Dermal fillers

Dermal fillers have evolved enormously.

They are no longer simply about "putting volume back". Modern filler treatment can be used to restore structural volume, refine facial proportions, improve skin quality, support lax tissues and, in carefully selected patients, stimulate the production of new collagen.

At Lior Medical, we think about fillers as tools with different jobs.

The right treatment is not necessarily the treatment that adds the most product. It is the treatment that addresses the reason a particular area has changed, while respecting your anatomy, your facial movement and the way you want to look.

Our approach is therefore based on assessment first, treatment second.

Three different jobs for fillers

Although many injectable products are casually called "fillers", they can behave very differently in the tissues.

I broadly divide the fillers I use into three functional categories.

1. Structural or volumising HA fillers

Filling, shaping and contouring

These are the traditional hyaluronic acid (HA) dermal fillers that most people think of when they hear the word "filler".

Hyaluronic acid is a naturally occurring sugar molecule found throughout the body, including the skin and connective tissues. In injectable fillers, HA is formulated into a gel with different physical properties depending on how it has been manufactured and stabilised.

These fillers can be selected to provide different degrees of:

• Volume
• Projection
• Structural support
• Contouring
• Soft-tissue support
• Shape modification

They can be used in areas such as:

• Lips•
• cheeks•
• mid-face•
• chin•
• jawline•
• temples•
• peri-oral area•
• earlobes•
• selected facial folds and contours

The goal is not simply to make an area "bigger".

A well-planned treatment may instead be about changing the relationship between different parts of the face.

For example, what appears to be a lip problem may actually involve support around the mouth. What looks like a lack of jawline definition may partly relate to changes in the cheek, chin or lower-face tissues.

This is why we assess the face as a whole rather than treating individual lines in isolation.

Think of these fillers as the architects.

They can help build, support, replace and reshape.

2. Skin fillers

Less about volume. More about the skin.

Skin fillers are a different concept.

These are generally finer, more fluid HA-based injectable materials designed to be placed within or immediately beneath the skin rather than being used primarily to create significant structural volume.

Their purpose is to improve skin quality rather than facial size.

Depending on the product and treatment technique, the objectives may include improving:

• Hydration
• Skin smoothness
• Fine lines
• Elasticity
• Radiance
• Texture
• Overall skin quality

This is an important distinction.

You can have beautifully structured facial contours and still have skin that is dehydrated, crepey, uneven or lacking in luminosity.

A structural filler cannot necessarily solve that problem.

Skin-focused injectable treatments are designed to address a different layer of the ageing process.

Think of these fillers as the renovators.

They are not primarily there to build a new cheek or jawline. They are there to help improve the environment in which the skin lives.

3. Hybrid biostimulators

Support + skin quality + biological stimulation

The third category sits somewhere between traditional filler and skin treatment.

These are injectable materials that combine components with different functions, such as hyaluronic acid and calcium hydroxyapatite.

They can provide some immediate structural support while also encouraging biological processes within the treated tissues, including collagen remodelling.

They may be useful when the problem is not simply "I have lost volume", but rather:

"My tissues don't feel as firm as they used to."

They may be considered for:

• Skin laxity
• Lower-face ageing
• Jowling
• Loss of definition
• Reduced tissue support
• Skin quality
• Subtle lifting and tightening
• Restoration of facial architecture

The aim is generally not to create a visibly filled or puffy appearance.

Instead, the treatment is designed to improve the quality and behaviour of the tissues over time.

Think of these as the builders and renovators working together.

They can provide support while encouraging the tissues themselves to become stronger and more resilient.

Why the distinction matters

One of the biggest misconceptions about aesthetic medicine is that there is one treatment called "filler" that can fix everything.

There isn't.

Different products have different physical properties, different tissue behaviours, different indications and different levels of reversibility.

A filler that is excellent for creating lip shape may be completely inappropriate for another anatomical area.

A product designed to improve skin quality should not be expected to create cheek projection.

And a biostimulatory treatment designed to improve laxity is not simply a substitute for a traditional volumising filler.

Choosing the correct material is part of the treatment.

Choosing where, how deeply, how much and why is equally important.

What are dermal fillers actually made of?

The answer depends on the type of filler.

Hyaluronic acid

Hyaluronic acid is a naturally occurring substance in the human body. Injectable HA fillers are usually formulated as gels and may be chemically stabilised or cross-linked so that they remain in the tissues for longer than naturally occurring HA.

One of the particularly useful characteristics of HA fillers is that they can be broken down with an enzyme called hyaluronidase when clinically appropriate.

This does not make HA filler "risk free" or automatically reversible in every situation, but it is an important safety advantage when compared with materials that cannot be enzymatically dissolved.

Calcium hydroxyapatite

Calcium hydroxyapatite is a mineral that is chemically similar to the mineral component of human bone.

In injectable form, it is suspended within a gel carrier. Depending on how it is formulated and injected, it can provide structural support and/or stimulate collagen remodelling.

It is not simply "bone injected into the face".

Other biostimulatory materials

Other injectable materials, such as poly-L-lactic acid, work primarily through biological stimulation rather than acting as a traditional volumising HA gel.

Different materials have different properties, advantages and limitations.

This is precisely why I don't believe in a "one filler fits all" approach.

How long do fillers last?

This is one of the most common questions I am asked.

The honest answer is:

It depends.

Longevity is influenced by:

• The material used
• The formulation
• Where it is injected
• The amount injected
• Your metabolism
• Your individual tissue characteristics
• Movement in the treated area
• Your age and lifestyle
• Whether the treatment is being used for volume, structure or skin quality

As a broad guide, many HA fillers last somewhere in the region of several months to around 12–18 months, although some products and treatment areas can last longer.

Calcium hydroxyapatite-based treatments can have effects lasting around 18 months or longer, depending on the formulation and indication.

Biostimulatory treatments may behave differently again, because the visible result is partly related to changes occurring within your own tissues.

These figures are ranges, not expiry dates.

Your face does not wake up on the 365th day and announce, "The filler contract has ended."

The material gradually changes and is remodelled over time.

Importantly, the fact that a filler is no longer visibly obvious does not necessarily mean that every trace of the material has disappeared.

Filler does not stop ageing

This is another important expectation to understand.

Fillers can restore, support and improve tissues.

They cannot stop the biological ageing process.

Your skin will continue to change. Your bones will continue to remodel. Facial fat compartments will continue to change. Muscles will continue to move. Gravity will continue to have opinions.

The goal is therefore not to create a permanently "fixed" face.

The goal is to create a result that remains natural, proportionate and harmonious as you continue to age.

How much filler do I need?

There is no universal answer.

Two people of exactly the same age can require completely different treatment plans.

The amount required depends on anatomy, tissue quality, facial proportions, previous treatments and the objective we are trying to achieve.

More filler does not automatically mean a better result.

In fact, one of the most important skills in aesthetic medicine is knowing when enough is enough.

I would rather build a result gradually than over-treat you in a single session.

Is filler safe?

Dermal fillers have a well-established role in aesthetic medicine and are generally well tolerated when appropriate products are used in appropriately selected patients by appropriately trained medical practitioners.

But "safe" does not mean "without risk".

Filler injection is a medical procedure.

Common short-term effects include:

• Swelling
• Bruising
• Redness
• Tenderness
• Mild pain
• Itching
• Temporary asymmetry

These generally settle over days, although swelling can sometimes persist for longer depending on the area and treatment.

There are also less common complications, including infection, persistent lumps or nodules, inflammatory reactions and delayed swelling.

And there is one particularly important complication that every responsible filler practitioner must understand, recognise and be prepared to manage:

Vascular occlusion.

Very rarely, filler can unintentionally enter or compress a blood vessel.

This can compromise blood flow and, depending on the vessel involved, may result in tissue injury, scarring or, in extremely rare circumstances, visual impairment or stroke.

The overall risk is low, but the potential consequences can be serious.

This is why filler should never be regarded as a simple beauty treatment.

Anatomy matters. Technique matters. Product selection matters. Patient selection matters. And having a practitioner who knows how to recognise and manage complications matters.

For HA fillers, access to appropriate emergency management, including hyaluronidase where indicated, is an important part of responsible practice.

Who is a good candidate?

Dermal fillers may be appropriate for adults who:

• Have a specific aesthetic concern that filler can realistically address
• Have reasonable expectations
• Understand the benefits and limitations of treatment
• Are medically suitable for the procedure
• Are prepared to accept the possibility of temporary swelling and bruising
• Understand that results may require more than one treatment
• Are willing to maintain their results over time where appropriate

A consultation is essential because the question is not simply:

"Do you want filler?"

It is:

"Will filler improve the concern you have, and is this the right treatment for you?"

Who should not have filler?

There are circumstances in which filler should be postponed or avoided.

Treatment should generally be delayed when there is:

An active infection or significant inflammation

This includes infection, inflamed acne, cold sores in the treatment area, significant dermatitis or other active inflammatory skin conditions.

The skin should be healthy before injecting it.

Pregnancy

There is insufficient safety evidence to recommend elective dermal filler treatment during pregnancy.

For an elective aesthetic procedure, there is simply no reason to take an unnecessary risk.

Breastfeeding

Safety data during breastfeeding are limited. Because this is an elective treatment, I generally prefer to defer treatment while breastfeeding unless there is a specific medical reason to consider otherwise.

A history of significant previous filler reactions

Previous complications, inflammatory reactions, granulomas or unexplained persistent nodules need to be discussed carefully before considering further injectable treatment.

Certain significant medical conditions

Bleeding disorders, significant immune dysfunction, severe allergies, uncontrolled systemic illness and some medications or medical treatments may alter the risk profile.

These situations do not always mean that filler is permanently impossible, but they do mean that individual medical assessment is essential.

Unrealistic expectations

This one is important.

If you are looking for a treatment that will make you look exactly like somebody else, permanently reverse ageing, completely eliminate natural asymmetry or guarantee perfection, filler is not the answer.

A good result should still look like you.

What about previous filler?

If you have had filler elsewhere, please tell me.

Even if you believe it has "all disappeared".

Previous filler can influence the anatomy, tissue planes and treatment options available today. In some circumstances, ultrasound imaging may be useful when there is uncertainty about what material remains in the tissues.

This is particularly important when planning further treatment in an area that has already been injected repeatedly.

Your previous injectable history is part of your medical history.

Before your treatment

At your consultation we will discuss:

• What you would like to change
• What I think is realistically achievable
• Your facial anatomy and proportions
• Previous injectable treatments
• Your medical history and medications
• Allergies and previous reactions
• The most appropriate product and treatment plane
• Expected swelling and recovery
• Potential complications
• Whether staged treatment would be safer or more appropriate

If you have an important event coming up, please tell me.

Filler is not something I recommend doing for the first time two days before your daughter's wedding.

Give your face time to settle.

Where possible, avoid scheduling significant dental procedures, vaccinations or other procedures likely to provoke inflammation immediately around the time of filler treatment. Your individual timing should be discussed with your practitioner.

After your treatment

Some simple rules make the first few days easier.

Expect some swelling.

Swelling is particularly common in areas such as the lips.

Your immediate post-treatment appearance is not your final result.

Don't judge the result too quickly.

The first few days can be deceptive.

The tissues need time to settle, and swelling can temporarily exaggerate asymmetry.

Avoid unnecessary pressure and manipulation.

Unless specifically instructed otherwise, don't massage, squeeze or repeatedly examine the treated area.

Take it easy initially.

Strenuous exercise, excessive heat and alcohol may increase flushing, swelling and bruising in the immediate post-treatment period.

Protect your skin.

Avoid unnecessary sun exposure and follow the specific aftercare instructions you are given.

And most importantly:

If something doesn't feel right, contact me.

Increasing pain, unusual skin colour changes, mottling, significant blanching, marked asymmetry, unusual visual symptoms or other concerning symptoms after filler should never simply be "watched".

Early assessment matters.

The most important expectation of all

Filler should not make you look like you have had filler.

The best results are often the ones where someone notices that you look fresh, rested, balanced or somehow more like yourself, without being able to identify exactly what has changed.

Sometimes that means adding volume.

Sometimes it means improving skin quality.

Sometimes it means supporting an area that has begun to sag.

And sometimes the correct answer is:

"I don't think filler is the treatment you need."

That is an important part of aesthetic medicine too.

My role is not simply to inject.

It is to understand why you are seeing the change, what can realistically be improved, which treatment is most appropriate, and when to stop.

A personal approach to fillers

I don't believe in treating a face by numbers.

There is no universal number of syringes, no perfect age to start and no single treatment plan that works for everyone.

My approach is deliberately individualised.

Sometimes the best result comes from treating one area.

Sometimes facial harmony requires considering several areas together.

Sometimes a staged approach is safest and most natural.

And sometimes doing nothing is the right medical decision.

Good aesthetic medicine is not about adding more.

It is about making thoughtful changes that respect anatomy, biology and the person sitting in front of me.

Explore the three types of filler

• Dermal fillers for fillingFor volume, shape, projection, support and contouring.
• Skin boostersFor hydration, texture, elasticity and overall skin quality.
• Hybrid fillers & biostimulatorsFor a combination of structural support, skin quality and tissue remodelling.

Each deserves its own conversation.