Dermal Fillers

Dermal fillers are injectable gels used to restore volume, soften static lines and change contour in areas such as the cheeks, lips, chin and jawline. Most fillers used in the UK are made from hyaluronic acid, a substance that occurs naturally in skin and binds water.

How it works

The gel is injected into the dermis or deeper tissue planes, physically adding volume where it is placed. Hyaluronic acid fillers have a significant practical advantage: they can be dissolved with an enzyme, hyaluronidase, if the result is unsatisfactory or if a complication occurs. Non-hyaluronic acid and permanent fillers cannot be reversed this way, which is why they carry a higher risk profile.

What is involved

• Treatment time: usually 20 to 30 minutes depending on the area.
• Anaesthetic: topical anaesthetic cream is common; many fillers also contain local anaesthetic.
• Duration: typically 6 to 18 months, varying by product, site and individual metabolism.

Risks and limitations

Common temporary effects are swelling, bruising, tenderness and lumpiness for a few days. Recognised complications include prolonged swelling, nodules, infection, and delayed-onset inflammatory reactions occurring weeks or months later.

The serious risk is vascular occlusion: filler entering or compressing a blood vessel, which can cause skin death (necrosis) and, very rarely, blindness if it affects vessels supplying the eye. This is a medical emergency. It is the main reason to be treated by someone who both recognises it and holds hyaluronidase to treat it immediately. Ask about this before any injection around the nose, glabella or under-eye area, where the risk is highest.

Regulation in the UK

Non-surgical cosmetic injectables are not yet subject to a licensing scheme in England. At present no qualification, training or medical registration is legally required to administer dermal filler. The Health and Care Act 2022 created the legal framework for a licensing scheme, but it has not been fully implemented. Since 1 October 2021 it has been a criminal offence in England to administer dermal filler or injectable muscle-relaxing treatments for a cosmetic purpose to anyone under 18.

Because of this, the single most useful thing to check is who is treating you: their professional registration (GMC, GDC, NMC or GPhC), what training they have in the specific procedure, what insurance they hold, and what happens if there is a complication out of hours.

Who it may not suit

Filler is generally avoided during pregnancy and breastfeeding, in active skin infection at the site, and where there is a history of significant reaction to a previous filler. Autoimmune conditions warrant discussion. Filler cannot lift substantially sagging tissue, and using increasing volume to try to achieve a lift produces the heavy, overfilled appearance that is difficult to reverse.

Information on this page reflects NHS and British Association of Dermatologists patient guidance and current UK regulatory position. It is general information, not medical advice, and it is not a substitute for an individual assessment by a qualified clinician.