How Well Do You Know Your Fillers?

Did you know that you don’t have to be a medically trained practitioner to administer fillers? But that the enzyme used to dissolve hyaluronic acid fillers, hyaluronidase, is a prescription-only medicine that non-medical practitioners won’t be allowed to prescribe if something goes wrong? Do you know the different types of cosmetic fillers, or the various reputable brands? Do you know how long dermal fillers stay put for? With aesthetics treatments more popular than ever, we asked the experts to share their insights on what people should know before considering injectables. 

How Popular Are Dermal Fillers?

Filler is one of the UK’s most widely used cosmetic treatments, and one of the least understood. The British College of Aesthetic Medicine recorded a 100% year-on-year rise in dermal filler procedures among its members in 2021 as demand went mainstream, and the UK’s non-surgical aesthetics industry, of which filler is a cornerstone alongside anti-wrinkle injections such as Botox, is now valued at more than £3 billion. Industry estimates indicate that more than 600,000 dermal filler treatments are performed in the UK annually. Patients are becoming more relaxed about tweakments, but there’s still a gap in knowledge when it comes to anti-wrinkle injections like Botox and dermal fillers. What’s in the syringe, how long does it really stay put, and how do you identify a good practitioner from a risky one?

We put those questions to three of the UK’s leading injectors: Dr Dean Rhobaye of the Sloane Clinic on Harley Street, Dr Ash Soni, plastic and reconstructive surgeon at The Soni Clinic in Ascot and London, and Dr Sophie Shotter, President of the British College of Aesthetic Medicine (BCAM) and founder of Illuminate Skin Clinic. 

Not All Fillers Are The Same

Here’s the first misconception around fillers: dermal filler is not one product. Hyaluronic acid (HA) fillers differ enormously in their particle structure and physical properties, known as rheology, and that determines how firm, soft or spreadable they are once injected.

‘Filler isn’t a one-size-fits-all treatment, says Dr Sophie Shotter. ‘It needs to be matched to the tissue behaviour of the area being treated. Thinner, more fluid formulations work best in delicate zones like the tear troughs or lips, where the tissue is mobile and you need something that integrates softly rather than sitting rigidly… The skill is in the practitioner choosing the right product for the right depth and the right anatomical layer, not simply defaulting to whatever’s in stock.’

‘HA fillers are not interchangeable,’ agrees Dr Rhobaye. ‘A structurally firm filler may be needed deep on bone to project or support the cheeks, chin or jawline. A softer, more adaptable gel is usually preferable in a mobile area such as the lips, while thin-skinned or lymphatically sensitive areas such as the lower eyelids require a smooth, low-swelling product, meticulous placement and very conservative volume.’

How Does Filler Affect The Way Your Face Moves?

Filler doesn’t just add volume, it can change how your face moves. Dr Rhobaye calls this myomodulation: ‘the way strategically positioned filler can mechanically support, facilitate or restrain the action of a facial muscle’. Placed deep, filler can act as a structural anchor; placed more superficially, it can alter how tissue moves when you smile, frown or speak.

Should You Ask Which Brand Your Practitioner Uses?

Patients are asking about filler brands more than they used to, and our experts are split on whether the brand of filler should be a key consideration. Dr Shotter sees the rise in brand-awareness as a good thing. ‘A few years ago, most patients simply trusted their practitioner and didn’t think to ask. Now it’s a routine question in consultations, which reflects growing public awareness that not all fillers are equal, and that provenance matters. Asking to see the product packaging is a perfectly reasonable, and increasingly common, request.’

But choosing the ‘best filler’ doesn’t always mean getting the best results, says Dr Rhobaye. ‘Most leading manufacturers produce several fillers with very different physical properties and clinical indications. There is no single ‘best filler’, and the brand alone does not determine the outcome.’ At the Sloane Clinic, he works with ranges including Juvéderm Vycross, Teosyal, Restylane and Belotero, which are matched to the job at hand.

Dr Soni is a Restylane advocate: ‘It has a variety of treatment options and so can allow for dynamic facial animation and movement, e.g. smiling and laughing. It also means I can achieve a natural look from filler, which can often be a concern for patients.’

Our advice: it’s worth asking the question. ‘The manufacturer is important because products should be legitimately sourced, traceable and supported by appropriate clinical and safety data,’ says Dr Rhobaye. ‘Patients should always be told the exact product used and should be able to request its batch and traceability details.’

(c) Alexander Krivitskiy, Pexels

The Questions To Ask Before Getting Fillers

Speaking of questions, it’s worth having a set ready for your practitioner. Here are some suggestions from our experts: 

• What is your professional background, and how much specific experience do you have with facial fillers? 
• Are they medically qualified, a doctor, dentist or nurse prescriber, and what insurance do they hold?
• What is the anatomical diagnosis, and why is filler the right treatment? Could surgery, skincare or an energy-based treatment do the job better, or is no treatment the right answer?
• What exact product will be used, how much, and in which layer of tissue? 
• Can you see the packaging, and why has that particular filler been chosen for this area?
• How long might the filler realistically remain in the tissue, rather than simply how long the visible result is advertised to last?
• What happens if something goes wrong? Do they keep hyaluronidase (the enzyme that dissolves HA filler) and an emergency kit on hand, and is there a written vascular-occlusion protocol? 
• Who manages a complication outside normal clinic hours?
• Can you see standardised, unedited before-and-after photographs of the practitioner’s own patients?

Dr Shotter’s BCAM has built this into its Vet It Before You Get It campaign, with a free Pre-Consultation Safety Questionnaire covering six areas: professional credentials, clinical supervision, insurance, product safety, emergency protocols and clinic governance. ‘I’d encourage every prospective patient to work through it before they say yes to treatment,’ she says.

Dr Rhobaye is candid about why this matters so much. ‘The uncomfortable reality is that the vast majority of people injecting fillers worldwide are not specialists in advanced facial aesthetics in any meaningful postgraduate sense. Some are not healthcare professionals at all.’ A 2023 national analysis found that only 32% of identified UK injectable practitioners were doctors; a larger 2026 analysis put the figure at 28.4% of almost 20,000 practitioners. Reaching genuine expert-injector level, one international competency study estimated, takes roughly six years of experience and around 1,800 procedures.

Dr Soni’s advice starts even earlier than the consultation. ‘Ensure your aesthetic goals align with your provider’s goals before you’ve even had a consultation. Research the provider thoroughly, look at before and afters, and read reviews. Ask the provider about what type of issues, or complications, they have ever had to deal with previously.’

Will Filler Make You Look Unnatural?

This is what puts most people off, because the examples they notice are the overfilled ones. ‘Bad filler announces itself, whereas excellent filler is usually invisible,’ says Dr Rhobaye. ‘People almost certainly encounter many natural results without recognising them as filler. When someone says, “I hate fillers,” they often mean, “I hate being able to see filler”.’ An unnatural result, he says, usually comes down to poor assessment, an unsuitable product, excessive volume, or an injector treating isolated features without considering the whole face.

Dermal Fillers FAQ

Q: Does filler migrate? 

A: Yes, it can. Ultrasound research has found that filler doesn’t move randomly; it can follow predictable pathways governed by fascial layers and anatomical planes. Problematic migration is more often the result of poor placement, an unsuitable rheology or excessive volume than an inherent flaw in the material itself, according to our experts.

Q: Can it cause serious complications? 

A: Most side effects, bruising, tenderness, swelling, are temporary. Vascular occlusion (where filler blocks a blood vessel) is rare but serious, which is why hyaluronidase, a rehearsed emergency protocol and proper anatomical training matter so much. BCAM’s Clinical Review found that fillers accounted for the majority of concerns requiring medical correction, ‘ranging from infection and lumps to vascular occlusion and necrosis’. Dr Shotter says: ‘That statistic isn’t an argument against filler, it’s an argument for who should be allowed to inject it.’ Complications rise sharply, she notes, where treatment is carried out by under-qualified or non-medical practitioners.

Q: Is filler temporary?

A: No. Perhaps the biggest myth of all is that filler simply disappears after six, twelve or eighteen months. The evidence increasingly says otherwise. A 2026 systematic review found measurable HA persistence at 24 months across multiple formulations. One MRI review detected HA filler in all 33 patients examined at least two years after treatment, with some deposits still visible eight to fifteen years later. ‘This does not mean that every filler treatment lasts for a decade,’ Dr Rhobaye is careful to add, ‘or that the full cosmetic correction remains unchanged.’ 

The visible effect can fade well before the product itself is gone, as it disperses, degrades or becomes less projected. But for many, though not all, patients, modern cross-linked HA filler behaves as an injectable implant rather than a treatment that simply wears off.

Q: Should you get annual top-ups?

A: Re-treatment should not be automatic. ‘Automatic annual ‘top-ups’ can be problematic,’ Dr Rhobaye says. ‘Treatment should be based on fresh examination, not on a marketing timetable.’ Add filler on top of filler that’s still there, and you risk cumulative volume, puffiness or distorted proportions over time.

The Last Word 

All the experts we spoke to encourage their patients to treat filler like the medical procedure it is, not a beauty top-up. ‘Filler is an advanced medical and anatomical treatment, not simply the act of injecting volume,’ says Dr Rhobaye. ‘It deserves a level of planning and respect as a procedure with potential long-term effects.’

‘Share your aesthetic concern and ask if filler is the right treatment for your desired outcome,’ says Dr Soni. ‘If it is, ask what brand of filler they use, and what the downtime and recovery may look like.’

Dr Shotter advises always keeping a record. ‘BCAM has recently been urging patients to keep an “aesthetic passport”, a permanent record of exactly what procedures, products and practitioners they’ve used over time, because so many people go years without knowing precisely what’s in their face. Between vetting who treats you upfront and keeping a record afterwards, patients hold far more power over their own safety than they often realise.’

You can find out more about the experts we spoke to and their work by visiting their websites. Dr Dean Rhobaye (Sloane Clinic, Harley Street, sloaneclinic.com), Dr Ash Soni (The Soni Clinic, Ascot and London, thesoniclinic.com) and Dr Sophie Shotter (Illuminate Skin Clinic and President of BCAM, drsophieshotter.com)