The fine art of fillers

” Beautiful young people are accidents of nature, but beautiful old people are works of art.” – Eleanor Roosevelt


Modern-day cosmetic dermatologists may have an arsenal of secret weapons at their disposal to combat the signs of ageing, but sculpting a face is an art form. Choosing the right specialist is as important as choosing the right treatment.

One of these “missiles” for which this particularly holds true is fillers. Used inexpertly and you could end up with big fish lips like Hollywood stars Lisa Rinna, Meg Ryan or Paris Hilton, or other unnatural looks which will have people whispering behind your back “What has she done?”


Volume loss is one of the first telltale signs of ageing. It starts to occur in the mid-thirties and continues to progress. Slowly and imperceptibly, like a piece of fresh fruit exposed to the elements, the skin starts sagging. The underlying tissue starts to lose its fullness, resulting in the unwelcome appearance of fine lines and wrinkles. Common complaints associated with volume loss in the face are deep grooves around the nose area, “marionette” lines (from the corners of the mouth and chin) and hollows around the eyes, which can give the face an unwanted worn-out, angry or tired look.


Smoking accelerates the ageing process. The harmful toxins in tobacco interfere with the body’s mechanism of renewing collagen cells effectively. Smoking cigarettes ages skin faster than anything else apart from sun damage, making smokers look older than nonsmokers of the same chronological ages. If you needed any extra motivation to quit smoking, then this is it.

To avoid a dehydrated, “leathery” looking face, it’s common sense to protect your skin by keeping out of the sun as much as possible, wearing a hat that blocks the sun and using sunscreen.


Previously this aspect of facial ageing was overlooked but we are now realising what an important role volume plays. Many patients find injectable dermal fillers beneficial. And while fillers can’t reverse the ageing process or make a person look drastically younger, a fresher, more rejuvenated and energetic look is certainly achievable.


In the world of dermal injectable fillers, there’s a wide range of substances available under an equally large number of brand names. Fillers can roughly be divided into three main groups: short-lasting, semi-permanent and permanent.

– Temporary or absorbable fillers

These are the most commonly used type of fillers, popular for their immediate results, low risk and lack of side effects. The main component is usually hyaluronic acid. Found naturally in the body, hyaluronic acid helps retain moisture and gives skin its youthful, supple and elastic appearance.

Some temporary fillers contain collagen, which come from a bovine (cow) or porcine (pig) source, or are synthetically produced in a laboratory. Products made from collagen will require a skin test whereas for fillers made from hyaluronic acid this is not necessary.

When injected under the surface of the skin, the product fills and smoothes away facial furrows and creases. It’s also suitable for improving the under-eye area, treating acne scars and other skin contour imperfections.

Overall the procedure is fairly painless although post-treatment some redness, bruising and swelling may occur. For augmentation of the sensitive lip area, a numbing cream containing a mild anesthetic is often applied prior to the treatment.

Patients can expect results to last from anywhere between three and eight months. There are rarely any long-term side effects associated with temporary fillers. Because they are 100% biodegradable, the biggest advantage is that if the patient is not satisfied with the end result, the effects will disappear on their own over time.

– Semi-permanent fillers

Semi-permanent biodegradable fillers typically consist of either hyaluronic acid or collagen plus a silicone derivative. They temporarily add volume to the skin, providing patients with optimal correction of lines and wrinkles. Depending on the product and the amount used, synthetic fillers usually last a bit longer, in some cases even a few years.

– Permanent fillers

Used to fill in deeper wrinkles and folds, permanent fillers can contain a variety of ingredients such as animal products, purified silicon oil or other FDA-approved materials. Besides for plumping up sunken areas, permanent fillers can be used for cosmetic purposes such as a non-surgical nose job. As these type of injectables are non-absorbable, they may pose problems because of the increased risk of developing granulomas and hard lumps under the skin.


Most people seek long-lasting or even permanent improvements in order to avoid frequent trips to the doctor’s office. However, I prefer using short-lasting fillers – it’s definitely worth considering a substance that will disappear over six months or so to ensure that the result meets one’s expectations than be stuck with an unsatisfactory result forever.

Regardless of the material, there is a learning curve to injection techniques as well as understanding how the varying substances interact with the skin. This means it’s crucial to find an experienced medical practitioner, someone who has perfected the art of using dermal fillers, and preferably with more than one kind of filler.