The Complete Guide to Dermal Fillers

Dermal fillers have become one of the most popular cosmetic treatments in the world, used to restore volume, smooth lines and reshape the face without surgery. Roughly one in five UK women has now had or is considering getting filler of some kind. They’re quick, the results are immediate and depending on the type of dermal filler, you can dissolve them if something isn’t right. In this guide we explain what dermal fillers are, how they work, the different types and what they can actually do. We explore pretty much every use from dermal fillers for lips and cheeks to tear troughs, jaw and hands. This guide also covers what dermal filler treatment involves, how long it lasts, whether it’s safe, UK regulation and alternatives.

Please note, we no longer offer in-person injectable treatments. We’ve kept this guide updated because we believe the public deserve clear, evidence-led information without commercial bias.

What Are Dermal Fillers?

Dermal fillers are injectable gels that add volume beneath the skin to smooth lines, restore lost fullness or reshape a feature. The vast majority of modern fillers use hyaluronic acid, a sugar molecule that occurs naturally in the skin. Alongside collagen, it gives skin its hydration, structure and plumpness. They’re sometimes called soft tissue fillers, and they restore volume to areas like the cheeks, lips and under-eyes as well as softening lines and folds.

Most fillers are temporary, because the body gradually breaks them down and absorbs them over time. Crucially, you can dissolve hyaluronic acid fillers with an enzyme (hyaluronidase) if the result isn’t right, which is a major safety advantage we’ll come back to.

How Do Dermal Fillers Work?

Fillers work by physically adding volume where it has been lost or where more definition is wanted. Depending on the product and placement, the same treatment can plump, contour, lift or smooth. Thinner gels sit superficially to soften fine lines and add hydration. Thicker, more structural gels go deeper to rebuild volume in areas like the cheeks or jaw.

Some fillers do more than add volume. Calcium hydroxylapatite and poly-L-lactic acid also stimulate the skin to produce its own collagen over the following months. So part of their effect builds gradually rather than appearing straight away. With hyaluronic acid the result is immediate, although the final look settles over two to four weeks as any swelling resolves.

What Are the Different Types of Dermal Filler?

Dermal fillers fall into a few groups depending on what they’re made of. Each behaves differently, lasts a different length of time and carries a different safety profile. The main types of dermal filler are:

• Hyaluronic acid (HA): This is the standard choice for the face and by far the most widely used. HA fillers are versatile and suitable for almost any area, and their effects last roughly six to twelve months (longer with more advanced products). Their biggest advantage is that they’re the only type that you can dissolve with hyaluronidase if there’s overcorrection or a complication. Reputable brands include Juvéderm, Restylane, Belotero and Teosyal.
• Calcium hydroxylapatite (CaHA): This is a thicker, mineral-based gel (the same mineral found in teeth and bone) used for deeper volume loss and contouring. It lasts around eighteen months and also stimulates collagen, but it cannot be dissolved. Radiesse is the best-known brand of CaHA filler.
• Poly-L-lactic acid (PLLA): A collagen stimulator rather than a traditional filler. The gel itself dissipates within days. The result then builds gradually over a series of injections across several months and lasts up to two years. Sculptra is the main brand, and like CaHA you cannot reverse it.
• Polymethyl methacrylate (PMMA): A semi-permanent filler containing tiny microspheres that stay in the skin. Bellafill is the main example. Because it isn’t absorbed and cannot be dissolved, it’s rarely used on the face.

This is why hyaluronic acid is the standard for facial work. The fact it’s reversible makes it far safer than the permanent and semi-permanent options. Older collagen-based forms carried a real risk of allergy and long-term scarring.

What Areas Can Dermal Fillers Treat?

Fillers are popular for use across the face, and increasingly on the hands, to restore volume, define features and soften lines. The main areas that dermal fillers can treat are:

• Lips: Filler can define the lip border, correct asymmetry, enhance the cupid’s bow and add volume. Only hyaluronic acid is suitable here. Basic products last six to eight months, and more advanced ones like Juvéderm Volbella up to twelve to eighteen months. The lips are mobile and vascular, so filler tends to break down faster than elsewhere. The modern trend is firmly towards subtle, natural lip enhancement designed around the individual face, not the overfilled look of a few years ago. If a previous result isn’t right, it’s better to dissolve it or let it fade completely before trying again. That way each treatment enhances rather than corrects.
• Cheeks: Filler can restore midface volume loss, contour and lift the cheeks, and soften the nose-to-mouth lines. Thicker, structural fillers like Juvéderm Voluma and Volift give support and last longer. Standard fillers are more suitable for lighter correction.
• Tear troughs (under-eyes): This is one of the most technically demanding areas. The injector places thin hyaluronic acid to fill the hollow that casts a shadow under the eye. This softens the dark circles and under-eye bags that the hollowing creates. A less-is-more approach is essential, often around 1ml shared between both eyes. It’s important to be honest about the limits here. Tear trough filler can’t treat darkness caused by hyperpigmentation, and it can’t remove an actual eye bag (it only conceals the shadow that deepens it). In people with puffiness or fluid retention, it can even make bags look worse. Cheek filler is often needed alongside it to support the midface.
• Jaw & chin: Filler can define and sharpen the jawline, build projection in a small or recessed chin, and balance the proportions of the lower face. Thicker structural fillers work best here.
• Nose (non-surgical rhinoplasty): Filler can smooth a bump, lift the tip or straighten the profile without surgery. This is one of the highest-risk areas for vascular complications, so non-surgical rhinoplasty should only ever be done by an experienced medical injector.
• Nasolabial & marionette lines: The deeper folds run from the nose to the mouth and down towards the chin (the marionette lines). Filler softens them by replacing the volume lost higher up the face, rather than simply filling the crease.
• Hands: Filler restores lost volume on the back of the hands, softening the appearance of prominent veins and tendons. Both hyaluronic acid and calcium hydroxylapatite work well here.

What’s the Difference Between Fillers & Botox?

Fillers and Botox are often confused, but they do opposite things. Botox relaxes the muscles that cause dynamic lines, the creases made by movement like frowning and squinting. Fillers add volume to plump hollows, restore lost fullness or define a feature. In short, Botox softens movement whilst fillers restore structure. Neither improves the quality of the skin itself. The two are frequently combined because they address different signs of ageing. Both are temporary and require repeat treatments to maintain results.

What Does Dermal Filler Treatment Involve?

Treatment should always begin with a consultation, ideally with the medical professional who’ll carry out the procedure. A good practitioner assesses your face, discusses realistic goals and checks the treatment is suitable for you. They’ll also counsel you on the risks and aftercare.

The practitioner first numbs the area, usually with a lidocaine-based cream, though some offer a dental-style anaesthetic injection. The filler then goes in through a fine needle or a microcannula, depending on the area and the result wanted. The practitioner often massages it afterwards to disperse it evenly and avoid lumps. A single area usually takes fifteen to thirty minutes, and a lip treatment around thirty to forty-five minutes. The result is immediate, but the final look settles over two to four weeks as swelling subsides. Some asymmetry or unevenness during that time is normal. There’s little real downtime, though there’s aftercare to follow which includes:

• Use an ice pack and stay hydrated to ease swelling and bruising.
• Avoid strenuous exercise, saunas and very hot environments for the first day or two.
• Avoid ibuprofen and aspirin (unless you normally take them for another condition), because they can increase bruising.
• For lips, eat soft foods and avoid drinking through a straw or smoking, because puckering can disturb the filler in the first few hours.

A reputable clinic will offer a follow-up appointment at four to six weeks. They’ll also provide written aftercare instructions and clear aftercare guidance on when and how to reach them sooner if there’s a problem.

How Long Do Dermal Fillers Last?

How long filler lasts depends on the type, the area treated and your own metabolism. As a rough guide, hyaluronic acid lasts around six to eighteen months, calcium hydroxylapatite up to eighteen months and poly-L-lactic acid up to two years. Mobile, vascular areas like the lips break filler down faster than structural areas like the cheeks.

These averages are only a guide, though. In some people filler breaks down very slowly and can persist for years, well beyond the expected window. Because hyaluronic acid is dissolvable, the treatment can be adjusted as your face changes over time and there’s no permanent commitment.

Are Dermal Fillers Safe?

In the hands of an experienced medical professional, dermal fillers have a good safety record. Most side effects are mild, temporary and related to the injection itself. However, there are rarer and more serious risks that you should understand and discuss with your practitioner. The possible side effects of dermal fillers include:

• Common and mild: Redness, swelling, tenderness, bruising and minor bleeding at the injection sites. These usually settle within a few days.
• Uncommon: Infection (signs include fever, swelling and discharge), temporary lumps or unevenness that can often be massaged out, and cold sore reactivation around the lips in those prone to them.
• Rare but serious: Vascular occlusion, where filler blocks or compresses a blood vessel. This can cause skin death (necrosis) and, if it affects a vessel supplying the eye, even blindness. It’s rare. In one large review of over 290,000 injections, serious complications occurred in around 0.004%. Even so, it’s the reason facial anatomy and injection technique matter so much. The warning signs are severe pain, blanching of the skin (a white or dusky colour) and a change in temperature. Filler can also migrate into nearby areas, which in the lips creates the “duck pout” ledge. Persistent lumps or granulomas can form weeks or months later too.

The single most important safety factor is who performs the treatment as they will use the safest technique and product. The fact that hyaluronic acid can be dissolved with hyaluronidase in an emergency is another major reason it’s more suitable for use on the face.

Are Dermal Fillers Regulated in the UK?

This is where fillers differ sharply from Botox, and it surprises most people. Botox is a prescription-only medicine, so it must at least be prescribed by a medical professional. Dermal fillers are not. Most hyaluronic acid fillers count as medical devices rather than medicines. This means they’re sold without a prescription, and there’s currently no legal restriction on who can administer them. In other words, anyone can legally inject filler in the UK, whatever their training.

The government has stated an intention to introduce a licensing scheme and tighter regulation, but that has not yet been implemented. The one firm rule already in force is that it’s illegal to give filler to anyone under 18 for cosmetic reasons. Until then, the responsibility falls on you to choose a medically qualified injector who works somewhere with proper emergency protocols and aftercare. That means a GMC-registered doctor, a GDC-registered dentist or an NMC-registered nurse.

What Are the Alternatives to Dermal Fillers?

Honestly, nothing replicates exactly what filler does, because nothing else safely adds volume beneath the skin. What good skincare and other treatments can do is improve the quality of the skin, so the whole area looks plumper, smoother and more even. Below are some of the alternatives that can help address similar concerns to dermal fillers:

• Skin quality and fine lines: Retinoids, and prescription tretinoin in particular, stimulate collagen and cell turnover to firm the skin and soften fine static lines over time. Vitamin C and peptides support and protect collagen. Daily SPF is non-negotiable, because UV is the biggest driver of skin ageing. None of this replaces lost volume, but it improves the canvas.
• Pigment & dark circles: Sometimes under-eye darkness or dullness around the mouth comes from hyperpigmentation rather than hollowing. Here, topical agents like retinoids, hydroquinone, tranexamic acid, azelaic acid and niacinamide fade the pigment in a way filler simply can’t.
• Collagen stimulation: Skin boosters and microneedling can improve hydration, firmness and texture by stimulating the skin’s own collagen. They don’t plump like filler, and we won’t pretend otherwise, but they genuinely improve skin quality.
• Lips specifically: A hyaluronic acid lip balm can hydrate and create a subtle, temporary appearance of fullness by plumping the surface. Gentle exfoliation and an SPF lip balm keep the lips smooth and protected. The effect is mild and short-lived, but it’s a real non-invasive way to enhance the lips day to day.

For volume itself there’s no exact substitute that isn’t surgical (e.g. fat grafting), and a good practitioner will tell you so. However, optimising your skin quality first often delivers more than people expect. It can also make any filler done later look better and last longer.

How to Get Dermal Fillers in the UK

Dermal fillers are widely available from private clinics and med spas. Cost varies widely depending on the area, type and amount of product, geographical location as well as the qualifications of the injector. Price can range from a couple of hundred pounds for a straightforward single area to several hundred or thousands for more complex work. A reputable clinic will also include aftercare and a follow-up as part of the service. Because the field is largely unregulated, the most important thing is to choose a medically qualified, insured injector who works somewhere equipped to manage complications. It’s also worth remembering that filler only addresses volume and structure. You can improve the quality of your skin (its texture, tone, fine lines and sun damage) with good anti-ageing skincare.

At City Skin Clinic, we no longer offer injectable treatments. What we do provide is custom skincare that treats the skin itself. We use evidence-based ingredients like tretinoin and pigment-correcting actives where appropriate. Our doctors design a plan entirely around your skin. You can read more about our custom anti-ageing treatments, book a video consultation or use our online consultation form. The journey towards great skin starts here.

This article is for general information only and is not a substitute for medical advice, diagnosis or treatment. Dermal fillers should only be administered by a suitably qualified medical professional after an individual assessment. Always consult a qualified medical professional about your treatment options.