Dermal Fillers

A dermal filler is a gel injected under the skin to replace lost volume, add structure or soften a fold that is there even when your face is still. In the US, the FDA regulates fillers as medical device implants, not as drugs^[1]. Most fillers used today are hyaluronic acid, but not all, and the difference matters if something goes wrong.

Hyaluronic acid is the forgiving choice for a first treatment because it can be dissolved. Permanent and collagen stimulating fillers cannot simply be removed, and the FDA notes that taking them out can be difficult or impossible^[1]. Ask which family your product belongs to before anything is injected.

The FDA has approved fillers for adults aged 22 and over for these uses^[1]:

• Moderate to severe wrinkles and folds, such as the lines from nose to mouth
• Adding volume to the lips, cheeks, chin and the back of the hand
• Restoring facial fat loss in people with HIV, and some acne scars

It lists injection into the nose, the forehead and between the brows among the uses it has not approved^[1]. These are also the areas where blindness after filler is most often reported:

Source: a 2024 review of 365 new cases of vision loss after filler^[5]. A "non surgical nose job" is one of the highest risk things you can ask a filler injector to do.

It suits people who have lost volume with age, want to balance a feature such as the chin or lips, or have a fold that stays when the face is at rest. It works best for a small, gradual change you can build on.

It is not for you, or needs a doctor's view first, if:

• You are pregnant or breastfeeding.
• You have an infection, cold sore or inflamed skin at or near the area.
• You have had an allergic reaction to a filler or to lidocaine, the numbing agent many fillers contain.
• You are under 18. Cosmetic filler for under 18s is illegal in England^[6].
• You want a large change. Surgery or doing nothing may be the more honest answer.

Bruising, swelling, redness, tenderness and itching are common and usually settle within days^[1]. Less common are lumps, nodules, infection, and swelling that flares up later during an illness, after a vaccination or after dental work^[1].

The serious risk is filler entering or pressing on a blood vessel, which blocks blood flow. The FDA lists tissue death, vision loss including blindness, and stroke among the reported complications^[1]. These are rare, but when blindness happens it is usually permanent: in the 2024 review, 68% of patients with reported outcomes regained no vision^[5].

Act at once if you have severe pain, skin that turns white, grey or blotchy purple, or any change in your vision during or after treatment. Tell the injector immediately or go to A&E or the emergency room. Minutes matter.

The FDA's warnings, all of which apply anywhere^[1]:

• Do not buy filler online. It may be counterfeit, and no filler is approved for home use.
• Do not have filler applied with a needle free "hyaluron pen". These devices are not approved for fillers and serious injuries have been reported.
• Never accept injectable silicone for cosmetic use. It is not approved and has caused permanent disfigurement, stroke and death.

Ask to see the box or syringe before it is opened, and note the product name and batch number for your records.

This is where fillers differ sharply from Botox. Botox is a prescription only medicine. Fillers often need no prescription^[3], so in practice there may be no doctor, nurse or pharmacist anywhere in the chain.

The government announced a licensing scheme for non surgical cosmetic procedures in England in 2025, with practitioner and premises licences run by local councils^[7]. Until it is in force, checking the injector is up to you:

• Search the GMC register for doctors, or the voluntary JCCP and Save Face registers, which the NHS recommends^[3].
• Ask whether the clinic keeps hyaluronidase, the enzyme that dissolves hyaluronic acid filler, and who can prescribe it in an emergency. It is a prescription medicine in the UK.
• Be wary of anyone whose training is a short course alone.

The NHS puts dermal fillers at £200 to several hundred pounds a treatment, depending on the product, the number of syringes and the area^[2]. In the US, plastic surgeons reported an average fee of $715 for hyaluronic acid fillers and $901 for other fillers such as Radiesse and Sculptra in 2023^[4].

Most clinics price per syringe. Lips often take one; cheeks, jaw or a full face plan can take several, sometimes over more than one visit. Ask for the number of syringes and the product in writing before you agree to a total.

A quote far below the local going rate is a reason to ask what product is being used and who is injecting it, not a bargain.

• Consultation. Medical history, a look at your face at rest and moving, and a plan: which product, how much and where. You should hear the risks before anything is injected.
• Numbing. Many fillers contain lidocaine; some clinics also use a numbing cream.
• Injection. By needle or a blunt cannula. A good injector checks your skin colour as they go.
• Afterwards. Some swelling and bruising for a few days. Avoid pressing the area hard and follow your injector's aftercare.
• Review. A two week check to judge the settled result before any top up.

• Who will inject me, and what is their medical qualification?
• Which product will you use, is it hyaluronic acid, and can I see the box?
• How many syringes do you expect, and what will the total cost be?
• Do you keep hyaluronidase on site, and what is your plan if a blood vessel is blocked?
• Is a review appointment included?