Stephen McCulley, Reconstructive and Aesthetic Surgeon. MBChb, FCS(SA)Plast, FRCS(plast)

Why would I choose to have fillers?

Fillers are an excellent form of treatment for improving wrinkles and grooves in the skin, as well as helping to thicken areas such as the lips, chin and cheeks, which can appear thinner with age.

Are there different types of fillers?

Fillers fall into two main categories, permanent and temporary.

What are permanent fillers?

Permanent fillers can either be made of an artificial product, or from the patient’s own fatty tissue, which is taken from one area of the body and injected into the problem area.

Is fat a reliable material to create permanent fillers?

Once the fat is removed from the body and prepared to be reinserted, there is a chance that not all of the fat will survive. Usually 40-50% of the fat that is injected survives, which is then permanent. However, it is very important to note that it is impossible to predict the survival of the fat, and the amount that survives can vary from 10-100%. This needs be fully understood before embarking on the procedure.

If the desired effect is not achieved due to not enough fat surviving, the procedure can be repeated.

What are temporary fillers?

Temporary fillers come in several different types, the best known being Hyaloronic acid, which is a man made but natural component of skin with no animal products in it unlike Collagen.

The most well known Hyaloronic products are Restylane and Juvederm, which Stephen McCulley regularly uses. It is very safe and slowly disappears in the skin.

There are different types/thicknesses of fillers and they are used for different purposes.

Thinner fillers are better for treating fine lines but they don’t last for as long.

Thicker fillers are very good for deeper injections and adding more bulk.

Within the Juvederm range the following variants are available:

  • Juvederm 2 – Fine filler for fine lines.
  • Juvederm 3 – Good general filler for creases and some deeper lines.
  • Juvederm 4- Thicker filler for longer lasting filling of deeper grooves.
  • Juvederm Voluma – For deep volume filling of the cheeks.

What does the procedure for temporary fillers involve?

Temporary fillers are placed under the skin my means of an injection. Occasionally local anaesthetic will be used, however, Juvederm naturally contains some local anaesthetic.

The procedure will be carried out in Stephen McCulley’s clinic, and it will usually take between 15-30 minutes.

How long do temporary fillers last for?

Temporary fillers last from 3-12 months. The exact time scale can vary between patients and can also depend on the type of treatment and where the treatment has been administered. For example, highly mobile areas such as the lips tend not to last as long as other areas, and the results from Perlane will last longer than Restylane.

What does the procedure for permanent fillers involve?

Permanent fillers, (involving fat injections) are usually carried out in hospital, depending upon the area to be treated, the procedure is usually performed as a day-case under local or general anaesthetic.

The fat is removed by Liposuction, generally from the thigh or abdomen although sometimes, small amounts of fat can also be removed from the stomach and buttocks. After extraction, the fat is specially prepared and then re-injected into the area using small needles.

How long does the surgery take?

The procedure for temporary fillers takes approximately 15 – 30 minutes.

Permanent fat injections take approximately 30 – 45 minutes.

Will I have to stay in hospital overnight?

No, fillers, both temporary and permanent are treated as a day case.

Can Fillers be used on the face?

Fillers can be used on the face to enhance the lips, smooth deep creases, fill in scars and improve areas that have become thinner. The great advantage of this technique is the ability to permanently enhance these areas using the patient’s own fat.

Is there any scarring involved with fillers?

In the majority of cases, patients experience virtually no scarring after receiving treatment for either temporary or permanent fillers.

Can I take any medication at the time of my treatment?

It is essential that you discuss any medication that you are taking when you have your consultation so that you can be advised on an appropriate treatment plan. Aside from any prescription medication, you will need to refrain from taking any over the counter medicines or herbal remedies prior to surgery and for three days following the treatment, in particular aspirin, ibuprofen and voltarol based tablets.

Will smoking effect my treatment?

As with all types of surgery, smoking can heighten the risk of complications. Therefore, it is strongly recommended that you stop or at least significantly cut down on the amount that you smoke around the time of surgery.

How long should I expect the recovery period to last for?

Following the procedure, the area that has been treated will be a little red and swollen for around 24 hours. The swelling can last slightly longer on the lips, due to their sensitive nature, and they may take a little longer to settle down. Occasionally patients may experience some topical bruising but this will fade normally.

Will I need to take any time off work?

You should not need to take any time off work after undergoing treatment for temporary fillers, although you are likely to experience some swelling for 24 hours. Recovery from Permanent Fillers may take slightly longer as this requires a formal operation. You will be able to discuss expected recovery times in your consultation with Stephen McCulley.

Will I be able to exercise following treatment?

On the day of treatment, it is advisable to refrain from strenuous exercise. However patients should be absolutely fine to resume all normal activities in the days following surgery.

Will I be able to drive after receiving the treatment?

Once a patient feels free of pain, isn’t restricted in movement, and is fully able to perform an emergency stop, they are fine to resume driving. These precautions are to ensure that patients are still covered by their motor insurance policies.

How soon will I see the results of my surgery?

Patients will be able to see the results of the treatment immediately, although the effect will initially be slightly more pronounced than expected due to the swelling. This excess swelling will settle down and the result will be seen after 24-72 hours.

Are there any complications associated with fillers?

This is a routine procedure, which offers successful results for the vast majority of patients. However, as with any form of surgery, there is always a certain element of risk and it is important that patients understand any potential complications.

Possible complications include:

  • Skin irregularity: If the filler is too superficial it can cause lumps and shadowing in the skin. Sometimes this can take a long time to disappear.
  • Asymmetry: The same injection will be performed on both sides of the face, however, there is a small chance of the injection taking greater effect on one side compared to the other.
  • Bruising: Any bruising will be minor.
  • Allergic reactions: Exceptionally rare.
  • Disappearance of filler: As detailed above, the survival of fat for permanent fillers is unpredictable. If the fat doesn’t survive, it can result in the filler not having as pronounced effect as expected. This can be rectified however, with a futher treatment.

Most of the above complications would only occur if the product was to be injected into the wrong place, however, with an experienced cosmetic surgeon such as Stephen McCulley, you can be assured that you are in the best possible hands.

How much do filler treatments cost?

Temporary filler treatments:

Juverderm 2: from £225.

Juvederm 3: from £250.

Juvederm 4: from £300.

Fat injection treatments for the face range from £2,100

The prices listed are all-inclusive and cover:

  • The pre-operative assessment and investigations.
  • The operation.
  • Hospital stay and any treatment required.
  • All follow up care, (nursing and with Stephen McCulley) relating to your surgery.