Fillers: 28 things no one tells you before getting them
Of all the cosmetic treatments out there, fillers are probably the most misunderstood. Not only is the actual procedure shrouded in mystery (more on that later), but horror stories of overfilled, toddler-plump cheeks and bodge-job lips continue to give it a bad rap today.
In short, fillers are substances injected beneath the surface of the skin to add volume and fullness. In the right hands, it's not about changing the face or exaggerating facial features to unnatural proportions – which is why there's currently a backlash to what has been dubbed “Instagram face”.
As ever, what you choose to do to your body is up to you. Fillers are still a medical procedure and, as such, should not be taken lightly. But if you are keen to try them, you'll be relieved to know that a less-is-more approach, combined with advances in filler formula, means you can opt for a more natural look as aesthetic practitioners can now subtly elevate the hollows of the face or add barely detectable volume to your lips.
Before even drilling down into the finer points – for example, how long you should leave before a wedding to get fillers – the most important thing to consider is your practitioner.
Do your research and ask for a practitioner's qualifications and experience. Check the Professional Standards Authority (PSA) or other independent associations, such as the British College of Aesthetic Medicine (BCAM). If they are a doctor, they should be registered with the General Medical Council (GMC); similarly any dentist who also injects filler must be registered with the General Dental Council (GDC)and nurses with The Nursing & Midwifery Council (NMC).
Above all, "always choose an experienced provider, who is not only medically trained, but has extensive experience with facial anatomy,” notes Dr Ashwin Soni, a plastic and reconstructive surgeon.
This is a general mantra when it comes to any injectable treatment but keep scrolling for all the other crucial things no one tells you before getting fillers. We spoke to renowned aesthetic doctors and a plastic surgeon so that you feel armed with all the information you need to make the best decision for you.
1.Filler won't ‘freeze’ your facial muscles
Dermal fillers are often confused with Botox. They are both injectable drugs but that is where the similarities end. “Botulinum toxin is a neurotoxin and stops a muscle from moving as much – meaning it can calm down the harsh facial expressions we see with age, such as frown lines and a pebbled chin,” says aesthetic doctor Dr Sarah Tonks. “Fillers, on the other hand, are either for volume replacement when fat or bone disappears with age or as skin quality improvers.”
2. All fillers are not the same
“There are many different brands and types of filler out there of varying degrees of quality,” says Dr Soni, who recommends hyaluronic acid-based fillers. "These are the best in quality and safest if there was ever an issue as they can easily be dissolved if needed by the enzyme hyaluronidase," he adds. Hyaluronic acid fillers typically last between 6-18 months.
Other types of filler, also named after the material they’re made with, include calcium hydroxylapatite (CaHA), a substance found naturally on our bones. “They are typically stiffer than hyaluronic acid gel fillers, which means that they can be used for support – for example, along the jawline – and can theoretically last longer than hyaluronic acid fillers,” Dr Soni explains.
Poly-L-lactic acid products are another type of dermal filler you may come across. “They are used to soften lines, and also help to stimulate your natural collagen production,” he continues. “It degrades quickly after treatment, but as it stimulates collagen production, the effects can gradually be seen over a few months.” Sculptra is the most well known brand for this type of filler.
3.Fillers are injections of a naturally-occuring substance in your body
"The majority of fillers used nowadays are made of hyaluronic acid, which is a naturally occurring glycosaminoglycan (a safe sugar) found throughout the body’s connective tissue,” says Dr Soni. You're probably already familiar with the ingredient as it's a staple in many hydrating serums thanks to its ability to hold 1,000 times its molecular weight in water. When injected beneath the skin's surface it can plump, hydrate and restore lost volume.
“Check with your provider before undergoing filler that they are indeed using hyaluronic acid,”advises Dr Soni. “You do not want to your provider to use a more permanent based filler, as they can have issues long term, such as lumps, granulomas or scarring within your tissue. High quality hyaluronic acid based fillers are biocompatible and incorporate beautifully into the skin.”
4. Multiple types of fillers are sometimes used on the same patient
“Each area of the face requires a different density," says Dr Soni. “For example, to perform jawline sculpting, you would need a more dense filler for support, whereas for under the eye you would need a much thinner, watery filler.”
5. Take it slowly and don't do everything in one sitting
“I prefer to approach the full face in stages, starting from the top down, because each area that is treated will have a knock on effect to parts of the face below it,” says dermatologist and aesthetic doctor, Dr Wassim Taktouk, who prefers to leave a gap of four to six weeks between appointments. "When hyaluronic acid is injected, it binds water to the filler so there will be a change in volume between the first injection and the next.”
6. Don't have filler injected into nasiolabial folds
Often referred to as the ‘parenthesis’ either side of your mouth, Dr Taktouk warns against having filler injected deep into these grooves. “This is when filler can look really obvious and unnatural,” he says. A more natural-looking alternative, he says, is injecting filler into the cheeks. The extra volume hoiks up the skin and lower face tissue.
7. It shouldn't be painful and there is minimal downtime
“Generally speaking, fillers are not painful and you can use numbing cream if necessary,” says Dr Tonks. Additionally, the cannulas that are used are blunt tipped – not sharp, like needles. “Downtime is usually limited to a few days for the swelling and bruising to subside,” she adds.
8. There is normally some bruising
“It’s normal to get some bruising after fillers – sometimes you may be lucky and not experience any," says Dr Tonks, noting that some areas of the face are more likely to bruise than others, such as around the eyes or mouth. "If you use a cannula there’s less chance of bruising but it’s not appropriate for everything,” she adds.
To alleviate post-filler bruising and swelling, Dr Soni advises, “patients should sleep with an extra pillow for the first couple of days to minimise any chance of swelling, and to use ice packs on the first day after treatment.”
9. There are other side effects to note, too
As with any injectable procedure, there are risks involved. “These include the risk of late stage inflammation and infection,” Dr Tonks explains.
On rare occasions, filler can accidentally be injected into a blood vessel and lead to blurred vision or permanent blindness. Seek medical help immediately if your skin turns blue and you’re in a lot of pain as these are possible warning signs that filler has entered your bloodstream.
10. Have filler done at least three weeks before a major event like a wedding
The last thing any bride wants on her wedding day is any sign of residual bruising or swelling. For this reason, Dr Tonks recommends leaving three weeks “as the absolute minimum” before a major event such as a wedding.
11. Not all fillers naturally dissolve after 18 months
There are a few factors to consider. “Different fillers have different amounts of hyaluronic acid and cross linking, which determines their ‘stiffness'," Dr Taktouk explains. “Think honey vs a gummy bear in terms of consistencies. Generally the thicker the filler the longer it lasts so you will get a range of breakdown starting, which can start from six months but can go up to two years.”
12. Fillers can stretch the skin
This can happen – but basically, it shouldn't. “If done correctly, your fillers should not be stretching the skin,” says Dr Soni. “This only occurs when too much volume has been injected into an area of the face that can't accommodate that much filler. For example, a common area that is over-injected by some providers is the lips.”
13. Fillers shouldn't feel hard under the skin
“Unfortunately not all fillers are created equal,” says Dr Taktouk, adding: “A good quality filler will slowly integrate into the tissue over time and as long as the filler is suited for purpose then there should not be hard lumps felt. You always need to ask what is being injected into yourr face - you’d be surprised how many people don’t.”
14. It shouldn't take a few tries before you get the look right
“Honestly, it all depends on the experience of your provider but it's unlikely that you will need a few sessions to get the look right,” says Dr Soni. “I always see my patients for a follow up around three weeks after the procedure. Most are happy with the results from their initial filler treatment and only very occasionally do I need to make tiny adjustments.”
15. A solid skincare routine can make your fillers more effective
No cosmetic treatment is ever a substitute for skincare – both work in synergy to give you the best possible results. “In order to approach the skin holistically, you need to consider all factors that enhance the skin in every way,” says Dr Soni. “Skincare routines can complement filler treatments really well, as you are improving the quality and appearance of the skin. What fillers can additionally do, is prevent makeup from sitting in certain creases – for example, under the eyes or in the smile lines – by decreasing the depth of those lines.”
16. Fillers can move position
It is rare, but filler can move within the first 2-3 days after treatment. “To minimise any chance of filler migration, the right type of filler should be injected and the right volume for that particular anatomical area to prevent any of it travelling into other parts of the face,” says Dr Soni.
17. Kissing won't cause your filler to move or breakdown faster
There is no known evidence that routine kissing will cause a more rapid breakdown of the product or move the filler. “Clinically-speaking, it is true that filler that is injected into areas that are mobile don't seem to last as long,” says Dr Tonks. “But having a kiss isn’t going to make your filler instantly disappear – that has more to do with the actions we all make every day like speaking and eating.”
18. It's a good idea to bring photographs of yourself when you were younger to your consultation
To ensure you still look like you post-filler, Dr Taktouk recommends patients bring photographs of themselves when they were younger to the initial consultation. “I can see what they used to look like and where the fat and volume has been lost,” he says.
19. Lip fillers can look uneven for a couple of days after treatment
“It is very normal for lip fillers to look uneven for a few days after treatment due to swelling,” says Dr Tonks. “Remember, too, that nobody is perfectly symmetrical.”
20. Aftercare is important
Filler is often advertised as a fuss-free lunchtime tweakment but you should heed the aftercare advice from your practitioner to swerve any unwanted side effects. “Avoid any intense gym workouts for five days after treatment in order to minimise both the chances of filler migration and the increased risk of bruising,” says Dr Soni.
“You can wash your face immediately after treatment, just be gentle,” he continues. “I would, however, avoid facials and facial massage for four weeks after filler treatment.”
21. Avoid getting filler right before visiting the hygienist or dentist
For the same reason that you should avoid facials and facial massage for four weeks after filler treatment, avoid dental treatments as they involve stretching the face, which could potentially cause your fillers to migrate. Speak to your aesthetic practitioner about when to get future dental work.
22. You can't have fillers when you're pregnant
This is non-negotiable for Dr Tonks, who says, “no filler while pregnant or breastfeeding,” as fluctuating hormones can interfere with blood flow and produce swelling. On the plus side, many women tend to have a naturally increased lip size during pregnancy due to increased levels of oestrogen.
23. Avoid caffeine for about 24 hours before your procedure
“The theory is that caffeine can dehydrate the skin, and that patients who have too much caffeine could theoretically have a slightly more ‘sunken’ appearance,” Dr Soni says, adding: “The reality is that it makes no difference to the results – just stay hydrated before your procedure.”
24. Sleep on your back for 24-48 hours after filler injections
“Sleeping on your back is better for the first two nights post-filler – ideally with a pillow to prop you up," advises Dr Taktouk. "After that you can sleep on your side.”
25. Ask about the practitioner’s complication rates and adverse events
“I have personally never experienced a complication with filler, but it could happen, and you have to inform patients of all the risks prior to them undergoing any treatment,” says Dr Soni. “Professionals should be conducting regular audits of their work, and should have a database of everyone they have ever treated.”
26. Fillers are temporary
“On average, jawline sculpting lasts between 12-18 months; for tear trough (under eye filler) it is around 12 months; cheek sculpting is 12-18 months and lip filler only lasts between 8-9 months,” Dr Soni explains.
27. A face can reject fillers, but it's rare
“I have heard of issues with cheaper quality filler,” says Dr Soni. “But if it is biocompatible and hyaluronic acid based, the chances of this happening would be incredibly low.”
28. If I don’t like it, you're not stuck with it
Most filler products today are hyaluronic acid products, which can be reversed, by injecting a product called hyaluronidase into the parts of the face that have been filled.
“This is an enzyme that our body naturally produces and is used to slowly break down the hyaluronic acid,” Dr Taktouk explains. Although he notes this is still a medical treatment so it’s important to do a patch test to make sure you are not allergic.
For more from Fiona Embleton, GLAMOUR's Acting Associate Beauty Director, follow her on @fiembleton.
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