McKeown Medical
202 W George St, Glasgow, G2 2PQ
Date posted — 29.03.24
Dermal fillers are one of the most important tools we have available. One of the reason that they continued to grow in popularity over the years is that they can restore many of the key signs of ageing, including restoring volume loss to reduce sagging skin, as well as reduce facial lines and wrinkles. They can even be used to contour the face, for camouflaging a bump or the nose or correcting a receding chin. As well as being very versatile, they are also generally – in the hands of skilled doctors and surgeons – very safe, and less risky than traditional surgical options.
Most modern dermal fillers are made of hyaluronic acid. The hyaluronic acid in dermal fillers is a natural substance that is identical to the hyaluronic acid we have present in our own connective tissues. Because it is identical to our own hyaluronic acid, the risks of allergic reaction is very low which means you can have treatment without the need for a test patch first. Although the name dermal filler suggests the material is injected into the dermis (skin), actually most fillers are injected under the skin – into the facial fat, to restore volume that’s been lost through the ageing process. There are other types of filler materials available, including calcium hydroxylapatite and poly l lactic acid (known commercially with names like Radiesse, Harmonica or Sculptra), although these are less popular except for specific indications.
Hyaluronic acid is the most commonly use type of filler because it is very versatile and long lasting. The different types of filler have different characteristics – from thick gels like cement, all the way through to thin gels like water in consistency – and everything in between. It’s also popular because, in the event of a complication, it can be dissolved using an enzyme called hyaluronidase.
Fillers made from calcium hydroxylapatite are popular for different reasons. Radiesse, for example, is a very hard gel that is recommended for creating projection on the chin or jaw bone (although it’s not one we use in our practice). Harmonica on the other hand is helpful for stimulating your own collagen production and can be helpful for areas where we want to improve skin quality without using laser – like in the cheek area.
Poly l lactic acid (PLLA) is available in a couple of commercial preparations. It also works by stimulating your own collagen production, although it has a habit of causing lumps and so it is best used on non-facial areas like crepe skin on the arms or neck.
Dermal fillers are a very effective way to improve many of the aesthetic concerns our patients have about their appearance. In experienced hands, they are both safe and effective and can deliver natural results. In consequence, most of our patients go on to feel better about themselves with improved psychological well being and reduced social anxiety about their appearance.
The improvements achieved by dermal filler treatments are usually visible immediately following treatment. However, they typically continue to improve over the coming weeks and months as any swelling from the injection procedure settles, the filler integrates with the tissues and – quite often – the filler retains additional volume from water in its environment. This means that most patients are happy straight away, but even happier as time goes on.
Patients can normally resume normal activities immediately after their dermal fillers. Although it is common to experience some swelling and redness from at the injection site, this is usually quite minor and patients get back to normal quite quickly. The exception to this is when we treat the lips. The lips swell more than any other part of the face and if you plan to have this area treated you should expect some visible swelling for at least a few days after treatment.
It’s a misconception that fillers only last a few months. In fact, most modern dermal fillers last 18 – 24 months, and sometimes even longer than this.
Although dermal fillers get a bad rep because of over-done celebrities, when the treatment is performed appropriately with the aim of simply restoring what’s been lost (rather than trying to create something nature never intended), the results are extremely natural and effective.
The results of dermal fillers are long lasting, but non permanent which means they can be adjusted and tweaked further as your face continues to change with age. Before we had dermal fillers doctors had to restore volume loss using surgical implants. The implants would look great at the start, but as the underlying facial shape continued to deteriorate with age, they implants would look less natural and eventually need to be changed. With dermal fillers however we can continue to tweak and adjust easily because of the results are not permanent.
Most dermal fillers are reversible, which means we can inject another material – and enzyme called hyaluronidase – to dissolve them. This is helpful if you are not satisfied with the appearance of your treatment, or if you experience a complication.
Dermal fillers are predominantly used for patients in their 40s, 50s, 60s and 70s to restore lost volume to the face. We can, and do, treat patients older than this, although the results tend to be more modest into the 80s and beyond. Occasionally we use dermal filler in younger patients, particularly if they have a bump on their nose of if they have a week chin that would benefit from moving forward a little.
One of the most important parts of the face we use dermal filler injections is the cheek. Loss of volume from the cheek is one of the most significant changes that occurs as part of the facial ageing process. There is a tendency to focus too much on the volume loss from the front – or apple – of the cheek. However, the back of the cheek, in front of the ear, as well as the lower part of the cheek also lose volume too and to create a natural looking result we need to pay attention to all parts of the cheek for a balance, harmonious look that is natural and attractive.
The lower jaw – or mandible – also loses a tremendous amount of volume with age although in this case it is predominantly from loss of bone. This means there is less bony projection to hold the overlying skin and soft tissues in place, so they slide forward contributing to the jowls. To address this, we often use injectable fillers under the jaw to restore the proportions of the bone and reduce one of the underlying causes of sagging jawlines and jowls.
The cost of dermal fillers really depends on your own anatomy and how much volume you need. If you are in your 50s, and you haven’t had any procedures in the past, then your face has probably been losing volume for the best part of 30 years and so it is going to take a bit of work to restore all of that. For a patients in their 50s, 10 – 20mls might be required charged at £300 – £325 per ml, that comes in at £3000 – £6500. You don’t need to do all of that at once: you might do 8-10mls, then come back in a year or two and do another 8-10mls. Or you might do 3 or 4mls at a cost of £900 – £1300 per session and come back and keep doing that every few months until you reach the point of ‘optimal correction’. When your face has been fully restored, and you reach the point of ‘optimal correction’, the costs of maintaining the results tend to diminish. Typically, in the longer term, most of our patients have 1 or 2mls per year and that’s enough to keep them going. Ultimately, it’s a personal preference and it’s our job to work with you to find a treatment plan that suits your goals and your budget.
The initial consultation process for treatment with dermal fillers is vital to make sure you achieve the outcome you want. It’s the time where you talk to your doctor about what it is that you don’t like, and what you want to achieve. Patients chose to come to our practice because we focus on creating natural looking outcomes that make our patients look fresh, but not frozen. Not all practices are the same: some practices cater to different aesthetic tastes, for example with prominent lips or sharp chins and cheeks. We prefer looks that are softer and more subtle. There are no right or wrong answers on this, but it is important that both the doctor and the patient use the consultation process to make sure that both on the same page about what the goal is. A great way of doing this is by looking at before and after examples of previous patients. A previous before and after photo is not a guarantee that you will get the same result, but it is helpful tool to communicate and give you an idea of the particular doctor or clinics style of work.
We start with some very clear, detailed clinical photographs of your face so that we can study the proportions and the areas of concern thoroughly. We then utilise this to plan the areas of that face that we want to treat with dermal filler.
Before your appointment it is helpful if you come with a clean face, with no make up. Before any dermal filler procedures can take place it is important that the skin is both clean and then disinfected to minimise the chances of complications. Typically, the anaesthetic built into the filler is enough to make the treatment comfortable for most patients. Occasionally, if we are performing filler injections in a very sensitive area – like the lips – we will also use an additional topical anaesthetic cream for maximum comfort.
The injection of dermal fillers into face usually occurs in a step wise pattern. We inject a small amount, check that we are achieving the outcome we are expecting, before continuing to inject more. We constantly stop and reassess throughout the procedure to make sure we are getting to where we expect to be. When we are doing this we may ask you to sit up and lie back several times so that we can check in different positions.
Afterwards we use some antiseptic to clean the injection sites. It is common for the injection site to ooze a little blood for a few minutes afterwards and we will give you some sterile gauze to press on the skin until it stops.
In general, when you inject dermal fillers, the results last for a long time. Fillers typically last up to two years, which is when a touch up is required – although it can be even longer than this. Underestimating how long the fillers last, and repeating too frequently, is one of the main reasons people get unnatural results from filler procedures. If you have well performed filler injections, and you have a good doctor who doesn’t try to encourage you to do repeat treatments too frequently, you should achieve a youthful appearance that looks very natural.
Dermal fillers work by restoring volume to the face. That makes they can correct hollows that appear with age, as well as reduce the appearance of deeper wrinkles and folds, like the nose to mouth lines (known as nasolabial folds), or marionette lines. In addition, fillers can be used to improve the facial contours, making the face look both more youthful and attractive.
Dermal filler injections are one of the most popular types of cosmetic treatment because they address one of the biggest causes of facial ageing – volume loss. That being said however, it’s important that we don’t overuse them and recognise that not all signs of ageing are caused by volume loss which is what traditional plastic surgery – like facelift surgery – still has a role to play in managing the ageing process. Likewise, lasers and muscle relaxing injections are also important to improve the appearance of lines and wrinkles as well as skin quality to achieve a comprehensive rejuvenation. Like with most things in life, moderation is key.
Dermal fillers are different from Botox. Botox is a muscle relaxing drug, that is helpful to reduce the appearance of lines on the upper part of the face: especially the forehead, frown lines and crows feet. The signs of aging in the middle and lower part of the face however are predominantly caused by loss of volume, which is where dermal fillers are more helpful. To say one is better than the other would be misleading, because they both simply do different things and the best option for you will depend on what your concerns are.
Most dermal filler injections are very comfortable. Most modern fillers come with some local anaesthetic built into the filler, so they numb as they go and patients are often surprised at how little discomfort they experience (patients who watch my YouTube videos are always suspicious that we edited the video to miss the patient wincing in pain – but we don’t. It’s just really not that painful!) Some areas of the face are more sensitive – for example, the lips – and so if you plan to have lip fillers, then we would normally use a topical anaesthetic cream to make the procedure more comfortable.
In general, dermal fillers last a lot longer than most people expect. You can read my full blog article on the question here: . There is a misconception that fillers only last a few months however if you were to top up your fillers every few months, you would find that it won’t be long until you look over-filled. Most of our patients have a touch-up procedure after 18-24 months. In some cases, dermal fillers may last even longer than this.
Dermal fillers are gel like substances that are injected under the skin, into the fatty layers of the face, t replace volume that’s been lost through the ageing process. This can reduce the appearance of hollows on the face, smooth wrinkles, or improve facial contours. Although dermal fillers suggest that they are injected into the dermis (ie the skin) in fact most fillers are actually injected below the skin, making ‘soft tissue fillers’ a more accurate terminology.
Most modern types of hyaluronic acid fillers are very safe. The hyaluronic acid in the filler identical to our body’s own naturally occurring hyaluronic acid, which means that the risk of allergic reaction is very low. The risk of your body rejecting the dermal filler material is believed to be around 1 in 1000. If this happens, it means that the filler may need to be dissolved by injecting an enzyme that breaks down hyaluronic acid.
Of course there is a downside to fillers. Dermal filler injections are a medical procedure and like all medical procedures they have a risk of side effects and complications. However, if you attend a regulated medical clinic and are treated by an appropriately trained medical professional then the risks of side effects and complications should be low.
Most people don’t need to worry about volume loss from their face until their late 30s or early 40s. Until this age, most patients are able to get by with less invasive options like sunscreen, gentle lasers and muscle relaxing injections to keep their skin in good health. If you take good care of your skin, then it will usually be late 30s or 40s before you really start to notice the signs of volume loss that need to be treated with filler injections. At this age, the volume loss may be subtle and it might not bother you until much later – into your 50s or even 60s. It is fine to start fillers at a later stage in life if that is when the signs of ageing begin to bother you. You don’t miss the boat by choosing to start later, but you might just need a little extra work to get you to optimal correction if you chose to start later.
There is no age at which you should stop getting fillers. If the filler is still working for you, and having treatment makes you feel better about yourself, then you are good to keep going for as long as you like. We have many patients in there 80s and beyond who still come to the clinic every year or two for a little touch up. I once had a patient who told me she was having filler injections as a one-off treat for her 70th birthday. I just treated her again recently for her 80th (and have been seeing her every couple of years in between). If it makes you feel good, then why would you stop?
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The mouth area is one of the most prominent signs of ageing. The changes that happen around the mouth are complex, not just the loss of volume which is why over-relying on fillers can result in an unnatural appearance.
This patient had one of the very common signs of ageing around the mouth - lengthening of the top lip, which is the whole space between the base of the nose to the mouth. This patient had an upper lip lift, with an incision around the base of her nose to remove skin and lift the muscle. She also had a lip corner lift, with an incision around the edge of the lip at the sides. Finally she had a little filler in her top lip and mouth corners for a comprehensive rejuvenation. You can see where the incisions were made and the areas removed in the second image.
The surgical procedures were performed by the one and only @bramhallplasticsurgery. The patient is over the moon with her results! What do you think?
Thank you to our lovely patient for allowing us to share her pictures with you. This patient had full laser resurfacing three months ago and was back in the clinic for a follow up appointment absolutely loving life with her new skin.
She hated the lines and wrinkles around her mouth as well as the darkness and wrinkles under her eyes. She had previously tried to correct these issues with fillers although that wasn’t the best treatment option for these issues, so she decided to bite the bullet and come to the clinic for a full resurface.
It’s a big procedure, but she said she would do it again in a heartbeat for the results she has achieved. What do you think?
And in even more exciting news I am delighted to tell you that Dr Rhona Cameron has been promoted to the role of Medical Director.
Rhona has been with us for over 5 years now and in that time has become a tremendous asset to the business. As we continue to grow and expand our services, Rhona will have a managerial role alongside her fabulous clinical work, ensuring we are always at the forefront of medicine and doing all we can to improve the lives of our patients.
Three cheers for the legendary Dr Rhona! Hip-hip!
Big news! We`ve just launched a new online resource for all of our patients at drdarrenmckeown.com.
We could call it a new website, but that wouldn`t really do it justice.
This is the product of almost four years of work painstakingly listening to the questions our patients ask us over and over again and piecing together a resource that should answer almost every question you might possibly have about aesthetic treatment options.
We’re very thankful to all of the patients who have allowed us to use their pictures to extensively illustrate what the best treatment options are for each feature.
We`ve also included video content to almost every page so you can watch for yourself and see how the treatments work alongside the results, as well as in depth videos from our team, with more to come!
I really hope you find the new site to be informative and helpful in educating you on your best treatment options.
Here`s a quick whistlestop tour of the new site and the link is in our bio. If you have the time to take a look, I’d love to hear your feedback - particularly if there is anything you think we’ve missed or would like to see added. Let me know in the comments.
The deep plane face and neck lift is now accepted the gold standard technique of facelifting. There are still not many surgeons who can perform this technique and our exceptionally talented @bramhallplasticsurgery is one of the few who can. The procedure goes deeper under the muscles of the face to release the retaining ligaments and truly reposition the soft tissues, rather than simply placing tension on them. It`s a much more intricate technique that demands more time and attention to detail, but we believe our patients deserve this. This patient is nearly 3 months out from her procedure. You can see the scars have started to fade already and she is delighted with the improvement so far. Thank you so much to her and to all of our patients who allow us to share their pictures to show you how we do what we do!
Upper eyelid surgery is one of the most popular procedures we do in the clinic. The key to making it look great is not just in removing enough skin, but leaving enough behind too so that the result looks soft and natural - the art of which our resident eyelid surgery expert @bramhallplasticsurgery is excellent! This patient is over the moon with her results. What do you think?
Sometimes it’s hard to appreciate the full impact volume loss contributes to the ageing process. Loss of bone from the lower jaw can be a significant cause of sagging not only in the jowls, but in the neck too.
This patient was a classic example of just how important volume loss is in the jaw. As well as treating her jaw we also treated her cheeks and chin too, to achieve this improvement. She was delighted with the improvement.
What do you think?
Dermal fillers are some of our most versatile tools when it comes to treating the signs of ageing, but we hear plenty of myths in the clinic about how they work.
Here’s our dermal fillers expert Dr Rhona Cameron with the facts v fiction, tackling:
· Do dermal fillers look natural?
· How long do dermal fillers last?
· Can dermal fillers migrate?
Do you have questions about dermal fillers, or any treatment? Let us know in the comments and we’ll cover it next!
And this is why we talk so much about skin quality in the clinic! You can reduce lines and wrinkles with injectables, and achieve youthful facial contours, but to truly look youthful the skin needs to be in optimal condition too.
This patient opted for full laser resurfacing. She didn`t have too many wrinkles, but did have a lot of sun damage - especially a lot of dark pigmentation below the eye.
As well as reducing the lines and wrinkles, we were able to clear almost all of this pigment for her and her skin is glowing as a result. This is her two months out from her treatment, loving life with her new skin.
What do you think?