Many products have been produced to 'plump out' the deeper layers of the skin (dermis). The first to gain a widespread popularity was collagen which is bovine derived and hence has a Most commonly used over the last 20 years has been collagen, which is bovine derived and hence has a 2% allergy risk. More recently, synthetic products based on hyaluronic acid, such as Restylane, have become popular – they have a similar effect to collagen but without the risk of allergy.

The improvements gained from dermal fillers are, generally modest. The procedure for injecting them is relatively straight-forward and does not require anaesthesia or hospitalisation. The disadvantage is that they are not long-lasting, 3-6 months on average.

Some “permanent” fillers have been introduced but many have fallen into disrepute. This is particularly true of silicone which is no longer recommended for use by injection. Other permanent fillers have the distinct disadvantage that should they be uneven or lumpy it is impossible to remove them. For this reason I favour fillers which will eventually be broken down by the body as outlined above.