Dermal Fillers London

Dermal fillers injections are the most exciting development in cosmetic surgery in recent years. Dermal fillers are injected in a precise fashion beneath the skin to restore a loss in volume or create softness. They can also be used to fill out lines and wrinkles and address areas which developed creases. Dermal fillers are able to be used for a number of different aesthetic purposes including a non-surgical face lift. Soft tissue fillers can smoothen wrinkles, augment cheek volume, fill in acne scars, plump the lips and many more applications. The key to achieving excellence in dermal fillers relies on choosing a highly skilled dermatologist who has years of expertise in managing skin concerns of all types. Dermal filler perfectly complement anti wrinkle injections for a comprehensive approach to facial rejuvenation.

There are many types of dermal fillers and they each act in different ways. Some fillers work to attract the body’s natural water to create volume after injection. Other fillers are known as collagen stimulators – they work by stimulating production of collagen which is essential to healthy and youthful looking skin. Ever filler is unique and with specific uses. Many fillers have a more short term effect for skin rejuvenation, others last for much longer with a greater effect on collagen formation.

Expected results of dermal fillers

• Enhance cheek volume
• Fill in fine and deep facial lines
• Lip enhancement
• Smoker’s lines around the lips
• Nose reshaping
• Chin crease filling
• Treatment of facial asymmetry
• Dark circles beneath the eyes
• Filling in depressed acne scars

Dermal fillers can be used for the following areas:

• Forehead and glabella
• Temporal hollows
• Cheek fillers
• Tear trough fillers
• Jawline and chin
• Nasolabial folds
• Marionette lines
• Nose reshaping
• Lip fillers

Dermal fillers are an increasingly popular method for facial rejuvenation, and is consistently rated as the second most common nonsurgical aesthetic procedure performed with an estimated 60% increase in dermal filler procedures over the past 5 years. Proper use of these products requires expert knowledge of facial anatomy and the facial ageing process, and product characteristics. The goals of the procedure range from correction of age-related changes to optimisation of facial proportions.

Our practitioners are expert at facial volumisation and lifting and often use combinations of products and techniques to achieve pan-facial rejuvenation.

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RealSelf top doctor status is awarded to less than 10% of the RealSelf doctor community.  This status is earned by achieving consistently high patient satisfaction (from RealSelf reviews), getting excellent feedback on expert answers to patient questions, and after investing significant time in Q&A and other doctor activity. RealSelf top doctors are rated among the very best surgeons in the United Kingdom and USA.

All our plastic surgeons are on the GMC specialist register. The Royal College of Surgeons of England has an excellent information resource on cosmetic surgery.

Our dermal fillers clinic at 106 Crawford Street was recently inspected and rated by the Care Quality Commission as good across all five domains of care.

A facial plastic surgeon is trained to undertake aesthetic non-surgical and surgical procedures in the facial region. They are dedicated sub-specialists. Compared with general plastic surgeons, facial plastic surgeons are inherently better trained to perform delicate facial procedures such as dermal fillers or a full facelift and neck lift. The extra years of surgical training by facial specialists focused on the facial region results in an exceptionally high degree of skill.

• Alok Misra
• Ertan Erel
• Antonios Mitsakos

Our surgeons are full members of:

Juvederm is an approved hyaluronic acid filler widely used at Centre for Surgery. Hyaluronic acid is found naturally in the body and is a normal constituent of skin. The supporting connective tissues of the skin contain HA for support and lubrication. Juvederm works well for static skin wrinkles and deeper skin folds in the face. Juvederm is known to have a smooth consistency which enhances injection accuracy and is designed to be injected into the dermis of the skin. The dermis is the deeper layer of skin beneath the epidermis and contains important structures such as nerves, blood vessels and collagen. Juvederm HA fillers have a duration of effect of between six and nine months before it gets naturally absorbed by the body. It is extremely rare to have an allergic reaction to Juvederm as the main component of Juvederm is hyaluronic acid and this is found naturally in the body.

The Juvederm® range of fillers:

• JUVEDERM® VOLUMA™  for treatment of cheeks and temples
• JUVEDERM® VOLIFT^™  for treatment of moderate to severe facial wrinkles and folds
• JUVEDERM® VOLBELLA™   for treatment of  lip augmentation and tear trough correction
• JUVEDERM® VOLUX™ – specially designed for the lower face for treatment of jawline and chin

• Would like to reduce line, wrinkles or folds on the face (nose to mouth lines, smoker’s lines, smile lines, laughter lines)
• Would like to increase volume to the lips
• Have experienced a loss in cheek volume or volume around the eyes
• Would to reshape the nose, chin, jawline but are not keen on a surgical procedure
• Treatment of facial scarring including acne scars

Hyaluronic Acid (HA) Fillers

Hyaluronic acid is found naturally within our bodies and is known to be one a substance with a very natural feel and look. HA fillers can therefore be safely injected into the skin for volumising and shaping. Compared with the older collagen fillers, HA fillers do not require formal allergy testing before injection. Hyaluronic acid works to generate soft tissue volume when injected into the skin. HA fillers are soft in consistency and have a gel-like feel to them. Differences between hyaluronic acid fillers relates to the degree of cross-linking and viscosity. Our skilled practitioners are expert in knowing what type of HA fillers are most appropriate for the facial injection locations. Hyaluronic acid fillers generally have effects which last from six to twelve months before the HA is broken down naturally within the body. The safety of hyaluronic acid fillers is also rooted in their reversibility. Hyaluronidase also known as Hyalase can be used to remove HA filler if required. HA fillers typically come packaged in 0.5ml or 1ml syringes and newer variants in lidocaine. Lidocaine acts to minimise discomfort during the injection of dermal fillers.

Facial fat grafting

Fat injections involve the use of the patients own fat which is then re-injected into the face. Compared with dermal fillers which are temporary in nature, fat injections are a more permanent option for adding facial volume. Fat injections can be ideal for patients that are not keen on having regular dermal filler injections each year. Fat injections to the face are a specialist technique that is only performed by fully qualified facial plastic surgeons.

Dermal fillers are extremely versatile with a wide range of applications in the face. Your practitioner will recommend the most appropriate HA filler based on the treatment area.

Deep forehead lines

Deep forehead lines develop due to the weight of the upper eyelid and brow and most commonly develop during the aging process. Patients then develop the habit of subconsciously raising their brows to keep the eyes more open. The treatment of horizontal foreheads line involves a combination of neurotoxin and dermal filler. Neurotoxin is first administered to relax the forehead muscles followed by the injection of dermal filler 2 weeks later.

Frown lines

The development of frown lines between the eyebrows is due to excessive frowning and squinting. The first line treatment of frown lines involves using neuromodulators to selectively the weaken the brow muscles which are responsible for causing the frown lines. In more advanced cases of frowning, dermal fillers may be required to address the static frown lines which are present at rest. Only the most experienced plastic surgeons are qualified to undertake dermal filler treatment in this region as they have a very sophisticated understanding of the three dimensional anatomy of the face.

Temple hollows

The temples are located on the side of the forehead and often begin to hollow with age. This can create a unsightly look to the upper third of the face. For many patients who otherwise demonstrate youthfulness, temporal hollows may be the earliest sign of aging. Targeted injections of dermal filler or fat grafting can be used to volumise the temple area and increase facial width in the upper part of the face.

Tear trough

The tear trough region refers to the area beneath the eyes. Deformities of the tear trough result in a sunken and hollowed-out appearance to the eyes which often gives the appearance of the patient looking permanently tired to others. Tear trough deformities lead to the formation of dark circles over the the lower eyelid. Dark circles can sometimes be treated with a concealer but the more long term solution is the use of dermal fillers for the more significant types of tear trough deformities. The ideal candidate for tear trough treatment with dermal fillers is a younger patient with good skin quality and mild to moderate hollowness in the lower eyelid area. In those older patients with more obvious bags under the eyelid, tear trough treatment with HA filler is not appropriate. The best treatment would be a lower eyelid blepharoplasty.

Hollowness of the upper eyelids

With age, many people develop hollowness of the upper eyelids. The periocular region including the surrounding bone tends to lose volume over time and this even affects the eyeball itself. The end result is a hollowed out appearance that can even be worsened with surgical methods. A complication of upper blepharoplasty develops when surgeons remove too much eyelid fat which can result in the development of an ‘A-frame’ deformity. With upper blepharoplasty, the best treatment is always to remove lesser amounts of eyelid skin and perform fat grafting or dermal fillers to the upper eyelid area and orbital rim. The increased youthfulness is a result of the added volume to address the hollowness of the orbits.

Cheeks

Cheek augmentation with dermal fillers is a commonly performed procedure. For the younger patient, cheek filler injections can used to increase facial cheek bone contour. For older patients with significant facial volume loss, cheek fillers can be used to restore plumpness to the cheeks and restore youthfulness. Cheek fillers are great for restoring cheek volume and also work well to lift the nasolabial lines.

Non-surgical rhinoplasty

Non-surgical rhinoplasty also known as rhinofiller is often used to address dorsal humps or increase the height of the nasal bridge. The nasal tip can also be reshaped. All dermal filler is injected in the superficial layer of the skin and the results can last from six to twelve months. Not all patients are ideal patients for non-surgical rhinoplasty including those who are desiring a smaller nose and also those who have previously had rhinoplasty surgery. A non-surgical rhinoplasty can be ideal for those who are considering a surgical rhinoplasty but not yet ready to proceed but would like to see how their nose could look after a surgical procedure.

Nasolabial lines

The nasolabial folds or nose to mouth lines are the deep lines located at both sides of the mouth which become more prominent when smiling. Almost everyone has nasolabial lines apart from babies. The presence of nasolabial folds does not imply premature aging. However they do increase in prominence with the aging process as the face begins to lose collagen and undergoes gradual loss of fat. This is often the case in the cheek region. It is important to avoid overfilling the nasolabial folds to avoid an unsightly protruding look. All our practitioners are very expert in dermal filler injections and often the best treatment is to support the nasolabial folds with injection of cheek filler which helps to elevate the nasolabial folds and therefore make them less visible.

Marionette lines

The marionette lines refer to the lines running from the mouth towards the chin. With age and the influence of gravity, the loss of elasticity results in the face being pulled down. Many patients develop prominent lines that form from the outer corners of the mouth and point toward the chin. These marionette lines can make patients look sad or angry when noted by others. Many patients who form marionette lines are thought to have a genetic link but the targeted injection of dermal fillers is now an excellent option to treat this aspect of the facial aging process.

Lip augmentation

Lip fillers are one of the fasting growing dermal filler treatments currently performed at Centre for Surgery. With the rise of many Hollywood celebrities having had lip fillers, many patients are now keen to have their lips enhanced with filler. Lip filler with hyaluronic acid is performed to enhance the lip volume or reshape the lips and to correct pre-existing asymmetry of the lips from trauma or previous injury. Optimum lip aesthetics dictates that the upper lip should be 2/3 the size of the lower lip. The use of lip filler can lead to subtle or very dramatic results depending on patient preference. Our philosophy is always to proceed in a slow and incremental manner to ensure you are happy with the size and shape of your new lips. Placing too much lip filler too quickly is what can often lead to the unsightly looking ‘duck lips’ or ‘fish lips’ which most would agree is not an ideal outcome from lip filler treatment. The expert placement of lip filler is dependent on always customising the treatment to fit the patients facial anatomy to ensure a natural and harmonious result.

Jawline contouring

Jawline fillers is a commonly requested treatment at Centre for Surgery. Precise placement of filler along the jawline can increase jawline definition. In men, jawline fillers can help to achieve a more masculine jawline with a more square shaped jaw as opposed to a rounded one. With the aging process comes a loss of bone and soft tissue elasticity. This eventually distorts the jawline leading to the eventual formation of jowls. By using dermal fillers in the area known as the pre-jowl sulcus, the excessive jowling can blended with the chin area to reduce the appearance of jowls.

Chin augmentation

Chin filler are often performed for a variety of reasons. Both chin wrinkles and chin recession can be successfully treated with dermal filler injection. For patients with a lack of facial balance, the injection of chin filler can help to restore facial proportions. A small chin can result in a more rounder looking face when compared with a stronger chin which gives the impression of a more oval shaped face. Men often prefer a more angled chin due to its more masculine appearance. For many patients who not keen on chin implant surgery, chin augmentation with dermal filler can be great option to achieve a more defined chin and jawline.

Acne scarring

Acne scars are a very common sequel to previous untreated active acne. Acne scars come in a number of common variations but many can be treated successfully with the precise placement of dermal filler during acne scar treatment to elevate the acne scar depressions and also improve overall skin texture.

The key to success in dermal filler injections lies in our surgeons being dedicated facial plastic surgeons with many years of training and expertise in achieving results which are both natural and beautiful. Unlike anti-wrinkle injections, dermal fillers do carry significant risks if not performed properly. With injectors who lack knowledge of facial anatomy, dermal filler can be inadvertently injected into a blood vessel which could lead to serious complications. Dermal filler when injected into blood vessels could result in blood flow to a particular part of the face being severely restricted. If this is not treated quickly enough, it could lead to serious tissue injury of the face. Patients are often happy to see their local cosmetic nurse injector or Medispa for neuromodulator injections but will always go to a fully qualified plastic surgeon for dermal filler treatment.

Dermal filler injection techniques

Linear threading – The entire length of the needle is inserted into the location of filler injection which is then slowly withdrawn in a straight line whilst injecting the filler, Threading is the term used to describe the small deposits of filler placed into the line, fold or wrinkle.

Serial puncture – Dermal filler is injected in very small deposits placed at injection points which are situated very close to each other

Fanning – this technique is similar to linear threading however the direction of the needle or cannula is moved just before the exiting the skin and a line of filler is placed in a new direction

Depot – Dermal filler is placed multiple times into a given treatment area as a bolus injection

Cannula Method or Needle Method of injecting dermal filler

Dermal filler can be injected with either needles or the newer hollow blunt tipped cannulas. Each have their advantages and disadvantages as discussed below.

Cannulas are hollow tubes with a blunted and rounded end that requires a separate needle puncture prior to being inserted into the skin. Due to the their blunt tipped end, cannulas have a lower risk of penetrating bloods vessels as their blunt tip maximises their ability to glide past blood vessels. Dermal filler placement with cannula also requires less needle pricks through the skin with the ability to treat more areas from a single entry point.

Advantages of cannula for dermal filler

• Less risk of localised bruising and bleeding
• Less discomfort with cannula injection
• Less risk of blood vessel injury
• Less downtime and quicker recovery due to less bruising and swelling

Dermal filler injection using needles is the more traditional method. There are certain applications which make a needle for injection more preferable. This is often the case where only a very small amount of filler is required to create an optimum effect. Fine lines, acne scars or small touch-up injections would be an ideal example of this. Creation of the ‘cupids bow’ on the upper lip would also be better with a sharp needle for increased precision. The micro-droplet technique is also well suited to performing with sharp needles. The micro-droplet demands the highest level of accuracy and precision and needles best for this purpose. In most cases, a combination of both a needle and cannulas technique is the best option to ensure you benefit from the advantages of both techniques for injection of dermal filler.

There are a number of a factors which will impact on the final cost of your dermal filler injection procedure:

The success of dermal fillers injections relies on the patient being properly prepared for the procedure in the weeks beforehand. Prior to the procedure, you will be required to stop certain products and medications and also reduce intake of certain foods that are high alpha-omega 3.

Two weeks before dermal fillers injection

Patients should avoid fish, fish oil nuts or seeds or NSAIDS such as ibuprofen which have been shown to increase the risk of bleeding. Arnica tablets are very useful to help with reducing any post-injection bruising. Arnica tablets can be purchased over the counter from most pharmacies. If you are on any prescription medicines which are known to increase the risk of bleeding then these may need to be stopped before treatment. It is very important to speak with your GP before stopping any medicines and also to receive instruction on the best time to restart the medication. Patients on medicines which are vital for health should not stop their medicines in any circumstances. In this instance, having a cosmetic procedure may not be appropriate. Patients with a history of cold sores will need to commence a preventive course of acyclovir prior to treatment. This is to ensure there is no flare-up of herpes virus infection. Your doctor will be able to prescribe this for you before treatment. Finally it is very important to read and understand the treatment consent form so you are fully familiar with the benefits, risks and complications associated with dermal filler treatment.

The day of your procedure

Please make sure to eat a light meal before your filler injections. This helps to raise blood sugar and minimise the risk of fainting during treatment. Many people are understandably apprehensive about needle injections and this is amplified by not having eaten or drunk anything before your treatment.

Please refrain from wearing any make-up before dermal filler treatment on the areas which are planned for treatment. Your practitioner will need to remove any make-up from the treatment area before your procedure. You can bring a light make-up product to apply for camouflage immediately after filler treatment.

Please aim to arrive 30 minutes before your allocated appointment to enable the application of local anaesthetic numbing cream to the face. Local anaesthetic numbing cream needs at least 20-30 mins to achieve its full effect. This is why we ask patients to arrive a little earlier than usual.

Before you leave your appointment, we would advise booking your next appointment. This is to ensure you get your favoured timing as our surgeons often get booked up to three months in advance. We always ensure never to double book patients for any facial injectable procedure.

With dermal filler treatment, it is quite normal to have some localised bruising, swelling and some pinpoint bleeding from the needle entry points. If you had numbing cream applied then this usually takes 2-3 hours to wear off. You can improve the healing process by making sure to follow all the post-procedure instructions given to you by your doctor.

Top tips for optimum recovery after dermal fillers

• Use cold packs gently applied against the treated area for approximately 15 minutes on and 15 minutes off. This should ideally be continued for the first 48 hours after treatment.
• Any strenuous exercise should be avoided for the first 48 hours to reduce bruising and swelling.
• Do not massage your face or manipulate your face in any way after treatment. Facials or scrubbing of the face should be avoided for one week after treatment to avoid migration of filler. Gentle face wasking is allowed.
• Light make-up and/or concealer can be applied immediately after your treatment to reduce the appearance of bruising in the skin.
• Patients having non-surgical rhinoplasty should avoid wearing spectacles if they press into the treated area. You should bring your spectacles to your appointment so your surgeon can see if they are appropriate to wear after your procedure. If you like swimming and you wear googles for it then this will also need to be mentioned to your surgeon at consultation.
• Do take arnica tablets to accelerate the disappearance of bruising.
• Pineapples and pineapple juice have been shown to reduce swelling and so it is recommended to have pineapples after treatment.
• Try not to overanalyse your face for the first couple of weeks after treatment. It is very normal to have bruising, swelling and a degree of asymmetry often as a result of swelling. Your surgeon always recommends waiting two weeks before the final results can appear.
• If you have any pain or discomfort in the treated areas then it is recommended to take paracetamol to help with the post-injection pain. NSAIDS such as ibuprofen must be avoided as these increase the risk of prolonged bruising due to their action on blood platelets.

How long do dermal fillers last?

Hyaluronic acid can last up to 18 months when injected to areas such as the nose or cheeks. Dermal fillers effects can appear to reduce after a shorter period of time. In more mobile and dynamic areas of the face such as the lips where muscular contraction and movement is frequent, dermal fillers last a much shorter period of time. Dermal fillers in areas like the tear troughs or nose can last much longer – often over one year depending on the specific type of filler used.

The concept of ‘full correction’ with dermal fillers

In order to appreciate how long dermal fillers can last, it is important to understand that full correction means correcting a facial issue with the recommended amount of filler. As an example deep folds affecting the naso-labial lines may require 2 or even 3 syringes of Juvederm to achieve full correction.

Problems arise when a patient may choose to use only one syringe perhaps because of budgetary constraints. In this case, the ideal results will not be attained. Although the dermal filler will be present for a year and beyond, the results perceived by the patient will not be appreciated after a week or so as they are seen not to be visible. The reason for this situation arising is clear, immediately after treatment, the improvement is noticed but once the initial swelling subsides, the patient correctly think they need more volume and assume all the filler must have been absorbed by the body. To prevent this situation from occurring, it is important to understand your own starting point for treatment. If you have deep lines, wrinkles or significant loss of volume, you will require correspondingly more HA filler at the outset to properly correct your facial concern. This is why the concept of full correction is so vital and one which all our facial plastic surgeons are trained in to achieve optimum results.

How often do dermal fillers need to be repeated?

Dermal fillers need to be injected on a regular basis to maintain or even improve your results. The three factors which determine the frequency of injection include (1) the type of filler, (2) the volume previously injected and (3) the area of face injected.

Juvederm products are generally accepted to last longer than Restylane products. Belotero products last the shortest as the the Belotero HA gel is of a thinner consistency. The duration of effect depends on the HA concentration in each product as well the degree of cross-linking. Highly cross-linked fillers will last longer as do syringes of filler containing a higher HA concentration. Expert injectors at Centre for Surgery are expert in knowing which product to use for a particular indication as all the main HA filler brands have their strengths and weaknesses.

Common and expected side effects of dermal fillers:

Bruising

Bruising can last up to 2 weeks post-injection but can sometimes be as long as 4 weeks in patients with an underlying defect in blood clotting. Bruising can be covered with concealer. Injection of the tear troughs may result in more bruising than usual as this is known to be a highly vascular part of the face.

Swelling

It is not uncommon to have swelling which is not equal on both sides of the face as different patients may have degrees of pre-existing facial asymmetry and also the amount of filler injected. Swelling usually takes up to 2 weeks to resolve. Patient should sleep in a raised position on 2 pillows to speed the resolution of swelling. All patients should avoid the gym for the first couple of days to avoid further swelling. Avoid massage of the treated area to avoid further swelling and possible migration of filler.

Asymmetry

Facial asymmetry is often related to post-treatment swelling. Patients should wait a full 2 weeks before an assessment on whether asymmetry is persistent and if so, is it related to differences in volumes injected. Try to avoid over-analysing your face, it is not uncommon to identify new perceived differences in facial asymmetry after dermal filler treatment that were in fact always there to begin with.

Lumps and bumps

Injections of filler will result in a tissue consistency that will feel harder than your own skin. You must avoid massage of the area to prevent migration of filler. Any feeling of lumps and bumps usually resolves by 2 weeks as the swelling subsides.

Subtle results

A typical 1ml syringes of dermal filler is roughly equivalent to 1/4 of a teaspoon in volume. After the resolution of tissue swelling, it may become apparent that more filler injection is required if your objective is increased volume. Our specialist facial plastic surgeons take great care to avoid overfilling areas with large volumes at the outset. This is a guaranteed recipe for treatment failure. The optimum approach is always to add volume in an incremental manner with time to achieve the optimum result. If you are new to dermal fillers, it is often the case that the results will last for a shorter period initially. However with regular maintenance treatment, the results will be for longer as your body begins to generate its own natural collagen in the treated areas.

Dry lips after lip fillers

Lips can become dry after lip filler treatment. Application of cold packs and maintaining lubrication with Vaseline or Aquaphor should help. Ice should not be applied for than 15 minutes at a time.

Possible complications of dermal fillers

• Granuloma formation
• Hypersensitivity reaction
• Allergic reaction
• Herpes virus reactivation
• Acne recurrence
• Skin necrosis from filler injection into blood vessel
• Extremely rarely – blindness from injection into the glabella or frown region
• Infection and abscess formation

If you experience any of the above listed complications, please be sure to contact your surgeon immediately for an urgent assessment

Our aftercare programme was recently described as ‘outstanding’ by our regulator, the Care Quality Commission.