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Natural-looking aesthetic enhancement, restoration and definition of facial features restoration

Cosmetic hyaluronic acid fillers are soft gel implants that are injected into the skin and deeper layers of the face to enhance, restore, reshape and define facial areas and specific facial features. Hyaluronic acid (HA) is a substance that occurs naturally in the body; it is a powerful skin hydrator. HA Fillers can be injected superficially into the skin to fill out and treat fine lines and wrinkles, either in combination with or instead of BOTOX® for wrinkle reduction.

The most impressive indications, however, for HA fillers are when they are injected below the skin within the deep layers of the face. Here, they can be used to address areas of volume loss, reduce the appearance of sagging and define, contour and reshape key facial features such as the lips, cheeks, chin and nose. Through a combination of volume replacement and tissue support, they can also smoothen the skin surface reducing the appearance of not only wrinkles (such as in the forehead) but also depressions such as grooves, hollows and folds. This effect, in turn, can reduce unattractive facial shadows or areas of darkness, such as those that can occur under the eyes, as well as smoothen and highlight the contours of other facial features such as the cheeks or jawline.

Sloave Clinic London

Treatment Overview

icon-clock How long is the cosmetic filler procedure?

An initial appointment usually involves a detailed consultation with Dr Rhobaye for a tailored treatment strategy of around 20 to 30 minutes. The actual injection stage takes only 10-30 minutes, depending on the area(s) being treated.

icon-needle How comfortable is cosmetic filler treatment?

Cosmetic filler treatments are usually tolerated very well. The premium cosmetic fillers that we use for the contain a local anaesthetic to reduce any discomfort significantly. For particularly sensitive areas of the face such as the lips, an additional topical anaesthetic is applied before the procedure for even greater comfort.

icon-heart How long is the recovery time?

Cosmetic filler procedures are a minimally invasive technique with significantly less risk of complications and downtime compared to surgery. You can return to work or your usual routine immediately or very soon after treatment.

You may experience some very mild swelling and occasionally bruising, which can take a few days to settle. Should bruising occur, they can be adequately covered up with makeup.

You will be advised by Dr Rhobaye on the expected recovery time so that you can plan a suitable procedure date. If requiring treatment before an important event, please book ahead allowing time for both the treatment and a 2-3 week follow-up review.

icon-eye When will I see results?

The results from hyaluronic acid filler treatments are immediate, and you should expect a noticeable improvement straight away. However, these results will develop further as the fillers undergo a process of hydration (water absorption), bio-integration and eventually compaction, which can take some time to complete. There will inevitably also be a degree of minor soft tissue swelling which needs to resolve to assess the treatment outcome. Consequently, the final stable results can take several weeks to appear, typically 4-8 weeks.

results How long do the results last?

The duration of results from a first filler treatment depends on the treatment area and the type of filler used. For example, an initial lip reshaping may last 4-9 months, cheek augmentation up to 18 months, and tear trough correction 2-3 years. However, although HA fillers are classified as temporary, results can persist for a long time such that the baseline is improved with each treatment. This, in turn, means that you need less filler to maintain the same results and that the results can last incrementally longer with each treatment, especially if undertaken as part of a maintenance programme.

icon-calendar How many dermal filler sessions will I need?

This will be discussed during your consultation as it varies from patient to patient and on the treatment area and desired result.

For certain areas, only one session is necessary, whereas others may require several staged procedures over some time. We usually recommend that patients seeking further treatment allow at least 2 weeks (preferably 4-6 weeks) before undergoing additional filler procedures within the same area.

natural-icon Will it look natural?

A fundamental principle in our treatment philosophy is that the results have to look natural. We take great care and skill in achieving this through a carefully planned treatment strategy that is highly individualised to each patient’s specific facial anatomical features. Dr Rhobaye is a highly experienced specialist and leading authority in non-surgical and minimally-invasive facial aesthetics. He uses advanced methodologies and techniques incorporating higher-level treatment philosophies that consider the face as a whole to achieve a very natural-looking appearance without distracting or disproportionate features. It is a comprehensive treatment strategy for full facial rejuvenation using the very latest and most advanced filler technology.

Please look at our Photo Gallery for examples of our work. 

reverse Can the treatment results be reversed?

Our experience with cosmetic fillers is that the patient satisfaction rate of this procedure is extremely high. Nevertheless, one of the main advantages of using hyaluronic acid (HA) fillers is that the procedure is reversible. If a patient wishes to reverse the changes for any reason, a particular enzyme (hyaluronidase) can be injected into the treatment area to dissolve the HA filler.

Disclaimer: Individual results and reactions may vary and can be affected by factors such as anatomy, physiology, metabolism, physical as well as environmental stresses, and fluctuations in body weight.

Sloave Clinic London
  • Overview of filler types

    The general term ‘fillers’ in the context of aesthetic medicine describes a broad range of biologically derived (e.g. hyaluronic acid, collagen), biostimulatory (e.g. poly-L-lactic acid, calcium hydroxyapatite) or synthetic substances (e.g. silicone, polyacrylamide hydrogel). These products vary greatly in terms of their mechanism of action, safety, efficacy, ease of use, longevity, cost, and possibility of removal.

    Fillers are also broadly subclassified as being permanent, semi-permanent and temporary in terms of their biodegradability (i.e. ability to be broken down and removed by the body).  Some of these filler types appear to be significantly less reliable in terms of action and long-term safety, with some patients experiencing severe long-term side effects. Our strong preference, therefore, is only to use hyaluronic acid (HA) fillers, as these have an excellent long-term safety record and are very reliable when used by experienced specialists.  They also have the distinct advantage of being rapidly reversible if needed using an enzyme that is injected to dissolve the filler.

  • Variations in hyaluronic acid filler characteristics depending on the brand

    There is quite an extensive range of HA fillers products available in the medical field that differ in quality and production methods. These different HA fillers also have subtle but important variability in their characteristics, which mean that some are better suited for certain areas of the face than others. Furthermore, those from leading pharmaceutical companies have undergone robust research and development with excellent safety records. However, this is not necessarily true of products from other manufacturers which may have different qualities, efficacies and long-term safety records.

    We therefore strongly recommend that any patient seeking cosmetic filler treatment always makes sure that they understand what filler type and brand is used by the practitioner. Dr Rhobaye uses a premium range of the safest class of temporary and reversible HA fillers that have both an excellent long-term safety record and research-proven efficacy, namely Juvederm® Vycross, Teosyl®, and Restylane®.

  • Dermal fillers versus cosmetic fillers - differences in terminology

    Hyaluronic Acid fillers are commonly referred to as a type of ‘Dermal Fillers’, as they were initially mainly injected into the dermal (skin) layer to fill out fine lines and wrinkles, either in combination with or instead of BOTOX®. The name ‘Dermal Filler’ however is a misnomer as most modern indications for their use are actually below the skin, or subdermal, where they are injected into fat compartments or deeper on the surface of the skeletal bones and cartilage to restore volume, reshape, contour and define features (a process called soft tissue augmentation and remodelling). Subdermal fillers are also injected above, below and within individual muscles to selectively modify the action of specific facial muscles in a favourable way (a process called myomodulation). We, therefore, prefer to use the term Cosmetic Fillers to encompass both Dermal and Subdermal Fillers. Consequently, contrary to popular misconceptions, the science and techniques involved with modern cosmetic filler procedures are much more advanced than most people assume.

  • Mechanism of action of hyaluronic acid (HA) fillers

    HA fillers are clear soft gel implants made from hyaluronic acid molecules that have been cross-linked (bonded together) to varying degrees to improve their functionality and make them more stable and resistant against degradation. Unlike the non-cross-linked HA in our bodies, HA fillers can last for months rather than days although they are eventually broken down by natural enzymes. When injected into the skin or underlying fat, they bind with water molecules to form a viscous substance that gradually integrates with the host tissue to varying degrees. In doing so, the filler restores volume and provides tissue support, lift and hydration. With time, this substance gets broken down by natural enzymes in the body. However, there is increasing research evidence suggesting that HA filler injections can also stimulate healthy new collagen formation, potentially giving longer-term benefits even after the filler has degraded. Radiological studies such as MRI have also shown that fillers can last for many years (yet remain dissolvable if needed to be reversed), which may also explain the longevity of results in patients.

  • Treating different layers of the face using different filler densities

    Different densities of HA fillers can target selective layers of skin and underlying layers for specific results. For example, less dense fillers can be injected superficially into fine lines/wrinkles to smooth them. In contrast, intermediate-density fillers can be injected just below the skin such as in the lips or areas of mild depressions or irregularities to shape and soften. The densest versions of HA fillers are predominantly injected into the deep layers of the face to restore volume, add contour/definition and provide soft-tissue support as well as lift against facial sagging. Different cross-linking and production technologies also result in HA fillers with specific characteristics and properties that behave differently when injected into human tissue.

    Newer generations of HA fillers have had a transformative effect on non-surgical aesthetic treatments and can now achieve results comparable to surgery, with much less risk and downtime.*

    *Individual results and reactions may vary

  • Adverse reactions, risks and complications from cosmetic HA fillers

    As with any invasive medical procedure, patients can experience some degree of temporary side effects such as redness, swelling, itchiness, tenderness, and occasionally bruising at the site of injection. These are not complications but are normally expected reactions (sequelae) of this type of medical treatment. Unexpected complications are uncommon with HA-based cosmetic fillers but include nodule formation and possible skin infection. Serious complications have been reported in the medical literature, but these are rare to extremely rare and are more related to the injection technique and experience of the practitioner. These complications include facial abscesses, excessive swelling (angioedema), and vascular occlusion (blockage of blood vessels leading to skin or tissue death and even blindness). Allergic reactions are virtually unknown (which is why patch testing is unnecessary); if they occur, they are likely to be due to reaction to other substances that are combined with the filler, such as lidocaine anaesthetic, rather than an actual allergy to hyaluronic acid itself.

    It is essential to understand that these are medical procedures and should only be conducted by medical professionals with suitable training, skill and experience. Overall, however, treatment with HA fillers is significantly safer than equivalent surgery with substantially less downtime, and have the advantage of being able to be broken down and reversed if needed.

  • Reversing Hyaluronic Acid filler treatments

    Following injection, the HA fillers are progressively broken down by a naturally-occurring enzyme (hyaluronidase) in the body in a similar way that the hyaluronic acid in our bodies gets broken down. In rare circumstances, the HA fillers injected may need to be removed by injecting hyaluronidase enzyme into the filler deposit to break it down. This is another significant advantage of HA fillers over other types of fillers (particularly the permanent and semi-permanent class of products).

  • Advanced cosmetic filler techniques

    Modern injection techniques for HA fillers have significantly evolved from older ad-hoc methods of injecting. These advanced systems of injecting are based on targeting strategic points in each facial feature and over the full face. They have substantially increased the versatility and efficacy of fillers in facial aesthetics enabling experienced practitioners to now offer surgical grade results through a non-surgical, minimally invasive approach.

    By building on his experience in facial surgery, understanding of filler science and in-depth knowledge of facial anatomy, Dr Rhobaye has developed and refined an advanced and highly specialised system of injecting fillers. His techniques are based on the core principles of volumetric support, facial anchor points, contour enhancement, myomodulation, light and shadow concepts and facial proportionality. This treatment methodology also addresses the principle of direct versus indirect correction where treating one area of the face can have a positive or negative effect on an adjacent or even distant area of the face. By considering the face as a whole rather than in isolation, these techniques can avoid over- or under-correction and achieve an optimal natural-looking rejuvenated appearance that addresses areas of volume loss, shadows and sagging as well as defining key features of a patient’s face.

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