioners or Save Face. Dr. Yusra says, 'I would recommend checking the regulatory register to find out if your practitioner is a registered healthcare provider. This includes the General Medical Council, the General Dental Council and the Nursing and Midwifery Council.
‘Registered medical professionals like doctors, dentists, nurses and prescribing pharmacists have extensive medical training and knowledge, a deep and practical understanding of facial anatomy, ensuring a higher level of expertise and safety. They can also provide a comprehensive assessment, tailor the treatment to individual needs, handle any potential complications, and vitally, are able to prescribe the medication required to treat complications where necessary,’ she adds.
What are the industry and government rulings around dermal filler?
The government recognises the concerns surrounding the lack of regulation in this field and the potential dangers that this poses to the public, and highlight that the current regulatory framework places few restrictions on who can perform non-surgical cosmetic procedures. In its consultation into The licensing of non-surgical cosmetic procedures in England last year, the government noted, 'Current regulatory controls are fragmented. There are existing training standards for practitioners, such as the National Occupational Standards (NOS) in beauty aesthetics, in addition to competency frameworks developed and held by professional bodies, but there is no legislative framework to mandate that all practitioners are required to meet both training and infection control standards in order to carry out procedures.'
The consultation points out specific pieces of legislation, with significant local variation, that are being used to regulate non-surgical cosmetic procedures, including the Health and Safety at Work etc Act 1974, the Health Protection Regulations 2010, and the Local Government (Miscellaneous Provisions) Act 1982, which allows (but does not require) local authorities to put in place arrangements for the registration of certain cosmetic treatments, including cosmetic piercing, electrolysis, tattooing and semi-permanent make up, in addition to acupuncture. Some local authorities have also created bylaws relating to staff hygiene and the safety and cleanliness of the premises, furniture, and equipment. A number of local authorities in England have also introduced local licensing schemes which vary in the number and type of treatments they cover.
Given the current landscape, it is important to be scrupulous when researching and booking in for the treatment. Dr. Yusra advises that one should choose healthcare professionals who are regulated, regularly update their knowledge, and put safety at the forefront of their practice. When looking for licensed practitioners, enquire about the quality and source of the fillers used, and ensure that the clinic or facility adheres to proper hygiene and safety standards. Patients should also be cautious of treatment from practitioners who do not have the appropriate level of training and who are unable to diagnose or manage complications should they arise.
The lack of regulation around the non-surgical cosmetic industry ‘means that practically anyone, regardless of training or qualifications, can administer dermal fillers as they are classified as “medical devices” rather than prescription medications. However, there have been calls for stricter regulations to ensure patient safety,’ explains Dr. Jack. ‘The landscape of non-surgical cosmetic treatments like dermal fillers is continuously evolving. As a medical professional, I can’t emphasise highly enough the importance of informed decision-making, thorough research, and choosing qualified and experienced practitioners to ensure the safest and most effective treatments.’
