Many products have been manufactured and gained great popularity over the last 30 years or so for plumping the dermis (deeper layers of the skin) and so reducing fine wrinkles. In broad terms they may be classified into temporary, semi-permanent and permanent fillers. Although a permanent or semi-permanent filler is attractive in that the treatment does not need to be repeated, both have the major disadvantage that if irregularities, reactions or lumps beneath the skin develop as a result of the treatment there is no effective method of rectifying the problem. Indeed, the published evidence would suggest that attempts to remove permanent and semi-permanent fillers surgically are likely to make problems worse rather than better. Temporary fillers however have found great popularity and can be effective. Products designed to be used superficially usually aim to reduce fine wrinkles, for instance in the upper lip, or to increase volume of the lip. The thicker preparations are used to change contours such as increasing prominence of the cheekbones or chin. The thinnest (Vital) can improve the appearance of the back of the hands.

Collagen is used less than it once was because of the allergy risk (approximately 2%). The most popular temporary dermal fillers now are based on hyaluronic acid (the skin’s natural moisturiser) produced synthetically. They are made by a number of manufacturers but in general we tend to use Q-Med products. All are based on hyaluronic acid but vary in their viscosity (thickness) from Restylane Vital (the thinnest) to Restylane Sub-Q (the thickest). As a broad guide, the thicker the product the deeper it is injected. Generally they last between 6-12 months in most people. They are administered by injection, a process which takes little time. There may be a little redness and swelling afterwards and occasionally a little bruising but this will usually not last more than 24/48 hours at most.