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Dermal Fillers for Volume Loss & Reshaping

Available Dermal Fillers – Teosyal | Restylane | Juvederm | Radiesse

It is not just lines that become a problem with age. Skin gradually thins, elasticity is lost and there is a decline in collagen, hyaluronic acid and elastin. There is noticeable loss of volume with changes in facial bone and soft tissues. The attractive youthful triangle comprising of high cheeks and a small chin reverts to a bottom-heavy appearance as cheeks flatten and jowls appear. This is what we can try to tackle with the aid of dermal fillers.

Dermal Fillers Medicine

The basis of most dermal fillers, such as Restylane®, Juvederm® and Teosyal® is hyaluronic acid. Hyaluronic acid improves skin hydration, promotes collagen synthesis and normal skin function. It is crucial in the structural integrity of the collagen matrix, providing structural support and nutrients.

Our approach to facial rejuvenation is to examine the face according to Leonardo da Vinci’s 3 facial zones (Upper Third, Middle Third & Lower Third). Creative & artistic abilities have a great role here and clinicians tend to have a ‘double vision’ in which at first they clearly recognize the areas of volume loss and demonstrate this to their clients (many of whom are unaware of the gradual volume loss that has been occurring over years), and second, able to visualise the cosmetic result prior to dermal fillers treatment

Despite being the second most commonly performed aesthetic treatment, dermal fillers treatment still raise uncertainty and scepticism in many individuals. Much of this is due to unfavourable reports of ‘pillow faces’ and ‘trout pouts’. Additionally, the role of fillers is often misunderstood. On a basic level, it can be said that fillers do as they should; they fill. However, they have advanced much beyond their initial indication for ‘filling’ wrinkles. Sophisticated facial sculpting and contouring is possible with experienced hands.

In order for improved and natural results our cosmetic doctors may recommend a combination of treatments including dermal fillers, botox, skin treatments and/or cosmeceuticals just as artists uses more than one colour the best cosmetic doctors use the power of synergistic effect of more than one treatment modality.

Treatment Areas

Dermal Fillers Treatment Areas



1. Forehead Lines / Pillow Lines

Sleep lines around the forehead are common and may be due to multiple factors such as position of sleep and type of pillow used. These lines present great difficulty in treating as continuing the sleeping style will effect the results. However, with some minor adjustments to your sleeping position and a combination of skin collagen building treatments which include dermal fillers in the various layers of weakened skin and cosmeceuticals that promote strong collagen synthesis we can treat these lines to appear softer.

Dermal Filler Treatment forehead Before Dermal Filler Treatment forehead After

2. Frown / Glabellar Lines

The familiar, wearisome frown lines are an everyday complaint at our London clinic. For most, botox is the treatment of choice relaxing the muscles responsible for these ‘dynamic’ lines. However, 'static' frown creases that are visible at rest respond well to a combination treatment with dermal fillers.

As frown lines are such a common concern it would naturally be understandable to assume that dermal fillers in this region are an easy procedure. It is, however, a treatment that requires advanced, skilled practitioners who can apply appropriate experience and caution.

Dermal Filler Treatment for Filler Frown Before Dermal Filler Treatment for Filler Frown After

These frown lines were previously treated by botox to relax the muscles. Further treated successfully by dermal filler injections.

3 & 4. Tear Trough & Periorbital Lines

Periorbital rejuvenation with dermal filler Injections is a technically advanced treatment that can address many issues including dark circles, sunken tear trough regions, lines & wrinkles under and around the eyes.

Dermal Filler Injection Treatment for Filler Tear Tough Before Dermal Filler Injection Treatment for Filler Tear Tough After

see Tear Tough page for full information – click here

5. Non Surgical Nose Job

Mini Rhinoplasty

Dermal fillers are commonly used in the nose for a variety of indications. Some of them include nose hump reduction, flat nasal bridge in Asian & Africans, droopy tip as well as balancing the size and shape in patients who’ve had a previous unsuccessful rhinoplasty (surgical nose job). Ageing of the nose produces surface changes, nasal tip ptosis (droop) as well as some textural alterations.

Dermal Filler Treatment for Nose Before Dermal Filler Treatment for Nose After
Treatment for Nose with Dermal Filler Before Treatment for Nose with Dermal Filler After

6. Cheek Enhancement

Cheek EnhancementCheek enhancement, also referred to as malar augmentation, is an advanced procedure undertaken by our highly competent London doctors. With age, the youthful contour of the cheek can begin to flatten, resulting in a sunken, tired appearance. Eyes can appear weary and drawn as a malar groove appears. There is loss of tissue volume in the midface with descent of fat pads, reduced elasticity, collagen and hyaluronic acid.

Replacing cheek volume targets flattened areas or grooves. Current advanced techniques utilise a blunt ended, flexible cannula. This reduces the number of ‘injection sites’ as only one or two entry points may be required. The blunt end minimises risk of damage to vessels and nerves reducing the possibility of bruising and ultimate downtime. Cheek enhancement should be undertaken by practitioners that are confident in their practise, and have vast experience with dermal fillers.

7. Nosalablial Folds

The deep, diagonal folds that appear at the sides of the nose and extend to the corners of the mouth, or further, are also known as the ‘nasolabial folds’. These deep furrows are characteristic of the ageing face and project a fatigued, harrowed appearance. There are a multitude of causes for these grooves including loss of soft tissue volume, reduced elasticity and gravitating fat pads from the cheek region. Expressions over time also play a part. The procedure takes approximately 10-20 minutes and most individuals leave with mild redness and minimal swelling.

nasolabial Folds Scale

Filler Treatment for nasolabial before Filler Treatment for nasolabial After
Nosolabial dermal Filler Treatment before Nosolabial dermal Filler Treatment After

8. Perioral Lines (Upper Lip Wrinkles / Smoker’s Lines) Lip Lines

Flaccid, wrinkled lips lacking contour trouble many individuals. The vertical lines that appear around the mouth, also known as smoker’s lines, can terribly age an individual and detract from the sensuality and vitality that lips can be associated with. Women can find it infuriating when lipstick bleeds into these lines, blurring any lip definition.

There are a variety of treatments available which can be discussed with a personal approach by our accomplished cosmetic doctors. Botox may be advisable to relax some of the lip muscles, reducing the effects of habitual puckering. Dermal fillers can be injected into the lines themselves or into the vermilion border to strengthen the supporting edge of the lip. Resurfacing treatments such as peels and lasers can also greatly smooth the lines.

9. Marionette Lines

Marionette lines refer to the downward folds that extend from the corners of the mouth to the jaw. They can portray a constant look of despair and disatisfaction. Whilst many people are genetically predisposed, other elements influence marionette line formation including soft tissue volume loss, reduced elasticity, bony changes and active muscles in the lower face.

Dermal fillers can greatly improve these lines, also lifting downturned corners of the mouth into a neutral position. A combination treatment with botox to help uplift the mouth and dermal filler to reduce the furrow may be used. For deep grooves, our dermal filler doctors may recommend treating the area over time to allow the tissues to accommodate the filler.

Oral Commissures treatment via filler Before Oral Commissures treatment via filler After

10. Lip Enhancement

The lips form the focus of attention in the lower part of the face and a youthful attractive lip is associated with fullness and definition. Thin, wrinkled, flaccid lips can encroach with age leaving one looking weary and worn. Our skillful aesthetic doctors at CosmeDocs can help recreate these features with carefully practised techniques.

A brief anatomy of the lips can help to identify the possibilities available with dermal fillers for lip enhancement procedure. The body of the lip, the pink area, is called the vermillion. It has a dry part that is exposed to the air and a wet part which remains inside the mouth. They are separated by the wet-dry border and it is this region that is commonly injected with dermal filler in order to increase the volume in the lip body. The edge of the lip is called the vermillion border and typically older persons experience volume loss in this region with less definition and support between the lip and the facial skin. This can assist in the formation of lip lines, also known as smoker’s lines. The Cupid’s bow forms the central portion of the upper lip with two philtral columns extending from the peaks. Each of these areas may be treated to enhance overall shape, improve volume, support the border and diminish fine lines.

Dermal fillers used for the lips are temporary, hyaluronic acid based and contain an anaesthetic to ease discomfort during the procedure. In addition, a topical cream anaesthetic may be applied if required. The most common side effect of lip fillers is swelling! Our doctors will advise you to plan this treatment well in advance of any special occasions.

11 & 13. Chin Augmentation & Jaw Line Contouring

Dermal fillers can be used to improve the jawline and reshape the chin.

Chin Augmentation
Flat, recessed chins are an advanced procedure that can be successfully tackled with dermal fillers by skilled aesthetic doctors. The chin is assessed from anterior and lateral views with the aid of photographs. Any dental or bony conditions need to be excluded such as an excessive overbite. Chin enhancement treatment with dermal filler is only suitable for soft tissue changes. Our experienced practitioners will be able to examine your concerns and advise you of the possibilities.

Chin augmentation ideally requires great structural support and a filler that provides a firm filling effect should be used. The dermal fillers recommended may be one based on hyaluronic acid or calcium hydroxyapatite, such as Radiesse®. Both will provide a strong scaffold.

When performing chin augmentation the jaw line may need to be analyzed and improved. Cases below have undergone chin augmentation with jaw line sculpting so that his new chin blends nicely into the jaw lines giving a more natural result.

13. Chin Mental Crease

A deep horizontal groove can form across the chin forming what is also known as the ‘mental crease’. The usual factors such as dermal thinning, bony resorption, soft tissue loss and reduced elasticity are all contributory as well as dental changes. Overactive muscles in the chin can lead to dimpling as well as a prominent crease.

Treatment may best be approached with a combination of botox and dermal filler. Weakening the mentalis muscle reduces causative active movement and dermal fillers can be use to soften the crease.

What are the different types of dermal fillers?

The most popular fillers in the UK are Hyaluronic Acid (HA) based due to their safety, versatility and ease of administration. The various HA fillers differ in concentration, formulation and degree of cross-linkage. This affects their duration of action and the amount of swelling following the procedure. Most HA fillers now contain lidocaine to improve patient comfort and reduce the need for additional anaesthetic.

Radiesse®, a longer acting filler, is also popular for particular concerns and gives great structural support. It helps to stimulate fibroblasts which in turn help to synthesize new collagen.

How will I look immediately afterwards?

The filling effect is apparent after the procedure and the treated area may be red and tender with some swelling. As there is a risk of bruising this may start to appear following the procedure. However, bruises will be more obvious in the subsequent days.

What can I do to reduce bruising?

Certain medications and supplements thin the blood making bruising more likely. When possible, it is advised to stop taking aspirin, vitamin E, St John’s wort, gingkgo, evening primrose oil, garlic, feverfew and ginseng 2 weeks before treatment. It is best to avoid alcohol and nonsteroidal anti-inflammatory medication, such as ibuprofen and diclofenac, 2 days before.

Arnica tablets or gel may be used 2 days prior to treatment and continued afterwards for 2-3 days.

Cold compression just after the procedure will reduce swelling and constrict blood vessels, reducing any further bruising.

Warm compression may be used a couple of days after if bruising has developed. This will help speed up the healing process.

Pineapple and papaya both contain bromelain which helps to break down proteins releasing trapped blood from the tissues. Topical and dietary vitamin C will also aid the healing process as it helps to build collagen around vessels.

Camouflage make-up may be worn, although it is best to avoid application on the day of treatment if possible. Advice can be given on recommended make-up coverage.

What are the worst complications that can happen?

The vast majority of dermal filler treatments have no complications. Initial swelling, redness and tenderness usually settles within a couple of days. If bruising does occur it can take up to 14 days to heal so procedures should be planned well in advance of important events.

Any asymmetry that may occur can usually be managed by correction with additional filler. Bumps or lumpiness can be improved with massage during and after the treatment. If they persist, HA fillers may be broken down using the enzyme hyaluronidase.

Below is a list of rare but more serious complications:

Tissue Necrosis: Injected filler can obstruct blood supply to skin tissue causing ischaemia which can lead to necrosis. It may occur immediately after injection or hours later. All practitioners should be trained in managing these rare events should they ever occur.

Granulomas: These are nodules that may appear months or years after a treatment and they are more common with permanent fillers. They arise when the body reacts to the filler material by walling it off. They can be treated with corticosteroid injections or excision.

Infection: As the skin is breached, there is always a possibility of infection. To reduce this risk, the practitioner will ensure the area is adequately cleaned and that equipment and techniques utilised minimise any risk of contamination. Any persons with a history of cold sores in the area to be treated should be warned about the risk of reactivating infection. This may be prevented with prophylactic medication and treatment following the procedure.

Scarring: Although rare, it is possible for a scar to form if there has been any infection of if an individual has a history of hypertrophic or keloidal scarring. This information will be gathered whilst taking a medical history.

Is it more/less painful than botox?

Dermal filler treatments are tolerated very well with mild discomfort. The fillers usually contain an anaesthetic which helps to minimise pain and a topical cream anaesthetic can also be applied if required. As the procedure uses different injection techniques and generally takes slightly longer than a botox treatment it may seem more uncomfortable.

How much is usually injected?

Hyaluronic acid fillers normally come in 0.5 and 1ml syringes. The volume used will be decided on the area to be treated and the best possible filler for that indication.

Radiesse® or Calcium Hydroxylapatite is available in 0.3, 0.8 and 1.5ml and would be used for a semi-permanent result where more structural filling is required. Again, the volume used would be decided after examination of the particular area.

Will the filler be lumpy?

After the procedure the practitioner will massage the area to smooth any obvious lumps. At home a gentle massage may be used with the tips of fingers for the next 48 hours only if a lump can be felt. Usually the filler settles down within 2-3 weeks and feels 'normal'. If a bump persists it is advised to see the practitioner who may be able to correct this with a firm massage or break the product down.

Could I be allergic to the filler?

Although rare, it is possible to be allergic to filler material. This may be a mild allergy which could result in prolonged swelling or a severe hypersensitivity with swelling, redness, bumpiness and a rash. Treatment for these rare reactions usually requires antihistamines and steroids which would be arranged by the practitioner.

Can the filler move after it has been injected?

If the area is aggressively massaged after treatment, the product can move. Therefore it is best for individuals not to touch the area after treatment unless they feel any lumps or bumpiness whereby gentle pressure is recommended.

Will I be able to see the filler?

It is very rare to be able to ‘see’ the filler. HA fillers are colourless gel and not visible when injected correctly. If a filler is injected too superficially, the product may be seen as a bluish discolouration of the skin. This can be managed with compression and sometimes an injection to break some of the product down.

Will my skin/lips feel different afterwards?

Once the swelling subsides, the filler takes 2-3 weeks to settle and feel more like the surrounding skin/lips.

Will other people be able to tell?

Usually people ‘look better’ without obvious changes in their appearance. Good practitioners will be replacing volume that has been lost over the years and hence rejuvenating the overall features. As particular areas may swell more than others, such as the lips, a treatment may be obvious to family/friends.

How often will I have to have fillers?

This depends on each individual. Most fillers used last 6-12 months, however, as they also help to stimulate collagen and plump the skin it may not be necessary to have a repeat filler after this period of time. Unfortunately, some individuals may break the product down more rapidly than others. Advice is best sought at consultations or review appointments

Is it okay to have a different filler injected after having a previous treatment with a different brand?

Usually this is fine if there have been no complications. The Dermal Fillers London practitioner will want to know when the treatment was carried out, which product was previously used and the reasons behind wanting a different filler.