WTF is... filler anyway?

The mad wife in the attic of injectables - a quick lowdown

So… WTF is it?

It’s an injectable, commonly used to reduce wrinkles, fine lines and scarring; to promote a ‘fuller’ look or to increase volume of specific areas - especially in the face

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What’s the point of it? I mean, what does it actually do?

It fills your epidermis from the inside, giving a smoother appearance and/or adding volume.

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How does it work?

There are four main types of filler, sold under different brand names. All work to ‘fill’ the area they’re injected into.

• Hyaluronic Acid (HA) : HA fillers are hydrophilic, attracting and binding water molecules. This results in immediate volume augmentation, skin hydration and stimulates collagen production.

  HA fillers are the most commonly used

  • Brand names: Juvederm, Restylane, Belotero

  • Commonly used for: fine lines, lips, nasolabial folds, cheeks, and under-eye areas.

  • Longevity: 6-18 months (longevity depends on the injection areas and HA is the most versatile filler)

  • Results: Immediate (although final outcome will take a couple of weeks to settle in)

  • Reversible with hyaluronidase. Only HA fillers are dissolvable.

• Calcium Hydroxylapatite (CaHA): These fillers provide immediate volume through the gel carrier and stimulate collagen production through fibroblast activation over time, leading to a gradual and sustained volumizing effect.

  • Brand name: Radiesse

  • Commonly Used For: Nasolabial folds, marionette lines, cheek augmentation, midface volumization, jawline contouring, hand rejuvenation

  • Longevity: 12-24 months

  • Results: Immediate, with collagen stimulation further enhancing the outcome over several months

  • Reversibility: Non-reversible

• Poly-L-lactic Acid (PLLA): PLLA stimulates neocollagenesis, which boosts the body’s own collagen production

  • Brand Name: Sculptra

  • Commonly Used For: Full facial volumization, deep wrinkles and folds, cheek and temple augmentation

  • Longevity: Up to 2 years

  • Results: Gradual, with full results developing over several months

  • Reversibility: Non-reversible

• Polymethyl Methacrylate (PMMA): PMMA microspheres provide a scaffold for collagen deposition, resulting in long-lasting (possibly permanent) structural support.

  • Brand Name: Bellafill

  • Commonly Used For: Deep nasolabial folds, acne scars

  • Longevity: several years/indefinitely

  • Results: Immediate improvement (collagen). Long-term support from PMMA microspheres.

  • Reversibility: Non-reversible.

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How much is it?

This will vary substantially depending on how much you get. A syringe is typically 1ml.

A rough guide¹ for a single 1ml vial is provided below (ordered by most to least expensive.)

• Bellafill (PMMA)

  • UK: £600-£800

  • US: $1,000-$1,500

• Sculptra (PLLA)

  • UK: £400-£600

  • US: $800-$1,000

• Radiesse (CaHA)

  • UK: £350-£500

  • US: $650-$800

• Juvederm (HA)

  • UK: £300-£450

  • US: $600-$800

• Restylane (HA)

  • UK: £250-£400

  • US: $550-$750

• Belotero (HA)

  • UK: £250-£400

  • US: $500-$700

This is the cost of the filler to you and does not include the cost of your practitioner’s time/expertise.

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Does it hurt?

In my experience, it hurts surprisingly more than Botox.

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Have I had it?

Yes: nose, lip and marionette

Nose - once in 2021

Lip - annually since 2021

Marionette lines - once in 2023

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Would I have it again?

Marionette - probably not. My doctor injected me there to use up the final remnants of a syringe he’d done my lips with. It was fine, but I’m not mad keen on the idea of ‘filling’ a lot of my face.

Nose - 50/50. It hurt a lot and didn’t last very long. Watch this space.

Lips - Yes. I really love the result. I plan to only stop if they fall off².

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Should you have it?

Exercise caution. Resist the temptation to get a lot done or to get it re-done too soon (more on this below).

Ensure you do the proper research. Filler is much easier for a practitioner to fuck up than Botox.

So You've Decided You Want Cosmetic Work? What To Do Next: Part One (Research Phase)

If you’re in the UK, I will implore you once again to only get it administered by a doctor and not your dentist/your mate’s mate who did a 1-day course³.

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Anything else I think you should know?

1. Filler breaks down in the body over time and it can happen unevenly/unpredictably. Follow your practitioner’s advice and never get a top-up until they tell you it’s necessary. Filler build-up is a real thing and is one of the leading reasons why people can look as though they’ve had too much done.

2. Don’t be misled into thinking that filler is trivial just because you’ve read about a dozen Love Island contestants talking about getting it dissolved. Not all filler is dissolvable, dissolution hurts like a bastard⁴ (I don’t have first hand experience of this, but secondary accounts are eye-watering) and there is still a risk that it dissolves unevenly.

3. Filler to reduce fine lines and wrinkles (rather than to increase volume) is falling out of favour, with many practitioners steering towards laser or microneedling instead. Have informed conversations with your practitioner to ensure that filler is definitely right for you and the outcome you’re looking for.

   How To Talk About Cosmetic Work - Part Three: Talking to surgeons, practitioners and other healthcare professionals

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Reminder that any cosmetic work undertaken should be in accordance with The 6 rules of cosmetic work. Here they are, in case you missed them the first time…

The 6 Rules of Cosmetic Work (per me)

1. Don’t @ me

2. I don’t expect them to fall off

3. The US is far better regulated than the UK for injectables, so you have less to fear.

4. Just ask Henry VIII