Dermal fillers are used to ‘plump out’ lines, folds, and wrinkles of the face. They are most effective for static lines – that is ones that are apparent when the face is at rest. Most commonly, they are used for lines in the lower half of the face, with botulinum toxin injections being the first choice for lines in the upper face. Having said that, these two treatments can offer excellent results in both the upper and lower face, used either individually, or in carefully-tailored combinations. Fillers may also be used to enhance the lips, and to improve skin texture and quality.
Many people shy away from the idea of fillers. They have seen examples of “trout pouts”, “pillow cheeks”, or other unnatural results. These results may occur as a result of using too much filler, or putting it in the wrong place. Other adverse results are associated with the use of old-fashioned collagen injections (which had a relatively high rate of allergic reactions), or the use of permanent fillers. I do not use such products. All the fillers I use are hyaluronic acid (HA) based. HA is a naturally-occuring substance in our bodies, and a synthetically-manufactured version is used in dermal fillers. The products I use are FDA-approved, with an excellent safety profile. The effects can be expected to last between six months (in more dynamic areas such as around the mouth), to a year and sometimes longer. Should a patient wish to get rid of the filler before then, it can usually be dissolved away with a relatively straightforward injection. You can read more about removal of fillers here: http://www.fitzgeraldplasticsurgery.ie/facial-plastic-surgery/fillers/
Type of anaesthetic
None/ local anaesthetic
Length of procedure
1 day – 1 week (depends on area)
Onset of action
Duration of effect
6 months to 1 year
My goal is always to provide a subtle, natural result, which enhances your facial features and is specifically tailored to your treatment goals. I carefully analyse your face, looking at any pre-existing imbalances, your skin quality and underlying bone structure. I take into careful consideration your specific treatment goals, bearing in mind that most Irish patients prefer to avoid an obviously “done” look. I will explain to you my preferred treatment plan, and most importantly, make sure you understand why I am taking the approach I suggest. My mantra, particularly on your first treatment, is to always err on the side of caution. I want us both to be delighted with the result, and will always take the time to ensure we are both ‘singing from the same hymn sheet’ when it comes to goals and expectations.
I consider that one of the reasons that people are disappointed with the results of fillers is because they are used inappropriately – the wrong volume or placement used, or on occasion, because they are asked to do more than they are capable of. As a plastic surgeon, who can offer the full spectum of facial revitalisation treatments and procedures, I will not recommend a filler when I know that it is not going to give you your desired result.
Some patients do not like the idea of having a synthetic material, even one as safe as HA, injected into their face. For others, the cost and inconvenience of repeated treatments is off-putting. In these cases, a more permanent option using only your own tissue, is lipofilling, or injections of your own fat as a natural filler. You may read more about this procedure here.
Fillers are used to treat lines, wrinkles, and folds of the facial skin. Lines are not usually eradicated, but substantially softened. They can also be used for lip augmentation, outlining, and in the treatment of fine lines around the lips and mouth. Courses of fillers may be used to improve the skin quality of areas such as the décolletage, cheeks, and hands. Volume in the cheek and chin area may be augmented through the use of fillers. More unusual treatments are smoothing of minor lumps or bumps on the nose (such as may occur following trauma or surgery). We will discuss whether fillers are the appropriate treatment to fulfill your goals at the time of your initial consultation.
In order to decrease the discomfort associated with the procedure, local anaesthetic is used, either in the form of a cream or a simple injection (similar to that one would have at the dentist) in advance of the injections. The filler is then slowly and carefully placed into the desired area, via a number of injections. I encourage you to participate in this process, and will often have you look in a mirror as we go along.
Consequences and limitations
Immediately following the treatment, you can expect some swelling and numbness. The lips are particularly prone to swelling, which may worsen over a couple of days before gradually settling. Unless otherwise instructed, you should refrain from massaging/ rubbing the area for 24 hours following treatment, and excess pressure (e.g. lying face-down on a massage table) should also be avoided. Some bruising may occur at the sites of injection, and for this reason (combined with the expected swelling), I advise you to have your treatment done a minimum of two weeks before any major event/ occasion on which you would be self-conscious of these side-effects.
Allergic reactions to HA fillers are exceptionally rare. Very occasionally (1 in 20000 treatments), patients may experience a hypersensitivity reaction, characterised by redness, swelling, and itching. Even more rarely (1 in 65000 treatments), a granulomatous reaction at the injection site may occur. Mild superficial infections at the injection site are possible, although rare. I will discuss any and all concerns you may have in detail with you, prior to embarking on a course of treatment.
The results from fillers are not permanent. As a general rule, they last somewhere between nine and 18 months, and somewhat less than that (maximum six months) around the mouth. There is growing evidence that the presence of HA encourages your body to form new collagen in the sites that have been injected, and it is certainly true that patients who have had repeated treatments find that they can space their treatments further apart as time goes on, as the effect from each treatment is more sustained.