Nasolabial folds, frown (glabellar) lines, oral commissures and marionette lines (marionette is the French word for puppet / ventriloquist’s doll; the vertical folds down from the corners of the mouth), tear trough lines, crows feet / laughter lines, radial lip lines, to volumize thin lips, chin wrinkles and cheek augmentation.

This kind of treatment is a temporary solution because the gel disappears over time. This has the benefit of allowing the first treatment to be a more subtle trial as is preferred by some clients. The Juvederm and Restylane dermal fillers can last about 6 months and some clients report up to 12 months of satisfactory treatment.

You cannot be breast-feeding or pregnant or under the age of 18 when receiving dermal filler treatment. Those with a history of anaphylaxis, multiple severe allergies or a history of allergy to gram-positive bacterial proteins should not have the injections. Clients who take aspirin, clopidogrel, dipyridamole, warfarin and non-steroidal analgesics such as ibuprofen are at increased risk of bruising. Those taking immunosuppressive therapy are at greater risk of infection from any injection and should be considered with caution. Dermal fillers have not been tested on those with a history of excessive scarring – keloid or hypertrophic – or those with pigmentation disorders. There is a rare risk of blindness in one eye from the gel being injected into a blood vessel – (around 1 in 20 000) and so if you have poor sight or blind in one eye already it is particularly important to tell your consultant.

Any patient can suffer known complications such as prolonged puffiness (likely to relate to localised lymphoedema of local retention of natural tissue fluid eg from reduced drainage of lymphatic vessels in the facial soft tissues) / enlarged lymph glands at the jawline / under the jaw (granulomatous lymphadenopathy) – which can persist as long as the filler remains. In my practice from 2009 – 2021 I have seen ~7 patients (treated elsewhere) presenting with prolonged localised puffiness up to 3.5 years and 2 patients with granulomatous lymphadenopathy (also from treatment in other clinics) – to give you an idea of prevalence. I have managed 6 patients for whom another practitioner injected non-dissolvable agents and for 2 of these I have performed surgical removal of product (this is sometimes not possible to do, depending on the product).

You should ensure you inform the consulting practitioner of your full medical history. People with a history of cold sores may experience a recurrence after the treatment, although this can be minimized by the use of antiviral medicines. I agree to consult with my doctor if I have a history of cold sores or shingles prior to this treatment. Dermal fillers should not be administered directly after laser treatment, chemical peeling or microdermabrasion as the skin surface is not intact and there is a greater risk of infection.

This kind of treatment is a temporary solution to unwanted dynamic wrinkles because the injections only last about 3 or 4 months. This has the benefit of allowing the first treatment to be as subtle as a client wishes if there is a preference for having a trial treatment first. You will need 3 to 4 treatments per year to maintain best results and it is common for treatments to be offered in packages of 3 over 9-12 month time periods.

You must inform any medical practitioner who may prescribe you medication that you have had the injection treatment for up to 3 months after the treatment. After treatment, you should not exercise vigorously or have a hot bath for 12 hours. It is best to leave the area to settle for 1-2 days before considering any gentle massage to smooth any small collections of the filler into the tissues – this proposed delay is to theoretically minimise any risk of infection via the needle-track.

It dissolves away over time, but if necessary (this would be very unusual) this could be hastened by the injection of an enzyme hyaluronase into the product within the tissues. Before you start treatment – consider the following questions carefully:

1. Would I want someone to inject an enzyme that dissolves hyaluronic acid into my face (we have natural collagen in our face before the filler gel is injected, of course)?
2. A test patch of hyaluronidase injection is wise prior to injection and if you react to it then dissolving the gel may not be an option for you either.
3. Dissolving injection test patches and delivery attract further costs.

No-one ‘needs’ cosmetic treatments, however, many thousands of these types of treatments are safely performed each year and it has become established as a reliable and exciting mainstream treatment for improving the visible effects of ageing. Of course, the best long-term holistic approach for healthy youthful skin includes not smoking, protection from sun-radiation, keeping well hydrated, a healthy diet, exercise and plenty of sleep.