Doctor FAQs: your questions answered on dermal fillers

Dr Nikola Milojevic is an expert in facial rejuvenation, working at the pioneering Milo Clinic in London, where he offers some of the most innovative treatments in aesthetic medicine available. In this FAQ session Dr Milojevic answers everything you might want to know about cosmetic fillers.

What are dermal fillers?

In the world of aesthetic medicine the main two tools in which we can rejuvenate the ageing face are Botox and dermal fillers. Botox is used for wrinkles caused by muscles of expression, but dermal fillers replace the lost volume. We lose volume as we age - in the cheeks, temple, and chin, for example - and hyaluronic acid dermal fillers are used to replace that. I call it the syndrome of the deflated balloon.

What do dermal fillers contain to reduce signs of ageing?

Hyaluronic acid is something we have naturally in the face anyway along with elastin and collagen. In dermal filler injections, this hyaluronic acid comes in the form of a gel. We inject the gel into the areas of lost volume, and by injecting hyaluronic acid fillers, we are inducing new collagen and new elastin to be formed. This means we are re-inflating that balloon by lifting cheeks and filling in areas of lost volume - therefore rejuvenating the face on the whole.

How are dermal fillers done?

The procedure for dermal fillers is fairly simple. The vials we use to inject come in 1ml sizes, and there are various kinds of filler available on the market. We choose the specific filler for the specific area we want to treat - there are thicker fillers, and thinner fillers. The needle that we use is incredibly thin, so we target the area we want to treat, and we gently and slowly inject the filler.

How long does the procedure for fillers last?

Treatment usually only lasts 5-10 minutes, so the procedure is very quick. I like to inject small boluses (the administration of a certain amount of product or medication) carefully and slowly. Using the needle, we can be very specific in how and where we place the filler. As we place it, we also mould the filler to exactly the shape we want it, and at the end of the procedure, we stop any bleeding that there might be. It is all over very quickly, and the patient can actually put a little makeup on straight after the procedure, and go back to work.

I am a doctor of aesthetic medicine so I use the needle, not the scalpel.  What I'm amazed by with dermal fillers are the results we can achieve now without the scalpel. We can do all sorts of things and achieve all sorts of results which were only possible through a surgeon's scalpel in the past.

What procedures can be done using dermal fillers?

For instance, the 'wow' treatments at the Milo Clinic that we offer include filling eye bags - we can now get rid of most tear troughs, dark circles and eye bags under the eyes. We can now straighten noses, so we can literally take the most hooked of noses, with a dropped tip, or uneven noses after rhinoplasties, and achieve the look that the patient wants, just with hyaluronic fillers.

We can do the Nefertiti neck lift (a surgery-free neck lift), which means the jowly areas which start drooping over time can be tightened – we can refill that deflated balloon. Moreover, we can actually do non-surgical facelift, where we can place careful boluses of a chosen filler in certain areas of the face to tighten the face, lift it, rejuvenate it in a very natural way, and produce amazing results.

How long does it take to recover from dermal filler procedures?

What is great about all these cosmetic filler treatments is that the recovery time after these procedures is extremely short, and in fact for most patients is from anywhere from 1 day to 7 days.

Are there any side effects of a cosmetic filler procedure?

The only side effects we commonly see are swelling, and also some bruising, but these do go away very quickly with proper treatment – such as a special kind of cream and ice.

On very rare occasion, and I've never seen this in my career, we can get allergic reactions and infections after these procedures, but if they were to happen in the hands of an experienced doctor, a course of antibiotics or antihistamines would solve these problems as well with no worries at all.