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How I use dermal fillers in my practice

On 10th January 2023, aesthetic journalist Alice Hart Davis, who is turning 60 this year, was featured in a Daily Mail UK article on the treatments she’s had over the past 20 years entitled “I’ve got 20 years of filler stuck in my face - it’s meant to dissolve over two years”

While the title is sensationalistic the overall message from the article is one that sensible injectors (and I like to think of myself as one!) have been saying for years - you do NOT need to have filler “top-ups” every 6-12 months as the industry training companies will often tell you because fillers can last far longer than we first believed, upto 11 years, as it turns out, depending on the individual, the brand and type of filler used and more. 

So does this mean all dermal filler is bad and we should all abandon it? Alice says no, as do I, with my thoughts on her article as well as what I regularly discuss with patients in clinic and my advice around dermal fillers. 

Choose your provider carefully, ensure they’re an expert and stick to them.

  • one person/clinic for your face
  • it does not have to be me (I say this in clinic to every new patient also) 
  • is experienced and does their job well including complications management 
  • the skill is in repetition over thousands of hours and many years, not in a 2-day or 2-week boot camp or doing this on the side 
  • choose your practitioner based on their skill, not price of product - the same product in 2 different hands can yield very different results
  • if they are cheap, there’s a reason for it; what corners are being cut or are they practising on you? 
  • medical aesthetics is entirely discretionary and my advice usually is, if you can’t afford it (yet), keep saving; it’s better not to start than to start and stop as there can be an initial phase where it may look/feel like you are going backwards. Think of it like a home renovation - it can look & feel crappy while you are in the middle of it. 
  • realistic expectations and managing your anxiety around slow results, and common non urgent side effects is vital; medical aesthetics is usually for patient people 
  • trust in your provider and what they suggest. It’s ok to have a plan in mind, but go in with an open mind and be prepared to listen to the advice of the person you’re consulting. 

Filler for enhancement, maintenance or volume restoration are different.

  • younger people, mostly young women, commonly seek lip enhancement if they have genetically thin or asymmetrical lips. For these cases, 1-2 mls in 2 more more sessions is usually enough, and maintenance with additional treatments only as and when needed every 12-18 months or longer. 
  • for maintenance from as early as our 30s, filler can be used to subtly replace early volume loss before it’s very noticeable and the standard guide tends to be 1ml (the size of a blueberry) per decade; so for someone in their 30s, you’d expect around 3-4 mls just to maintain volume. Keep in mind a ketchup packet is 5mls. 
  • volume restoration is different entirely which is what Alice likely had when she began in her late 30s/early 40s, the typical age I start seeing women wanting to address persistent signs of ageing that they can no longer ignore, among them volume loss. When volume loss begins to take its toll on our face rarely as early as our 20s, they can present as hollows under the eyes, flatness around the cheeks and temples as well as prominent smile lines and early laxity around the lower face. Restoring lost volume can take far more than the 1ml/decade rule, easily double that in most cases, until maintenance is reached. 

 Once you’ve reached maintenance, less is more.

  • while there is no doubt that the initial outlay for a holistic full face rejuvenation is expensive the longer you leave it to begin, I always compare it to other discretionary spending we all undertake - holidays away; home renovations; orthodontics; designer fashion and more. 
  • thereafter, maintenance is far more manageable and given what we know of the longevity of fillers now, placed well, it can be the gift that keeps on giving for many more years until there is further volume loss due to the ongoing ageing process. 
  • at this stage I actively discourage my patients to focus on other modalities to maintain their results. 

For maintenance of skin quality without risking pillowface, collagen inducing therapies are my preferred treatment 

  • when you pick a clinician with significant experience and a wide skillset, you’re more likely to have a bespoke holistic plan devised for you that avoids overcorrection and odd results. 
  • at Skin Essentials, our focus is always on using dermal fillers in the initial stages to replace volume as quickly as your budget will allow, while working on skin, lines and wrinkles in the background, and then maintain with skin therapies and other collagen inducing modalities such as biostimulatory filler, which dissolve in a reliable manner to induce your own collagen in the process. 

If sagging  is your biggest and most pressing concern especially if you are also postmenopausal, you should not delay surgery if you can afford it. 

  • at Skin Essentials we pride ourselves on holistic, evidence based medical aesthetics 
  • we would never feel comfortable taking your money or selling you a product or service that we didn’t believe was right for you. 
  • fillers do not lift, they only replace volume which can subtly provide lifting effect in some faces
  • if at any point what worries you isn’t amenable to non surgical or minimally invasive procedures, I’ll be the first to suggest a referral to a plastic surgeon as there is no reliable way as yet to LIFT skin without surgery. 

The take home message from all of this? 

  • dermal fillers in experienced hands are exceedingly safe and risks are rare but not zero, as with any medical procedure 
  • the longevity of fillers means that placed well/ correctly, they can last potentially years, as the face continues to lose volume with age and are a worthwhile investment
  • collagen inducing therapies are an important adjunct that add subtle volume over months, improve skin texture and add plumpness reminiscent of our youth without risk of pillowface 
  • pick a highly experienced injector who has access to and training in using Ultrasound at point of treatment if needed 
  • while dissolving filler in the event of an emergency is absolutely necessary, using dissolver to remove poorly placed filler is to be avoided

Ultimately, for a harmonious and holistic approach to full face rejuvenation, it’s important to combine multiple modalities - personalised skincare, injectables including anti wrinkle and fillers, as well as skin therapies and fat dissolution methods as needed, to achieve results that will have you looking your best for years to come and possibly even avoid surgery if that is your plan. It won’t be cheap initially, and requires time, effort, trust and budgeting but most patients who commit say it’s absolutely worth it.  


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