Dermal Filler Injections and Lip Fillers

Dermal Filler Injections

Second only to botox, fillers are the mainstay of non-surgical aesthetic treatments. They are an extremely effective way of adding volume to deeper layers and hydration to superficial layers of your skin.

Modern hyalan fillers are safe and controllable. The wear off slowly, but should you not like the effect they can also be dissolved by an injection of hyaluronidase. The most popular areas are the lips, corners of the mouth, nasolabial lines, cheeks, tear trough and lateral brow.

As the fillers need to be injected there is some discomfort. This can be reduced with local anaesthetic. Occasionally there can be some bruising. The majority of my patients seem to prefer no local anaesthetic at all for all areas other than the lips. They find the numb sensation more unpleasant than the stinging of the injection. After the injection the area is usually red and swells a little for the first few days, before settling down.

The effects are immediate and last from 6 to 9 months for the thinner fillers and up to 2 years for the thicker fillers. It is important however to use the right filler in each location, as too thin too deep is poor value, and too thick too superficial is a lump that will need dissolving!

Your initial consultation is crucial to the success of any treatment.

It is your chance to explain and discuss your hopes and fears, so it may help if you write down a list of ideas and questions in advance. You may want to bring along a friend or family member for moral support or to ask additional questions.

It allows Mr Kamalarajah to review your medical history and lifestyle, photograph you (with your permission), assess your suitability for treatment and explain your options.

Finally, you can discuss possible procedures together so that you have a thorough understanding of what can be achieved and what risks there might be.

After the consultation, Mr Kamalarajah will write to your GP summarising the consultation.

As we age one of the effects is the downward sag of the midface. This results in the lateral extension of the tear trough until it effectively turns the youthful curve of the cheek into two curves, the lower of these curves extends into the nasolabial lines and into the jowl on the jawline. A facelift is an effective approach to the jowl, but doesn’t replace the missing volume. A better solution is therefore to replace the missing volume, hence the popularity of deep cheek filler.

A classic complaint for many is that of dark circles under the eyes. This is phenomenally difficult to correct surgically. One of the most effective techniques is to use filler to plump up the tear trough. The results are immediate and last from 6 to 9 months.

This is an advanced treatment with fillers and there have been variable results. The secret is to use a thick but not too thick filler, and to make absolutely sure that all the filler is injected deep to the orbicularis muscle directly on the bone. This can be slightly unnerving for the patient, as the tip of the needle needs to tap against the bone. The pressure on the plunger also needs to be released for some seconds before the needle is withdrawn to allow the build up of pressure in the barrel of the syringe to ease. If this is not done a trickle of filler comes out anterior to the muscle and can give a small lump. In my opinion less is more and I would recommend using only half a syringe each side initially. You can always top up after two weeks.

The skin is very thin in this area so bruising is more common and more visible, but will wear off over a few days and can always be hidden with foundation.
As ever with the hyalan fillers – if you do not like the result the filler can be reversed with hyaluronidase.

Tear Trough Fillers

This is particularly effective on its own in your 40s and 50s, and can be added to a facelift in your late 50s and 60s. I use the more viscous long acting hyaluranic fillers as they are effective, reasonably long lasting and crucially reversible. The technique is shown below. There has been debate as to how much filler is required. I like the less is more approach, and will put as little as 0.6ml in each side in the first instance, especially in a younger patient. If your cheeks are flat then you will normally need a syringe each side.

If you are considering tear trough filler always appraise your cheeks first, as cheek filler is a more effective approach to the lower part of the tear trough. I recommend doing the cheeks first, as you can then better judge how much filler you need for the tear trough.

Full, sensual lips have long been considered a beautiful facial feature but not all of us are naturally blessed with a generous smile. Our lips also get thinner as we age, a process that is often accompanied by the development of fine lines around the mouth.

Fillers are a simple and effective way of adding volume and shape to lips and of restoring smoothness to creased skin around the mouth. Treatments are quick, generally taking around 30 minutes, require no pre-test and the results are visible immediately.


Filling lips is a minimally-invasive out-patient procedure that offers a low risk of complications and minimal recovery time.

The treatment comprises a series of micro-injections. A local anaesthetic is often injected into the lips before an enhancement. The results are instant and last up to six months before a new treatment is required.

What To Expect

  • There may be some discomfort during treatment, although many patients find it relatively pain-free
  • Occasional contour irregularities can occur but, once any swelling has subsided, you can massage any tiny lumps with your thumb or index finger to flatten out any unevenness
  • If you are unhappy with the result, the filler can be easily and rapidly dissolved with an injection of hyaluronidase
  • After an enhancement, lips may appear swollen and uneven for up to a week.
  • Bruise at the injection point
  • Overfilling. The aesthetic effect of fillers requires judgement. If you put too much in it can simply look wrong. Make sure you discuss exactly the effect you want. The hyalan fillers can be dissolved if overfilled.
Lumps. The effect can be lumpy if the filler does not spread as desired, or if there is a local area of overfilling. There is a trade off between the thinner fillers which are less likely to create lumps but do not last as long and the thicker fillers that can be more lumpy but last longer. Lumps can be dissolved with tiny amounts of Hyaluronidase but the risk is that the main body of the filler is also dissolved.
  • Allergy. The risk is very low but possible. All practitioners should carry treatment for an acute allergic attack.
Inadequate result. This is easy to resolve with additional filler
  • Injection into a large blood vessel. This catastrophe must be avoided by knowledge of the anatomy and careful injection.