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Dermal Fillers

Dermal fillers (also known as ‘injectable face fillers’) are injectable gels made of high-density molecules which add volume or structure to the site where they are injected. They are one of the riskiest tweakments to get if you don’t go to a trusted practitioner due to the complete lack of regulation around the products in the UK. However, when used properly and safely, they can work wonders in reshaping and revolumising areas of the face.

This page is about dermal fillers in general. If you’re looking for information about the lips, then head over to my dedicated page on lip fillers. If you’re looking for information about the use of fillers in nose reshaping, then head to my page on non-surgical rhinoplasty. Scroll down for all the FAQs about dermal fillers.

Fillers 100

CATEGORY

Injectables

EXPECT TO PAY

£ 300 - 750

TWEAKMENT TIME

1 hour

LONGEVITY

3 – 18 months

ANAESTHESIA

Numbing cream

DOWNTIME

None

What are dermal fillers used for?

The way that dermal fillers are used in aesthetics has come on a lot since they were introduced. When fillers were really starting to take off, around the turn of the millennium, the focus was on finding obvious lines in the face – say, the nose-to-mouth (nasolabial) lines— and putting filler directly into those lines to bulk them out and soften them. Move on 10 years and our understanding of ageing had improved, resulting in practitioners using dermal fillers to combat loss of volume in the cheeks and around the mouth – some of the primary symptoms of ageing skin.

More recently, practitioners have preferred to look at the face not just as an assembly of parts — lips to boost, cheeks to fill — but as a whole, and to take a more thoughtful approach as to what might make that whole face look fresher and softer.

In the past couple of years, the focus has changed again. Along with subtle revolumising, doctors have been focussing on what fillers can do to add structure to the face, say by adding definition to the jawline (really helpful when that jawline is starting to soften thanks to mid-life bone resorption), or to give a man a squarer, more manly-looking jaw. There’s a lot that can be done for the chin, too, by adjusting its proportions subtly. Because they’re such common concerns, it’s worth mentioning that dermal fillers are also great for softening bags under your eyes or adding volume to hollow eyes.

In short, there are a great many applications for dermal fillers and even more are being found as aesthetic medicine develops. When you go for a consultation with a cosmetic practitioner, he or she is likely to suggest a number of options. Not so much in order to sell you more product, but with the aim of trying to create overall softness and freshness in your face. Also, if there are a number of options on the table, you don’t have to do them at once, but a coherent plan which can be carried out slowly and stealthily will give the best results.

Are dermal fillers safe?

Well-tested dermal fillers injected by a good practitioner are as safe as toxins or any other injectable treatment. However, the world of dermal fillers is a dangerous one in which you need to exercise a great deal of care. In the UK, there are no restrictions on who can take a training course in dermal fillers, and some of these courses are only a day or two long.

There are no requirements to show competence in injecting fillers before a practitioner sets up in business.   So, anyone — you or I or your next-door neighbour — can do it and they can inject you with almost anything, because in the UK fillers are not classed as prescription medicines. In this area of tweakments, even more than any other, I would urge you to follow every precaution to stay safe.

I’d encourage you to download the full dermal fillers factsheet, where I go into this issue in more depth, to ensure you really understand the ins and outs. You’ll find info on the brands you can trust and a full explanation of the reasons you need to be so careful.

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Do dermal fillers hurt?

Very little. The last time I had a full face of dermal filler injections, it was without even any numbing cream. There is only a low level of pain associated with treatment using dermal fillers and you’ll only feel pain when first receiving the injections using a syringe. You can ask for numbing cream – which any good practitioner will have on hand should you want it – to make it a painless experience. There are two ways of getting dermal fillers into the face: either through the tip of a sharp needle or through a cannula, which is like a blunt needle.

A blunt needle may sound like a terrible idea, but in fact, a cannula can nose its way along between the layers of the skin, pushing out of the way fibrous bands, or blood vessels, which a needle could just stab through, so it is gentler on the skin tissues. The practitioner begins by making a hole in the skin with a needle, then inserts the cannula through the hole. It feels a bit peculiar, having a cannula stealthily burrowing its way across your face, or running just below the surface of the lips, but it’s not painful.

How long does it take to see the results of dermal fillers?

You’ll see the difference immediately when you have dermal fillers, but bear in mind that at this point they will not have settled and are still relatively liquid and mobile. In short, don’t do what I did and go for a facial 2 days after getting tear trough fillers or you could end up with bumps where you didn’t really want them…

It’s not uncommon for people to experience swelling, redness and/or minor bruising in the treatment area after getting dermal fillers. Unfortunately, there’s no way to guard against or predict this – some people are just prone to this reaction. If you do have swelling then your true results might not reliably show until a few days have passed.

How long do dermal fillers last?

How long your filler lasts will depend on where you get the injection and how dense the product used is. For example, a small amount of a thin, pliable filler in the lips, which are mobile and constantly in use, will be broken down much more swiftly than a thicker filler used in the temples. Timeframes can range from 3 months all the way up to 4 years! Unfortunately, you can’t cheat and go for high density filler everywhere in the hope they last longer – high density fillers are only suitable for certain areas of the face.

Dermal Fillers - Before & After


FAQ ABOUT Dermal Fillers


What are dermal fillers?

Dermal fillers (also known as ‘injectable face fillers’) are injectable gels made of high-density molecules which add volume or structure to the site where they are injected. They are one of the riskiest tweakments to get if you don’t go to a trusted practitioner due to the complete lack of regulation around the products in the UK. However, when used properly and safely, they can work wonders in reshaping and revolumising areas of the face.

What are dermal fillers made of?

There are three main categories of fillers:

1) Temporary fillers made from hyaluronic acid gel. Most of the dermal fillers that you will find in the UK fall into this category.

  • Most temporary fillers on offer in UK clinics are made from different types of hyaluronic acid gel. The best-known, best accredited, and most commonly used brands of filler are Juvederm and Restylane and they both fall in this category, as do other well-known but less widely used products such as Teosyal, Hylaform, and Belotero.
  • Saying that Juvederm and Restylane are ‘best-known’ may be correct, but it is probably overstating the case, as most people who have had fillers injected don’t seem to have asked — or been told, or remembered — what brand of filler was used. I’ll get onto why it matters in a minute.
  • If you have heard of hyaluronic acid (HA) as a moisturising ingredient and are wondering whether fillers are made from the same stuff, the answer is yes, up to a point.
  • But the hyaluronic acid in the form that it’s used in moisturising serums would quickly be absorbed into the body and vanish. So in most hyaluronic acid filler gels, the molecules of hyaluronic acid are first stabilised and then ‘crosslinked’ into a kind of lattice to make them hang around for longer in the skin. The crosslinked gel holds onto moisture as well as hyaluronic acid does in a serum, and that moisture helps give the filler its structure and plumps up the skin from beneath.
  • Interestingly, there have been studies that show how using fillers benefits the skin above the treated area. This is because the presence of the hyaluronic acid filler improves the levels of collagen and elastin in the surface skin. This is the same effect as you get with the beneath-the-skin moisturising injectables such as Volite, Skinboosters, and Profhilo, which are now being described more as ‘skin tissue stimulators’ rather than just dilute fillers, because of the way they can help the skin regenerate itself, grow more collagen and elastin, and hydrate itself better. Many of these hyaluronic acid fillers come with a built-in anaesthetic in the form of lidocaine, to make the injection process more comfortable.

2) Temporary but longer-lasting ‘stimulating’ fillers made from substances like polycaprolactone, a bio-resorbable medical polymer, or poly-l-lactic acid, a synthetic material that has been used for years in medicine in absorbable stitches.

These stimulating fillers, such as Sculptra, Ellansé, and Radiesse, are also temporary but they are longer lasting than hyaluronic acid fillers, and work in two ways. Like the hyaluronic acid fillers, these ‘stimulating’ fillers come in the form of injectable gels that plump out the area where they are placed, but also, each contains a second substance that stimulates the skin to create more of its own supportive collagen, which develops over the course of the next six months and lasts for two years.

What are these extra, second substances?

  • In Sculptra, it is tiny particles of poly-L-lactic acid, a synthetic substance that has been safely used in medicine, in dissolvable sutures/stitches, since the 1980s. The poly-L-lactic acid takes around six months to be absorbed by the skin, by which time it has built new collagen that will last for two years.
  • In Ellansé, it’s minute round particles of polycaprolactone (a bioabsorbable material that is also used in sutures for stitches) that slowly get absorbed by the body but in the meantime are busy stimulating collagen growth.
  • In Radiesse, it’s particles of calcium hydroxylapatite (a bone-like substance that also eventually gets absorbed) which form a kind of miniature scaffold within the skin, around which a network of new collagen forms.
  • Pros and Cons of ‘Stimulating’ Fillers
  • The advantage of stimulating fillers is that they last longer than hyaluronic acid fillers, so they are a more economical option in the long term. The disadvantage is that, if you don’t like the results, all you can do is wait until the filler is all absorbed by the body.

3) Permanent fillers, such as silicone (which I would never recommend).

  • If someone tries to offer you permanent fillers, please, just say no. Why? Because you really don’t want anything injected into your face that is going to stay there for good.
  • Permanent fillers might sound like a great idea — no need to go back every year for a top up! So much cheaper! — but the potential problems are huge. Liquid silicone is popular in the USA for, say, filling out old acne scars, but with anything that is injected into your face, there is always a risk that the body will at some point in future decide that it doesn’t like this foreign material and ‘encapsulate’ it, growing collagen around it in a hard lump to shut it off from the rest of your skin tissue. If that happens, the only way to remove the growth, and the original filler, it to have it surgically removed.
  • Encapsulation isn’t the only problem. As your face changes over the years, and some parts of it sag and descend, the blob of permanent filler may no longer be exactly where you want it to be. So just don’t try permanent fillers. Particularly not in your lips.

Do dermal fillers work?

Yes, dermal fillers work well, both to revolumise areas of the face where there has been volume loss due to the normal processes of ageing, and to add structure to the face, for example in the chin or jawline, or to add definition to the cheekbones.

  • Perhaps I should qualify that previous statement. In the right hands, fillers work extremely well, but if they are injected by a practitioner without medical experience, proper aesthetic training and the ability to handle potential complications, they can be a disaster waiting to happen.
  • If they are injected inexpertly, they can easily look bizarre. We have all seen pictures of well-known faces with chipmunk cheeks or over-inflated lips.
  • But worse than looking bizarre, they can be dangerous. See the section below on the potential side-effects of dermal fillers.

What do dermal fillers do?

Dermal fillers are used in a number of ways, from filling deep lines in the skin to revolumising the face to adding structure or symmetry to the face. They are usually made hyaluronic acid which holds many times its own weight in water, and this hyaluronic acid is ‘crosslinked’ to keep it stable within the skin, thus providing soft volume under the skin which plumps up deflated cheeks or thin lips, or hollow temples, or sharpens the jawline. Fillers comes in different thicknesses depending on what they are to be used for – you need a firmer filler to provide structure in the face and, say, augment the jawline, while you want a fluid one for use around the eyes.

Where can I get dermal fillers?

In too many places, at the moment. The problem with dermal fillers is that they are so easy to come by. The lack of regulation means that pretty much anyone can inject you with pretty much anything, all under the guise of providing a professional dermal filler treatment. Be very sceptical – not all fillers and practitioners are equal.

The key is knowing what to look for to ensure you are given a high-quality product from an experienced and reputable practitioner. The quickest way to do that is to use my practitioner finder– I only list those you can trust – or you can download the dermal fillers factsheet, which tells you which brands of filler are safe and make sure you follow my advice for staying safe when choosing who goes on to inject the filler.

  • Which brands of filler are considered safe? While all the best known and most widely used fillers have been put through lengthy and specific tests to assess their safety and how well they work, there are scores of others that haven’t. Many of these newcomers sound like fascinating, innovative products made from unusual ingredients like, say, seaweed, and some of them may well be the big new names of the future. But until they have been around for a few years and been shown to be safe and effective (and, have at least acquired a CE mark and, preferably, have also attained the gold standard of approval from the American Food and Drug Administration, the FDA — more on which in a minute), it is hard to know whether or not they may be problematic.
  • In the USA, facial fillers are classed as ‘cosmetic devices’ and are regulated by the Food and Drug Administration (FDA). Only the specific fillers that get through the lengthy FDA approval procedure can be used, and then only by medical doctors.
  • In the UK, facial fillers are regulated as ‘medical devices’ under  European Regulations and must have a CE mark, which says that the product does what it claims to do. A CE mark is much easier to obtain than FDA approval but it does offer some reassurance that a product is fit for purpose
  • After the PIP breast implant scandal of 2010, Professor Sir Bruce Keogh led a team that surveyed and reported on the whole area of aesthetic medicine as well as cosmetic surgery in the UK. One of the strong recommendations of the 2013 Keogh report was that face-fillers should be reclassified as prescription-only medical devices, but this hasn’t happened. Another recommendation was that there should be a central register of all surgical and non-surgical practitioners; yes, it’s a scandal that there still isn’t one.

The safest fillers

You can start with the FDA and search on their website (fda.gov, look for medical devices, dermal fillers, approval).

On that list, you’ll see two major lines:

  • Lots of hyaluronic acid-based products in the Juvederm range (from medical giant Allergan, which also makes most of the world’s breast implants and also makes toxins)
  • Many products in the Restylane family (now owned by the dermatology specialists Galderma)
  • You’ll also find a handful of others:
  • Teoxane’s hyaluronic acid fillers, which joined the list in 2018
  • Belotero Balance, a hyaluronic acid gel (owned by Merz Aesthetics)
  • Radiesse (calcium hydroxylapatite; also owned by Merz Aesthetics)
  • Sculptra (poly-L-lactic acid; owned by Galderma)
  • Elevess (hyaluronic acid-based filler that is rarely used in the UK)
  • Artefill, which used to be called Artecoll in the UK, though since 2015 it has been renamed Bellafill (still with me?). It is also a very long-lasting filler, combining collagen with microbeads of polymethyl methacrylate. (Why fill your face with plastic microbeads? To stimulate the growth of new collagen. You don’t fancy that? No, me neither.)

But in terms of what’s FDA approved — that’s it. Ellansé, which I’ve mentioned above as it’s an interesting filler with a lot of safety studies behind it, and its sister-product, a hyaluronic-acid filler called Perfectha, don’t yet have FDA approval but they are working their way through the lengthy process towards accreditation. Does that mean you shouldn’t use them? No – they seem very good, and plenty of great practitioners rate them highly.

And as for all the rest…

And yet, what about all the other fillers that can be found in the market in the UK? There are many. The Keogh report estimated that there were between 140 and 190, and that was years ago.

In the UK, the Medicines and Healthcare products Regulatory Agency (MHRA) classifies dermal fillers as ‘medical devices’ rather than as prescription medicines. If you ask what safety data there is to support them, you’ll be told they have a CE mark, which companies can self-certify for, or use independent laboratories to gain.

What a CE mark means and can you trust it?

Can you put much trust in a CE mark? I spoke to Rajiv Grover, a leading cosmetic surgeon and former president of the British Association of Aesthetic Plastic Surgeons (BAAPS) about this. He says: ‘Dermal fillers are classified as medical devices which only require a CE mark. A CE mark can be obtained by treating a handful of patients with a 6–12 month follow-up. Often the real issues with medical devices take longer than this to emerge.’

Often, companies will suggest, as I mentioned earlier, that the more novel types of injectable filler will be the big new names in the business within a decade. That’s always possible, but in the meantime, it is the UK consumers who are being used as guinea pigs by the companies who want to try out new products but are prevented by law from using them in other countries.

What the Keogh report called for back in 2013, and what all reputable cosmetic practitioners have been asking for, is to have dermal fillers classified as prescription medicines rather than simply as ‘medical devices’. That would mean fillers could only be obtained, and given to patients, by registered medical professionals (doctors, surgeons, dentists, and nurse-prescribers).

How much do dermal fillers cost?

The price you can expect to pay for fillers will vary hugely depending on the product used, how much is injected, the area of the face being treated, and the expertise and location of the practitioner. This is why I’ve given such a large cost ballpark above – to indicate the price of a small tweak in one area all the way up to full-face rejuvenation work. As with all tweakments, you get what you pay for, so if you find a price that sounds too good to be true – run! I’ve already talked about the problems in the industry, but do read on for an analysis of what can go wrong.

How long do dermal fillers take?

Unless you already know exactly what you want done and how, your first consultation should be a thorough needs assessment of your facial structure. This can take a good 20 minutes. Once you’re actually on the couch for treatment, though, the work itself will only take 15-30 minutes. If you’re not great with needles and want some numbing cream then factor in a further 20 minutes for the anaesthetic to take effect. So, there are a few variables, but you won’t be in there longer than 70 minutes.

What are the potential side effects of dermal fillers?

It’s a long list and I’m going to go through it all so that people can see how dangerous the lack of regulation is. I’ve put all these points in order of how likely they are to happen and how serious they are along with what you should do if you experience these issues.

  • Bruising. Any injection carries a risk of bruising, which will be temporary but which may take a fortnight to fade. Bruising is very common. Some people just do bruise more than others.

Taking exercise, which speeds up the blood circulation, or drinking alcohol, which temporarily thins the blood, soon after the procedure may make any bruising worse.

What to do: Bruises are easy enough to cover with concealer — I prefer the sort of product that is strong enough to cover tattoos.

  • Swelling and skin redness. It is very likely that there will be swelling around the injection site, and that the skin will be red, simply from the fact that a needle was sunk into your skin. The swelling will go down, which may take a few hours, or a few days.

There may also be swelling of the area that has been injected, though it can be hard to tell how much of this is due to the volume of the product that has been put in and how much is due to your face protesting at being injected. Again, this may take a few days to settle.

What to do: Swelling can be reduced by holding an ice-pack wrapped in a clean cloth to the area every few hours. A latex glove, filled with water, tied, and frozen, makes a quick ice-pack.

  • Rashes, swelling, or itching caused by an allergy to the particular substance used — this is rare, given that most fillers are made of substances like hyaluronic acid with minimal potential for causing reactions, but not unheard of.

What to do: Swelling that seems more like an allergic reaction may respond to an antihistamine.

  • Acne-like skin eruptions. These can result from bacteria getting into the holes left by needles on your face.

What to do: Wash your face with care, swab it with a salicylic acid toner, and don’t pick at the spots.

  • Infection at the injection site— again, this can be caused by bacteria getting into the injection site and needs swift treatment.

What to do: Consult your practitioner and send them photographs; you may need antibiotics.

  • Blistering of the skin. This is rare but has been reported, around the injection sites.

What to do: Consult your practitioner at once for advice.

  • Asymmetric result. The only way you would end up asymmetric after a treatment is if your practitioner had a poor sense of proportion. But once the filler is in there, your choices are limited.

What to do: Either you can have the filler dissolved (with Hyalase) or you can have more filler injected in the appropriate place to balance things up. You might want the corrective work to be done by a different practitioner.

  • Filler moving away from the intended treatment area over time. Filler ‘migrating’ away from the site where it is injected is not common, but it can happen.

What to do: The only solution is to have the misplaced filler dissolved with Hyalase, and start again.

  • Filler forming lumps under the skin (1). Fillers, particularly hyaluronic acid fillers, don’t often provoke reactions in the skin and integrate quickly and smoothly with the skin’s tissues. There are two ways they form lumps under the skin. The first is simply if the filler has been misplaced, or badly positioned, and not smoothed into shape, which practitioners will usually do with a firm, gentle pressure and massage after injecting the fillers.

What to do: If these lumps are obvious and you can’t live with them, you’ll need to have them dissolved with Hyalase.

  • Filling forming lumpy granulomas (2). The second type of lumps are more of a problem. However well tested fillers are, they are still a foreign substance that has been introduced to your body, and your body may, in its wisdom, at any point suddenly decide that it objects to having them there, and start to form a ‘granuloma’ around the filler. It’s not an allergic reaction, more of an inflammatory reaction, but the net result is that you end up with a lumpy growth with the filler encapsulated inside it.

What to do: The best way to treat these is with steroid injections, which interfere with the way the fibroblasts within the skin cells are enabling the growth. The other option is to cut the growth out, surgically, but a) it can be hard to get the entire growth that way, and b) it will leave a scar.

  • Filler injected into a blood vessel. This is rare but extremely serious. It is rare because one of the first things all injectors are taught is, once they have put the needle through the skin, to ‘aspirate’, i.e. to pull the plunger back a fraction, just to check that they are not in a blood vessel (so if they aspirate and blood comes into the syringe, they know they need to stop, get out of that area, and reposition). Because if filler is injected into a blood vessel, it can block that vessel and kill the surrounding skin tissues (necrosis), or that blockage can travel back to the tiny blood vessels that supply the eye, which can lead to blindness. That is extremely rare, but it is not unknown. The first signs that something is wrong are usually pain and skin blanching or discolouration at the injection site and, if it happens, your practitioner needs to treat it as an emergency. There may also be swelling and this discolouration may look like a bruise, but it’s not a bruise, it’s a really serious complication – look up pictures online of dermal filler necrosis if you want to get an idea of what it might look like.

What to do: Contact your practitioner immediately if you think this is happening. You need treatment straight away to try to shift the blockage.

When you’ve seen this list, you can see why it is vital to choose a practitioner who not only knows how to use fillers, but what to do if any problems arise, and it is one reason why the aesthetics industry is so keen that non-surgical treatments are perceived as the medical procedures that they are. This is something you should ask about at your consultation before treatment and this is where medically trained practitioners clearly have the edge over others. Because if you have a problem and your practitioner is not helpful, or is dismissive of your problem, you will need to seek help elsewhere.

What is it like to have dermal fillers?

The dermal fillers I’ve had have been quick, easy and painless. Even without anaesthetic cream, the needles cause very little discomfort going in – although I would recommend the cream if you’re bad with needles or you’re receiving treatment in a sensitive area. If a cannula is being used, there’s a weird sensation as it works its way under your skin, but it’s more disconcerting than anything else. Depending on the viscosity of the filler used and the area treated, your practitioner may massage the product around a little to ensure it sits in the right place and looks the way it should.

You won’t feel the filler itself as it’s injected into you, nor do you feel it once it’s sitting under your skin, but oh boy do you see the changes quickly! Immediately after the treatment you can look in a mirror and get a pretty good idea of what’s been done. There may be some extra swelling, so bear that in mind when taking your first look, but that should subside in a matter of days.

ASK ALICE

Alice answers your question. Want to ask Alice a question? Pop it in here and check back in a few days for the answer.

Hi Alice. More than 10 years ago I made the fatal mistake of having Bio-Alcamid injected into my lips. Soon after it started migrating and I had a lot of the product removed by the surgeon who initially injected it. Unfortunately, not all was...

Hi, I'm so sorry to hear this, how very difficult for you. This will need to be examined by a surgeon. It may be very difficult to remove product that has been in your face for so long. I presume you are looking for a different surgeon than the one who did the original work – because The Tweakments Guide is focussed on non-surgical procedures and practitioners, I'm sorry but we don't have any names to offer you on this just now.

What are your thoughts on the HarmonyCA filler?

It looks fascinating – it's a hybrid filler so it's a genuinely new concept of a product, and it has really good results on skin quality as well as providing soft 'filling' in the face by stimulating your own collagen production and I've seen good results in people who've had it. I haven't tried it yet but I will do soon.

Hi Alice, please can you help. My son is getting married in early December. I'm 67 and not sure whether to have Profhilo or facial fillers – not toxin as I have sensitive skin. I've had fillers before with no problem but feel attracted to Profhilo...

Hello, I'm sorry I didn't get back to you sooner and you will have made your mind up by now. Either would have been fine; eight weeks before a big event is enough time for fillers to settle down, or for Profhilo or any other sort of injectable moisturiser treatment to start showing results. I hope you have a very happy day for the big event!

Hi Alice, can dermal fillers yield as good a result as threading or would I best to bite the bullet and go with the latter? I am unhappy with my sagging face and the pronounced nose-to-mouth lines as well as loss of volume in my cheeks and jawline....

You need to get your face in front of a great practitioner who can offer both fillers and threads and ask their opinion – they will probably suggest that you have threads and see how much difference that makes, and then perhaps use filler to add in any extra volume that would benefit your face after that.

If money is not in abundance and you wanted to do a treatment, what would you say are the best ones to do? I’m 54 and recently have noticed I’m really ageing! Have a small amount of toxin on my 11s and forehead. But I’ve noticed lines on my...

Great question – the difficulty with answering it is that different tweakments work on different aspects of the signs of ageing that we see in our faces. So, yes, a small amount of toxin will relax the lines on your forehead. Creating a lift in the face usually needs filler, placed deeply to recreate the structure in the face that time is taking away (we lose volume from the bones in our skull as well as from the fat pads, so the skin starts to hang a bit looser, it's a bit like losing weight inside a dress that used to fit like a glove), plus skin-tightening treatments from devices such as laser, or ultrasound, or radiofrequency – and...

I’m using the NuFace Trinity regularly but am due to have Profhilo and possibly some fillers next week. How long before I can use the NuFace again? I imagine that I do need to have a break from it?

Hi, yes, your practitioner should advise you that you should leave off using the NuFace for a couple of weeks after any procedure, including Profhilo.

Could you confirm how much lip filler treatment for the top lip would be with Syed Haq, please? Same treatment he did on Gail. Thanks very much.

Hello, you should contact Professor Haq directly about this, and ask for a consultation. A treatment he did for someone else may not be the ideal thing for your face, so you need personalised advice.

What are the safest, cleanest brands of lip injections and Botox for someone starting out? What is a good, affordable clinic with a good reputation? Looking to start treatments and keep it affordable and want a trustworthy clinic.

In terms of brands, the ones that The Tweakments Guide thinks are good, safe and reputable are listed under the 'brands' tab on the website menu. I don't know what you mean by 'clean' in terms of aesthetics – what you want is a brand that is well-formulated and that has been extensively tested for safety and efficacy. Re treatments, I would advise finding a great practitioner who can advise you what is best and most appropriate for your face, so take a look at the TTG Practitioner Finder for people in your area. I recommend individual practitioners rather than clinics, as each individual's work is different, and each injector or...

I would really appreciate your advice, as I'm planning to get botox and maybe a bit of filler for the first time, aged 52. I've decided to go to the Cosmetic Skin Clinic in Devonshire Place, and I wondered which of the doctors there you would...

Hiya, TTG editor Georgia here. Of the practitioners at Cosmetic Skin Clinic, those we have listed on our Practitioner Finder are Dr Joanna Christou, Dr Johanna Ward, Dr Melissa Fitzgerald, Mr Dean Rhobaye, Dr Pamela Benito, Dr Matthew Jarvie-Thomas, and Lee Garrett. They're all brilliant and you'll be in safe, expert hands with any of them....

Hi, I have been reading about PDRN – any feedback would be great, I'm just wondering if it’s worth it. Thanks.

I'd say it depends on your practitioner – are they really good and have they convinced you that this is a product that will give you a good result for your particular concerns? I don't know PDRN but it looks like another product based on nucelotides which are an injectable treatment that sits somewhere between a filler – which add volume and structure to the face – and injectable moisturisers that regenerate the skin by improving hydration and function of the skin. Nucleotides create regeneration in the skin, but via a different mechanism....

Hello, I am 48 and really starting to look old, especially when I look at photos. What do you recommend as the most effective way to look fresher and better without Botox or filler? Is it HIFU or profound or another treatment? Or would I really need...

Hiya, TTG editor Georgia here. Dr Strawford will be best placed to answer all these questions for you once he's assessed your face and talked to you about your exact concerns. He is an expert practitioner with a great deal of experience. The tweakments you mention – HIFU, Profound (RF microneedling), toxin, and filler – all do different things that work towards making you look fresher and younger, but not in the same ways. Toxin for example won’t do anything about sagging skin but HIFU will, Profound will stimulate collagen production to tighten and plump the skin, but won’t replace lost volume in the ways filler will. So it all...

Please can you tell me if there is a home device (or two) which might help with the lines I have either side of my chin? Also, I have a burst blood capillary between my cheek and my nose, and am wondering if there are any devices/treatments that...

I fear that no home use device is going to be much help with those lines – it sounds like you may need a bit of filler. And home-use devices can't help with thread veins or a burst blood vessel, but a session or two of IPL or laser would help you clear that. Take a look at our Practitioner Finder to locate a great clinician in your area who could talk you through the options....

Hi, how do I find the best cosmetic doctors for fillers and toxins in Bordeaux, France? I have in the past always gone to CSC in London and been treated by Dr Mountford or Dr Joanna Christou, but I no longer travel back to the UK.

Hiya, TTG editor Georgia here. We currently only list UK-based practitioners, so I'm afraid we can't be of much help. If you were happy with your previous treatments perhaps you could contact CSC and ask if Dr Mountford or Dr Christou know of any colleagues in Bordeaux they'd refer you to.

Hello Alice, hope you are keeping safe. From following your social accounts and reading your articles on the new treatments and best practitioners to go to, I wanted to know your opinion on Dr Mayou at the Cadogan Clinic for toxin and fillers?

Hiya, TTG editor Georgia here. Dr Mayou isn’t one of our listed practitioners so Alice and I aren’t able to recommend her as such, but she’s a well-known and experienced dermatologist and GMC-registered doctor, and The Cadogan Clinic is very reputable.

I have under-eye swelling after cheek filler. My practitioner has said he’ll see me again at two weeks and look to dissolve it then. I’m worried though that it won’t work effectively. I look awful With eye bags. Will it resolve?

Fingers crossed that the swelling resolves. If it's still there at two weeks then yes, you'd be well advised to have it dissolved and don't worry, the dissolving injections usually work very well.

I'm searching for a new practitioner for tear trough filler after pregnancy. I had an OK experience before, however a few things put me off going back to the same person. While researching, other practitioners have suggested Juvederm Volbella. But...

I know what you mean about googling, it's enough to put you off anything. Tear troughs are tricky to treat and not everyone is a good candidate for filler in this area (if your eyes tend to go puffy and baggy and hold fluid anyway, the last thing you want is hyaluronic acid gel, which holds more fluid, in the area). Re brands/ products, it's more about the practitioner than the product. I.e. a good practitioner will know a) whether you're suitable for tear trough injections and b) what to use to get the result you're looking for....

I have a deep line across my forehead. What treatment would you recommend?

I'd suggest you made an appointment with a great practitioner to get their view on what has caused the line, and what the best way to soften it might be. Most of the horizontal lines on our foreheads are from the way we raise our eyebrows, and the lines settle into place over the years. Because these lines are caused by muscle movement, wrinkle relaxing injections of botulinum toxin A should help soften your line. For lines which are really deep, it may make sense to treat it with a soft kind of hydrating filler, but a skilful practitioner will know just what to do....

What are your thoughts about Sculptra? Is it dangerous and what are the risks?

Hi, no, it's not dangerous, it's a great product and gives really good results when injected by a brilliant practitioner. Because it is a collagen-stimulating injectable, it takes two or three months for the results to become apparent. Find someone on our register of trusted practitioners and you'll be in safe hands. You can also find out more about Sculptra here.

Hi Alice. Pls can you recommend one of the practitioners in the NW who can offer great toxins and filler treatment? I can’t waste money trying them all and don’t know who to go with. 56, wrinkles, muscle loss and scarring.

Hi, take a look at the Practitioner Finder - if you put in your postcode, it will come up with a selection of my trusted practitioners who are closest to you, and show you the treatments they offer.

I’m 47 and have had Morpheus8 followed by Profhilo, pleased with the outcome. I’m looking at tear-trough filler but have heard it can make you look puffy? Can you advise? Also, what's the most natural lip filler? I don’t want to have big lips...

For tear-trough filler, find a great practitioner and get them to assess whether you're a good candidate (if your under-eye area tends to go puffy anyway, you absolutely shouldn't have filler injected in there as it will hold water and make the issue worse). Re lip filler, as with any injectables, it's all about the practitioner rather than the product. A skilful injector will give you subtle, appropriate treatment with whichever products they prefer to use.

Hi Alice, do you feel filler is any good for necklace lines? I've had them for 20 years. Or is there a better alternative? I've done Morpheus8 and Profhilo and seen no difference.

Hmm, if Morpheus8 and Profhilo haven't made any difference, then maybe one of the softer fillers could help? A few years ago, I had injections of a filler called Aliaxin in my neck wrinkles (alongside Profhilo) which gave a very nice result with no strange lumpy bits. What does your practitioner suggest? They know your neck better than I do, and might have other tricks up their sleeve in terms of tweakments that could help you....

I have been considering chin and mandibular implants for years, for a more masculine look. I would much rather of course have fillers – is there a filler you recommend to give the most solid, long-lasting and natural result compared to facial...

Hi, there's a variety of fillers that could help you here, the sort that are firmer, with a higher lifting capacity, so they keep their shape when they're used for structural reshaping of, say, the jaw and chin. Find a great practitioner in your area, and have a consultation with them about what they'd do and how they'd do it and which fillers they use. Different practitioners prefer different brands for different reasons, but all the brands have fillers that can give the effects you're looking for, when used by a skilled injector....

I have a very deep horizontal line across my forehead. What would you recommend please?

I'd suggest you made an appointment with a great practitioner to get their view on what has caused the line, and what the best way to soften it might be. Most of the horizontal lines on our foreheads are from the way we raise our eyebrows, and the lines settle into place over the years. because these lines are caused by muscle movement, wrinkle relaxing injections of botulinum toxin A should help soften your line. For lines which are really deep, it may make sense to treat it with a soft kind of hydrating filler, but a skilful practitioner will know just what to do....

Alice, have you heard of breast filler?

Yes I have, there used to be a thick type of hyaluronic acid filler called Macrolane, launched in 2008 in the UK but taken off the market a few years later after continuously causing problems. Please, if you're contemplating doing anything to your breasts, find a reputable surgeon who specialises in breast work.

I live in London. Who do you recommend for facial fillers including cheeks, jawline and mouth lines? Thank you.

Any of the fabulous practitioners listed on the site. They're all people I'd trust with my face.

I'm getting work done for the first time. I originally wanted to go to PHI Clinic in London as I know they are one of the best, but cost is also a major thing for me. I’d probably want toxins, filler and possibly a skin peel.

Have you looked on our Practitioner Finder to see if there's someone I recommend who's more local to you? It's really difficult deciding where to go for treatment as none of the best practitioners are exactly cheap, and the PHI Clinic is excellent. I still think it makes better sense to have a smaller amount of treatment with an excellent practitioner, rather than masses of treatment with someone with limited skills/ experience – because you will see a better result. Have a consultation first, explain about your budget constraints, and see what your chosen practitioner can suggest.

I have been offered fillers for an unsatisfactory result of a facelift and fat graft. Please can you recommend someone in London?

Have a look at our Practitioner Finder to find someone we trust near you. Pretty much every practitioner on there offers dermal fillers, so you shouldn't have any trouble finding someone. It may be wise to let the results of your facelift and fat graft settle for some time though before you go in with injectables. Make sure you visit your practitioner for your follow-ups and to discuss why you're unhappy with the results from these procedures – dermal filler won't replicate the intended results of a surgical facelift....

What is your advice on filler removal? And which practitioners would you recommend, as it is difficult to search out this treatment?

Hiya, editor Georgia here. Your first port of call should be the practitioner who injected the filler in the first place, as they’ll know exactly how much they injected, where and which product they used. If this isn’t an option (maybe you had a bad experience and you don’t want to go to them again) use our Practitioner Finder to find someone near you who we trust. Any practitioner who does dermal filler will be able to dissolve it, and will also be able to advise on any follow-up treatment to meet your needs. If you know – or can find out – the details of your previous treatment as mentioned above, that will make the dissolving...

Toxin for some reason doesn’t work on me. I recently had soft fillers around the eyes and that made minimal difference. Is there any other treatment you would recommend? My practitioner can’t understand why it doesn’t work because I still have...

Hiya, editor Georgia here. It could be that you are resistant to the drug (botulinum toxin), but this is really quite rare. Manufacturer clinical trials showed that no more than 1.5% of patients develop 'neutralising antibodies', and the figures are something like 1 in 10,000 that it doesn’t work for. Usually, if the treatment doesn’t work, it can be because of the dosage (not everyone’s the same, and some people need a higher dose) or the dilution of the product. You could try another practitioner if yours perhaps isn’t quite so experienced. Toxin and fillers around the eyes will usually do different things (sometimes both are an...

Hi Alice. I’m looking for a recommendation for clinics in London who offer lip filler (and potentially non-surgical rhinoplasty filler). There are so many that come up upon searching and I'm looking for a good recommendation.

Hi, do you mean there are so many that come up when you search on our practitioner finder? To narrow your choice down from there, go onto each practitioner's website and look at examples of their work with lips and noses, to find someone who does a lot of the sort of work and gives the kind of results that you are looking for.

Hi Alice, I felt unwell this week with some specific and non-specific symptoms and now I have sore lumps appearing where I have previously had filler – chin, corners of mouth, right cheek and right nasolabial fold. Taking anti-histamines – do I...

Hi, it sounds like your immune system has taken a knock and your fillers are swelling as a result (it's not that common, but one doctor friend tells me that's how he knows when he's about to go down with a virus – his fillers start swelling). Antihistamine should be enough to soothe them until they calm down. If not, ask your practitioner for their advice on what to try next. No, it doesn't mean that you can't have filler in future, but just that to be aware that this may be a recurring problem for you, going forward.

Jowls... I have had Ultherapy and there is an improvement, but not as much as I thought. Would your suggest fillers?

Maybe fillers to define the line of your jaw. Or maybe radiofrequency microneedling to smooth and tighten the skin in a slightly different way? I'd ask your practitioner as they know your face and can suggest what sort of treatment could work best for you.

Hi! I would like to ask what treatment is the best for cheeks? I am 52 and I want my face to look younger.

Hi, probably carefully placed dermal filler. Find a brilliant practitioner, book in for a consultation and see what they suggest once they've had a good look at your face.

I'm considering getting Sculptra for facial rejuvenation. I'm researching Dr Askari Townshend as he has a clinic in London. I'm nervous about taking this leap – have you heard anything negative about him? I guess I'm seeking reassurance. Thank you...

No, he's fab, you'll be in good hands.

If you have filler, say in the cheek area, as it slowly dissolves, will the product slip and pool, creating odd, swollen pockets?

No – if the product has been correctly placed, which is something that any of the trusted practitioners on the website here will be able to do, it will stay in place. If you think your filler is moving from where it should be, go back and see whoever injected it and get their assessment of what's going on.

At 53 years old I hate the way my face is losing its 'scaffolding' and the lack of firmness around my jawline. I have had numerous Profhilo treatments and more recently 3 sessions of Morpheus8, but I can't see an improvement. What do you suggest?

I know what you mean about losing the 'scaffolding' in the face – that is exactly what's happening thanks to bone resorption all over the skull. It's like our skull is being sanded down on the inside. Those treatments that you've had WILL have helped – the Profhilo will have improved your skin condition and the Morpheus8 will have helped smooth and tighten your skin. What I'd suggest, if your practitioner thinks it's a good idea, is some careful work with filler along your jawline and in your chin, and maybe in your cheeks, to strengthen that internal scaffolding and redefine your contours....

Filler or toxin for marionette lines? I lost weight after cancer treatment which has left pronounced marionette lines.

Possibly a bit of both? Glad to hear that you are the other side of cancer treatment. Toxin helps by softening the muscles that exaggerate the marionette lines, and filler can prop up the areas around the mouth and chin that have lost bone (which just happens, over time) as well as fat. Find a great practitioner and ask their advice, they will know what's best for your particular face.

How do I lessen the appearance of hollow cheeks and sagging jowls without fillers, please?

You could try a skin-tightening treatment like radiofrequency microneedling or laser. How much of an improvement you might get in terms of skin-tightening depends on what sort of shape your skin is in at the moment. Unfortunately nothing except filler is going to replace lost volume in the cheeks. I understand why you might not be keen to try it, but honestly, in the right hands – like those of the practitioners on this site – you could get some lovely, subtle and appropriate results.  ...

I'm 51. Should I get an 8-point facelift or a full facelift?

That's a big question (should you have fillers or a surgical facelift) and the short answer is: it all depends. What does it depend on? Well... what does your face look like now? What are you hoping to achieve? How big a change are you looking to make? Are these changes things that can be addressed with filler? To get the answers to those questions you need to get your face in front of a great practitioner and take their advice. Also, the 8-point lift feels like a rather old-fashioned concept these days. Not everyone needs treating in the suggested eight points – it's usually better to allow a skilled practitioner to use filler where they...

What can help with plumping my mid face? My cheekbones are quite high but they look hollow underneath as I'm getting older (57)

Filler! Specifically, just some 'soft' (as in small amounts, thoughtfully placed) filler at the sides of the face beneath the cheekbones, just to soften that gaunt, angular look. Find a great practitioner on our practitioner finder and see what they can do for you.

Surely with all the treatments you’ve had over the years, why do you need so much filler? Does it mean all the things you’ve done in the past don’t work?

Great question, I mean, you'd think I'd be 'fixed', wouldn't you, with the amount I do. There's two parts to the answer. One is that there's a lot going on in an ageing face and each tweakment only treats one aspect of it. Pigmentation builds up – lasers or IPL clears it. Wrinkles become entrenched – toxin softens the lines. We lose bone mass from our skulls – fillers rebuild the contours of the face. Lips and cheeks deflate – again, fillers help here. Skin slackens and sags – laser/ RF needling/ ultrasound can tighten it... and so on. But it's like painting the Forth Bridge – by the time you've worked through all those things,...

I wanted to ask you if you have ever had tear trough filler and what was your experience? My dark circles/ hollows are of real concern to me and I'm considering this procedure with Dr Sophie Shotter who does my toxins. Your list of things that could...

Hi, I'm so sorry to have scared you with the list of things that can go wrong with/ after tear trough filler but I feel it's really important that people should be informed and aware of all the potential issues around any tweakment before they go ahead and book in for it. You would be told all these things at consultation stage and/or will find them all listed on the consent form that you will be asked to sign before going ahead with any treatment. Tear troughs are tricky. Some people are great candidates for tear-trough treatment but others aren't, so it's important to pick a practitioner who knows how to treat appropriately. The...

Who would you recommend in London for conservative fillers around the eye area? I’m thinking tear trough but also the outer area.

Have a look on our practitioner finder – you can search by tweakment as well as by area. There are loads of great practitioners on there who do really good tear trough work, and they will advise you whether this is an appropriate treatment for you.

Hi Alice, I have been using Carita My CLE facial device which is a microcurrent plus LED device. I understood I should not use this on toxins-treated areas which makes sense as this would work against the effect of toxins. But what about after...

Hi, oddly enough, microcurrent devices work really well on faces treated with toxin - because the microcurrent helps keep muscle tone in the muscles while they aren't being worked by the usual facial expressions (toxin doesn't do anything to the muscles; it disables the neurotransmitters that send messages to the muscles to contract. So, microcurrent is not directly counteracting the treatment). All the device manufacturers suggest you wait for two weeks before using microcurrent after toxin injections, and the same after filler injections (after two weeks, the filler will be properly settled).

Posting on behalf of my beautiful 65yo mum. Despite good skincare she has jowls, a drooping chin and a “turkey” neck. She has an autoimmune disorder, so Drs won’t do injections on her. What other tweakments could she look into, please?

When you have an autoimmune condition, tweakments aren't necessarily off the cards. Many practitioners are happy to treat patients with autoimmune conditions BUT they will want a thorough consultation with your mum first; it might be possible to have injectables such as filler at times when her condition is well under control (but not when she's had any flare-ups). Same for other treatments like radiofrequency microneedling, which can help with jowls and slack skin. Her best bet is to set up a consultation with a great practitioner in her area who will listen and talk her through suitable and safe options....

If I want multiple items – toxins, filler and Profhilo – but cost is an issue, what would the cost and results difference be between a great clinic like PHI in London and Skintique in Leicester?

The cost of procedures is less outside London; in terms of the results you'd get, what you really need to factor in is the skill and experience of your practitioner. They will discuss with you at consultation stage what your concerns are, what procedures would be beneficial for you, how much treatment you might need to move towards the outcomes that you're after. That way you can decide, with their help, where your tweakments budget is best spent. The practitioner is crucial in all this, and the lead doctors at both PHI Clinic (as well as Dr Manav Bawa and Dr Amanda Penny who run clinics at PHI) and Skintique are very good and are on my list...

Do you know of an eye surgeon in Scotland that could treat my hooded eyelids? If malar bags could be addressed too, that would be even better.

Hiya, TTG editor Georgia here answering on Alice's behalf. I'd advise first having a consultation with one of the many great non-surgical practitioners in Scotland before deciding to definitely go down the surgical route. If you look on our practitioner page, you can put in your postcode and find out who is nearby that Alice and I trust to advise you well. If you would in fact be better off with surgery (which is often the case with hooded lids and eye bags), they will be able to refer you onwards to a surgeon.

What is the most effective filler for a 63 year old with a thin face and thin skin?

Hiya, editor Georgia here answering on Alice's behalf. One filler isn't necessarily more 'effective' than another. Each brand will have a range of filler products in its line that are better suited to various indications depending on their composition – like the lips vs. the jawline, for example – but what's best for your own face is impossible to say for anyone other than the practitioner assessing you. Use our practitioner finder to find a brilliant injector near you, and set up a consultation. They may even recommend a treatment other than filler. This is the only way to find out what will be most effective for your concerns....

I have lumps under the surface of my skin (lower jaw area from Radiesse filler, which have become more pronounced. I have that this filler cannot be removed. Please can you advise?

Hiya, editor Georgia here answering on Alice's behalf. I'm sorry to hear this. You're right – Radiesse is a type of collagen-stimulating filler that can't be dissolved. How long ago did you have treatment? Lumps can occur immediately following injection but should settle after around four weeks. If it's been longer than this, unfortunately you'll have to wait until the filler is absorbed by your body, which can take up to 18 months. If they're really troubling you they can be surgically removed. I'd suggest following up with your practitioner and asking for a referral.

Hi Alice, I had Ultherapy after watching you have it! I went to Dr Victoria's clinic in Edinburgh...3 months later there is a subtle lift but wondering if I should try microneedling or fillers...it's the saggy jowls and tightening of the jaw.

Hi Becky, editor Georgia here answering on Alice's behalf. How long has it been since you had Ultherapy? Full results can take up to three months to be visible so you may wish you wait and see if you really do want to do something else. Having said that, yes – RF microneedling would be great to tighten up jowls and define the jawline a little more. You could have some filler along the jawline further down the line for extra definition, but fillers won't do anything for the jowls as such....

Please recommend a Dr or dermatologist that can deal with all skin and injectable issues in Manchester. I cannot find anyone please help!!! Thank you in advance.

Hiya, editor Georgia here answering on Alice's behalf. I put a central Manchester postcode into our practitioner finder and you can view the results here. Any of these practitioners should be able to help you.

Hi please can you tell me if you think 63 is too old to start toxins or fillers? I need something to make me look less grumpy around my mouth area.

Hi, what a great question but please, let me reassure you, you are never too old to start with toxins or fillers. Many practitioners have patients who are in their eighties or even nineties, who love the treatments and the benefits they see from them. Toxin and fillers are great for improving a grumpy-looking mouth. The toxin weakens the strength of the muscles that pull the mouth down, and the fillers can prop up the sides of the mouth just a little, or lift the cheeks a fraction which stops the lower face looking so saggy... so hop over to the practitioner section of the website, find someone in your area and have a consultation to see...

Lift my chin and lines from nose to chin

In a word: filler Take a look at this page about nose-to-mouth lines and scroll down to see the FAQs And click here to get to the practitioner finder, to locate someone great near you who can help.

I'm 57 with thin, dull skin, dark circles/ hollow under eyes, lack volume. What do you suggest please? 🙏

Hi, I'd suggest starting with some great skincare to address the quality of your skin and get it looking a bit fresher and livelier. Take a look at some of the products in the TTG shop eg this radiance-boosting bundle - there are videos explaining what the products do and why I rate them. It's worth considering hormone replacement treatment (start with your GP). Losing oestrogen as we go through the menopause wreaks havoc on the skin (as well as on our moods, joints, sleep etc) and replacing it helps the skin to function so much better and to regain a good deal of its strength, bounce and hydration. Re dark hollows under your eyes and...

Hi Alice, how long after the Covid vaccination is it safe to have fillers/toxins?

Hi, most doctors advise waiting a couple of weeks after having the vaccination before having fillers (or, if you've had fillers, to wait a couple of weeks before having the jab). There are relatively few instances where having the vaccination causes an immune reaction that makes fillers swell temporarily  - but it can happen. With toxins or other wrinkle-relaxing toxins, the general advice is the same - to wait two weeks after having the vaccine.

Hi Alice, I've got what I would describe as an old lady chin - ie dimply, lined, irregular, not smooth. I can't see anything on your site that mentions this. Can you advise please?

Hi, what a great question -- and you're right, there's nothing specific on the site about it - perhaps I should add 'old-lady-chin' as a new concern as I think we all know what you mean. Start with some effective skincare (vitamin C serum, retinoids, sunscreen) to help with the surface condition and quality of your skin, and then... As for tweakments - I'd say my usual thing of getting yourself in front of a great practitioner (lots on the site, here's the link, you can search by postcode) and discussing it with them. Here are some things they might suggest. Wrinkle-relaxing injections eg toxins - which I like because they stop the...

I’m desperate to get some filler advice as I've had it done on Friday and absolutely hate the results. I literally wanted to cry when I saw the results. Did my research but soon as I got there I felt some pressure and didn’t speak my mind and...

Oh heck you poor thing. You can have it all dissolved straight away if you're sure you want that done. (There is no need to wait. If the practitioner had injected the filler into a blood vessel during treatment, they wouldn't have to wait to dissolve that). If you just want hydration, better -- another time --  to try an 'injectable moisturiser' type treatment like Profhilo or Belotero Revive or Juvederm Volite as these are placed just below the surface of the skin, and just add hydration rather than volume, more info about injectable moisturisers aka skin boosters right here....

Hi Alice, I am thinking of getting a Dermalux Flex . I’m 61 and recently lost a stone in weight. I am taking collagen tablets but want to increase lost volume in my face and avoid fillers. Would this be a good investment? It’s expensive!

Hi, yes, the Dermalux Flex is expensive - it's brilliant for improving skin quality, hydration and firmness, it takes down skin redness, reduces inflammation and will help reduce pigmentation from age spots... BUT it can't help restore lost volume in the face. Nor can collagen supplements; they too help the strength and quality of the skin, but can't make the face regrow the fat pads or restore the bone mass that has been eroded by the years. Nothing can do that except fillers or fat transfer - and I know those are not something you want to do. Sorry.

Do you have a post or any advice on treating under eye hollows? I am terrified of looking fake, weird or done but on discovering this treatment is available i am very interested. Could you point me in the right direction?

Yes I do. I totally understand why you're cautious about having filler in your tear-trough area to treat under-eye hollows, but if it is well done, this is a brilliant treatment to disguise the appearance of those hollows. Take a look at this video where Dr Saleena Zimri is demonstrating a tear trough procedure And take a look at this page which is all about hollow eyes and what you can try - scroll down the page to see all the FAQs

Do you know of any non surgical treatments for a slight underbite?

Sorry, but no. If you have a retrognathic chin, i.e. overbite/weak chin, you can have fillers to advance the profile a bit, but not the other way round.

Is bruising normal for lip filler?

Yes, there is always a risk of bruising with any needle-based procedure, however good your practitioner is. If the needle nicks a tiny blood vessel... it's just bad luck.

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