What are Fillers

Hyaluronic acid fillers are described as medical devices which are injected in the skin and deep to the skin for the purpose of facial augmentation. They can be used for reconstructive or cosmetic purposes. They are mainly used for the correction of moderate to severe wrinkles and folds and for replacing volume loss to improve signs of ageing and for the purpose of facial enhancement, of which lip enhancement being the most popular. They can strategically be used in other areas of the face for beautification in younger age group who either do not yet show signs of ageing or just started to have age related volume loss on the face. They are also used to fill areas of scars both traumatic and due to conditions such as acne. There are a range of products available but the main leading brands are Juvederm®, Restylane® and Boletero®.

What is hyaluronic acid

Hyaluronic acid is a substance that is naturally present in human body. Apart from skin it is also present in other tissues such as joints, cartilage and around the eye. During our life time the ageing process, sun damage and exposure to environmental pollutants lead to depletion of this substance in the skin.

In skin it is present as a jelly like substance filling the space between tissues in the skin and acting as a cushioning agent and also hydrates the skin by holding water. This compound is responsible for providing the skin with its natural volume and flexibility.

Fillers are mainly used for treatment of following facial lines:

  • Smoker’s lines (perioral lines)
  • Marionette lines (angles of the mouth)
  • Deep smile lines (nasolabial furrows)
  • Smile lines (nasolabial lines)
  • Cheek depressions
  • Lip enhancement
  • Chin augmentation
  • Tear trough or areas under the eyes
  • Non surgical facelift
  • Non surgical rhinoplasty or nose correction

How is the treatment carried out

Dermal fillers are injected using very fine needles. The discomfort is usually described as minimal. After proper cleansing of the area, the product is injected using very fine needles.

These are known as temporary fillers as the material injected is slowly absorbed and metabolised by the body. The rate of absorption varies and depends on the type of product and your body’s ability to metabolise. On an average it would last from 6 to 12 months and sometimes longer.

What about side effects

Established and common side effects

tenderness, bleeding and bruising

Side effects due to poor technique

Lumps, nodules, overcorrection, blue appearance from too superficial injection

Uncommon side effects

Infections – bacterial and reactivation of herpes virus

Infectious granulomas, lumps, nodules

Allergic reactions

Non-allergic inflammatory reactions eg granulomatous reactions

Rare side effects

There can be numbness due to nerve damage

Vascular injury leading to necrosis, sloughing and scarring

Important considerations

Proper knowledge of facial anatomy and exhaustive training in injection technique will reduce the risks.

Careful consideration is important for patients with a history of bleeding disorder or taking blood thinners such as aspirin, warfarin, ginseng, vitamin E.

Prophylactic medications, like oral Aciclovir tablets may be needed if there is a history of herpes infection (cold sores).

Lumps can be treated by injecting hyaluronidase to dissolve the filler.

Anatomy and technique is crucial for filler in areas of thin skin like the tear trough and lips.

Thorough knowledge of anatomy will help avoid intravascular injection leading to necrosis and sloughing of skin.

Treatment with injectable fillers should not be carried out until any active infection or inflammation has been treated and completely resolved

Contraindications for Use

– Known sensitivities to the filler material

– History of severe allergy or anaphylaxis

-Safety of hyaluronic acid filler injections has not been established in pregnancy or when breast feeding, hence not be used in pregnant ladies and breast feeding mums.


After care for filler treatment


Avoid extremes of facial expression for up to 12 hours as it may move the product from its intended position.

Avoid any make up or creams for up to 12 hours, as the puncture wounds from the injections heal.

Within the first 24 hours, patients should avoid strenuous activity or exercise and massaging the area.

For the next 2 weeks it is advisable to avoid extensive sun or heat exposure, alcoholic beverages, UV light, use of steams and saunas

The treatment sites can produce more redness, swelling and/or itching if there is exposure to any of the above as described above.

Try to sleep with your head elevated and avoid sleeping on the injected sites for couple of days.

The redness, swelling and any tenderness subsides in the next 2 – 3 days. Bruising may take a week to 10 days.

After 12 hours any bruising can be covered up with makeup.

Any symptoms of redness, swelling or tenderness beyond 3 to 5 days should be reported.

Filler being injected into the skin

We value your feedback which also helps us to reflect and learn. At times we may call you after your treatment to check the results and to discuss any adjustments if needed.


The Abington Clinic

01604 451200