Hyaluronic Acid Dermal Fillers

 
 
 

Background

Hyaluronic acid (HA) dermal fillers have revolutionised aesthetics in that they produce natural-appearing results, are reversible and are temporary. Historically, aesthetic interventions were mainly limited to cosmetic surgery, or the use of permanent substances and implants (e.g. silicone, non-reversible fillers). These had their limitations and risks.

HA itself is a very hydrophilic (water-loving) polymer - a chain of molecules that naturally occurs in human tissue, in the space between cells. HA in tissue is continuously turned over every 24 hours, therefore, HA manufactured for aesthetics procedures is often cross-linked to allow a longer-lasting effect before it is broken down naturally. Depending on the composition of the filler, it can last anywhere between a few months (e.g. filler used for softer lines and wrinkles) to over a year (e.g. ‘heavier’ filler used to restore volume in the cheeks or to create structure to the nose and jawline).

Indications

The main indications for HA fillers are to improve the appearance of facial lines and folds, restore age-related volume loss, or to enhance and beautify the face by adding definition, improving symmetry and/or proportions. HA fillers can be used in the:

Lips - lip filler can improve definition of the vermilion border, cupid’s area or body of the lips. Lip thinning can have an ageing effect on the face; correcting lip ratio (difference between top and bottom lips) can beautify and harmonise the face.

Nose (non-surgical rhinoplasty) - dramatic results can be achieved with fillers in the nose, but in carefully selected cases. The best results are in noses with a ‘bump’ (technically called a dorsal hump), where the concern is noted from the profile/side view. Fillers can also be used to elevate the tip of the nose, which has a feminising effect (sometimes in combination with botulinum toxin, done in the same sitting. Filler cannot be injected in the tip of the nose as this carries risk, and therefore are not suitable for correcting issues with the nasal tip.

Upper face: temples - This is the only area in the upper face where we may recommend filler. This can help balance a face by creating the impression of slimming down the lower third, particularly when the temples are sunken in and the cheeks appear ‘heavy’. We do not consider filler between the brows (glabella) safe, and do not offer this at our clinic.

Mid face: cheeks, cheekbones/zygoma, nasolabial folds - mid face volume loss is extremely common with ageing, particularly from our 40s and onwards. Cheek filler can be very rewarding with a ‘3 birds with one stone’ effect: restore cheek volume itself, support the under-eye area and soften the nasolabial folds (these are all partly consequences of cheek volume loss). Filler can be used to beautify the important zygomatic area. The nasolabial folds are often improved by addressing cheek volume loss first, but persistent folds can be treated directly. More extensive support to the cheeks & mid-face can be achieved using PDO threads, which are often combined with dermal fillers.

Lower face: chin, jawline, marionette lines, jowls - Jawline filler can improve definition, or can be used to masculinise and widen the jaw. The same applies for chin filler. Interacting with the proportion between the mid and lower face can bring more harmony and youth e.g. by adding chin height to address ageing-effects, genetically small chins or to taper down the lower face (feminisation). Supporting the mid face has a very subtle effect on the lower third of the face (e.g. the ‘lift’ from cheek filler improves jawline definition and tightens the jowls), however this area can be supported directly with filler - volume loss is common around the mouth, jowling increases with age and the effects of gravity are another factor. More extensive support to the lower face & jowls can be achieved using PDO threads, which are often combined with dermal fillers.

Tear trough - The under-eye area is often victim of volume loss in the cheek, and in most cases, is improved simply by supporting the cheeks with filler (see the ‘Mid face’ section above). However, in some cases, there is a true tear trough deformity, that persists despite cheek restoration. Advanced filler treatments can be offered to address this following thorough consultation & assessment.

Contraindications

Filler treatments are generally safe in the hands of experienced, regulated Healthcare Professionals. The main contraindications are a known allergy to the products used, pregnancy, breastfeeding, broken, infected or inflamed skin in the treatment areas, permanent implants/prostheses in the treatment areas or Body Dismorphic Disorder (BDD).

Side Effects & Complications

In most cases, only mild and short-lived localised swelling, redness and/or bruising is observed. These usually settle in a few days. Bruising, if present, can take longer to disappear (in the order of weeks in rare cases). Bruising is most common in the lower part of the face or with treatments around the mouth. Swelling is most common with lip filler, and occurs in almost all lip cases to varying extents. Swelling is also a common concern with tear trough filler, which often requires several follow up visits and more time to settle. Rarely, infection, lumps/nodules, filler migration or asymmetrical results can occur. Vascular occlusion is very rare, but must be recognised and treated promptly with filler dissolving, to avoid scarring. The rate of serious complications is very low if the Practitioner’s technique is sound, and it is well documented that non-healthcare professional practitioners have higher complication rates.

Treatment planning and pricing

Treatment Planning

We use a consultation-based, clinical approach to plan your treatment. This is based on a thorough understanding of your concern, followed by an aesthetics assessment, and a specialised treatment proposal. In effect, we translate your concern to a treatment strategy. The aim is to address the issue using understanding of anatomy, ageing and aesthetics principles, delivering a treatment that leads to objective beauty. At Hourglass Aesthetics, we feel that facial fillers should not be sold as ‘products’ for isolated ‘areas’ or ‘by the ml’, as the lack of client-practitioner discussion & thorough assessment, often leads to suboptimal, disappointing or short-lived results. Several parts of the face may need to be addressed and multiple techniques may be combined, to address your concern. In some cases of course, what is desired is clear and can be addressed in isolation (e.g. lip enhancement).

Pricing

This is therefore guided by the complexity of the procedure and takes into account the time and expertise in delivering safe treatment, aftercare and managing any complications. Filler is not ‘sold by the ml’ at the clinic (it can be purchased online by anyone, for example, from prices as low as £20 per ml, athough the source and safety of the product may be questionable).

All our lip filler work is charged at £220 per treatment. We offer robust anaesthesia (lidocaine dental block in addition to Emla numbing cream) for maximal comfort. The volume used is whatever can be safely used to achieve the desired result, maintaining objective beauty. In our experience, more than 1ml per sitting is hardly ever required and we feel is not particularly safe. Robust follow-up is always offered and you have direct communication with your practitioner.

Non-surgical rhinoplasty is charged at £395 per treatment. This is an advanced treatment and is Doctor-led at our clinic. Safety is paramount and the process may require adjustment visits.

Facial fillers otherwise are charged at £150 per ml. This amount of filler is used as a guide, as this reflects the length and complexity of the procedure. This is not the cost of the product, but the value of receiving a safe treatment at our clinic by an experienced Doctor or Nurse. There is a £10 incremental deduction on each further ml (e.g. 1ml = £150, 2ml = £290, 3ml = £420 and so on). As a guide, this is what to expect and the approximate volumes we recommend for some popular facial filler treatments:

  • Fine facial lines: 1ml+ = £150+. Superficial minor lines require very light treatment, whether around the mouth, nasolabial folds, or marionette area. With significant volume loss, larger volumes of filler need to be used in the deeper planes.

  • Tear trough: 2ml+ = £350+. We recommend using 1ml per side on the initial sitting. If more volume is required, this is best spread out over several weeks, to allow time for swelling to subside.

  • Cheek filler: 2ml+ = £290+. We usually work with 1ml per side, more volume may be required depending on the degree of volume loss. Treatments can be spread out over weeks or 1-2 months if desired.

  • Nasolabial folds: 2ml+ = £290+. Again, for noticeable results, our standard recommendation is 1ml per side.

  • Marionette lines: 2ml+ = £290+. Depending on severity and degree of volume loss.

  • Chin filler: 2ml+ = 290+. Chins often require larger volumes to create structure and noticeable height.

  • Temple filler: 4ml+ = £540+. Temples require larger volumes to fill and we recommend 2ml per side for a start.

  • Jawline filler: Anywhere between 3-6ml+ = £420 - £750+. Creating larger structures requires large amounts of filler and this is also guided by the desired result. Men/masculinised jawlines usually require more filler.

Procedure

Prior to your Procedure

  • Prior to attending for your procedure, we recommend that you are well rested, hydrated and have not missed any meals.

  • If possible, please remove any makeup if worn, particularly in the planned treatment area(s)

Your Procedure

Following a thorough consultation to establish 1) an appropriate filler indication in response to your concern and 2) no barriers to treatment on safety grounds, you have the opportunity to leave things as they are to consider matters further (a ‘cooling off’ period), or to proceed with treatment on the day following fully informed written consent. This means that following thorough discussion, you consent to the treatment with full understanding of the benefits and risks.

Baseline photography is taken with your permission. The skin in the treatment area is cleaned then disinfected and anaesthetic cream is applied (for lip filler, local anaesthetic injections/dental block is also offered). The product is injected with either a needle or cannula. Several injections are usually required per treatment area. The procedure usually causes minimal pain. You may notice redness and tiny puncture marks and you may have a small amount of oozing due to the highly vascular nature of the human face. Some procedures require the filler to be massaged or moulded into its final shape.

Prior to departing, a follow-up appointment is arranged if required, you receive aftercare instructions and clinic contacts in case of any concerns/emergency.

Aftercare

Following dermal filler treatment we would advise that you:

  • Avoid rubbing the treated areas or applying any cosmetic products in the first 24hrs, to avoid introducing any infection or causing any irritation.

  • Try to sleep on your back for the first two days after a facial filler treatment, slightly propped up e.g. using 2 pillows, if at all possible. This can help reduce swelling, filler compression or migration.

  • For lip swelling, a clean ice pack can help in the first few days. Apply for a few seconds with very light pressure, and repeat over a period of a few minutes. This can be done several times a day. If bruising is an issue later on (e.g. day 3 onward), applying a clean warm pad can help clear bruising away due to vasodilatation.

  • You can also help clear away bruising with arnica cream (available at most supermarkets) or arnica tablets (available at health/supplement stores/pharmacies).

  • Avoid excess alcohol, strenuous exercise and/or extensive sun exposure for 24 hours following treatment - these situations encourage vasodilatation which can promote bruising.

  • Take Paracetamol for any discomfort and avoid the use of Aspirin, Ibuprofen or other anti-inflammatory drugs as these may promote bruising. Persistent, highly localised pain is unusual so make sure you contact your Aesthetic Practitioner with any concerns.

  • Report any changes you are concerned about to your Aesthetics Practitioner without delay - any marked swelling, itchiness, change in colour, paleness/mottling, discharge or if you feel unwell after a treatment.

Frequently Asked

+ Will I look 'silly' if I have filler treatments?

No. 'Odd'-looking results are often due to over-treatment, or poor understanding of facial proportions and aesthetics principles. If things look 'odd', 'done' or 'fake', the Practitioner has not delivered an appropriate result. There are countless examples in the media and of celebrities that have had excessive treatment, resulting in appearances that are far from natural to the human eye. We pride ourselves on delivering safe, natural-appearing results, as a result of our understanding of aesthetic principles and using an objective approach.

+ When will I notice results?

Filler results are instant. However, results look more natural and volume is enhanced over the subsequent 1-2 weeks, as the filler integrates with your tissue and draws in more water. We recommend that you keep well hydrated.

+ How long will my results last?

This depends on the type of filler used and the treatment area. Very light filler (e.g. for fine lines) lasts around 3 months. Moderate intensity filler (e.g. for moderate lines, lips) lasts around 6-9 months. Heavy filler (e.g. in the cheeks, deep facial lines, jawline, chin, nose) lasts around 1 year. There can be a lot of variation between individuals in the rate of filler breakdown.

+ What about alcohol and exercise following treatment?

Best to avoid heavy exercise and heavy alcohol in the first 24hrs after treatment.

+ Can I have facial peels or dermaroller with fillers?

We would recommend allowing 2 weeks after your filler to receive such treatments if they are in the same area. Aternatively you can plan these treatments before your filler appointment.

+ How soon can I have further treatment?

Strictly speaking, there is no restriction on repeating treatment. This may be the case if you require an adjustment, or if you desire more volume. Treatments can be spread out to help spread out cost too. When large volumes are required, it is best to stage the treatment over a few weeks to allow better integration of the product and achieve better results, in our opinion.

+ Do I need a follow-up appointment?

We offer all patients a follow-up appointment 1-2 weeks following treatment. This is to ensure results are satisfactory, there are no concerns and no complications. Follow-up can also be done virtually, if face to face assessment is not strictly required.