Fillers
Second only to botox, fillers are the mainstay of non-surgical aesthetic treatments. They are an extremely effective way of adding volume to deeper layers and hydration to superficial layers of your skin.
Modern hyalan fillers are safe and controllable. The wear off slowly, but should you not like the effect they can also be dissolved by an injection of hyaluronidase. The most popular areas are the lips, corners of the mouth, nasolabial lines, cheeks, tear trough and lateral brow.
As the fillers need to be injected there is some discomfort. This can be reduced with local anaesthetic. Occasionally there can be some bruising. The majority of my patients seem to prefer no local anaesthetic at all for all areas other than the lips. They find the numb sensation more unpleasant than the stinging of the injection. After the injection the area is usually red and swells a little for the first few days, before settling down.
The effects are immediate and last from 6 to 9 months for the thinner fillers and up to 2 years for the thicker fillers. It is important however to use the right filler in each location, as too thin too deep is poor value, and too thick too superficial is a lump that will need dissolving!
So which filler is best?
I'm personally not going to use any filler that I can't dissolve. There may be longer lasting results with Sculptra and Radiesse, but the fact that I couldn't remove any excess filler tips the results for me. I therefore only use the hyaluronic acid fillers, and if I'm really honest I'm not sure I can tell them apart. The QMed range are excellent, as is the Teosyal range. Belotero seems good, and I've no problem with Juvederm. They are all similarly priced, and I think can all be used very sucessfully.
The key is to use the right thickness filler for the depth and effect you want to acheive.
How to price fillers?
I charge full price for the first syringe and subsequent syringes are less. I do not like the overfilled look and would rather put in too little filler than too much. I therefore offer all my patients the option of returning after two weeks for extra filler at the second syringe price. This ensures there is no financial cost of using less filler.
If I have placed the filler too superficially and given you a lump I will dissolve the filler and refund your costs, or dissolve and re-inject for free two weeks later. This should be the standard of care from all clinics.
What can go wrong with fillers?
1. Bruise at the injection point
2. Overfilling. The aesthetic effect of fillers requires judgement. If you put too much in it can simply look wrong. Make sure you discuss exactly the effect you want. The hyalan fillers can be dissolved if overfilled.
3. Lumps. The effect can be lumpy if the filler does not spread as desired, or if there is a local area of overfilling. There is a trade off between the thinner fillers which are less likely to create lumps but do not last as long and the thicker fillers that can be more lumpy but last longer. Lumps can be dissolved with tiny amounts of Hyaluronidase but the risk is that the main body of the filler is also dissolved.
4. Allergy. The risk is very low but possible. All practitioners should carry treatment for an acute allergic attack.
5. Inadequate result. This is easy to resolve with additional filler
6. Injection into a large blood vessel. This catastrophe must be avoided by knowledge of the anatomy and careful injection.