Skin Deep Blog

Are YOU ready for a ‘liquid’ facelift? How fillers can refresh and strengthen your lips, cheeks and temples

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You don’t start looking hollow-cheeked and gaunt overnight. Like many aspects of ageing, this creeps up on you as the fat pads filling out your face start shrinking, usually in your early 40s

Even if you don’t have a particularly plump face, you have about 20 of these useful fat pads in the cheeks, under the eyes, around the temples and down to the chin and jaw. The ones under the eyes are the first to go, which makes the eyes a bit sunken, and then the cheeks begin to look less full, which is often the point when you start to notice the change

To add insult to injury, some of these pads may drift south from their original moorings, leading to pouchy bags under the eyes or a jowly jaw

What makes the process more noticeable is that these shrinking fat pads lead to less volume in the face. Imagine the fat pads as tiny balloons holding up your skin, but from which air is slowly escaping. This makes the skin sag and crease

If your younger face was on the solid side, as mine was, the reduction in volume is not always a bad thing

Why Bone Loss Is a REAL Bother

Another less desirable aspect of ageing is that we also lose bone mass in the face from the temples, the eye sockets, along the jaw and chin and around the mouth

The result is that everything in the face gradually starts to collapse inwards

This is all very natural, but it’s not great, is it? And this loss of volume and support is made worse by midlife dieting or strenuous exercise regimens. Cutting back your fat percentage may be great for your waistline, but it isn’t so kind to your face. This is what lies behind the old maxim that once a woman reaches 40, she has to choose between her face and her figure.

Hang on to a few extra pounds and your face should look softer; diet them away and it will swiftly look older

Fillers could be the answer

Re-volumising the face can work wonders to restore a bit of youthful softness. This is where facial fillers come in

If you hear talk of people having ‘liquid facelifts’, it will be facial fillers (which are technically gels, rather than liquids) that are doing the lifting. I’m a big fan of what can be done with fillers

‘Patients tend to be scared of fillers as they are frightened of looking too puffy or overfilled,’ says Dr Tracy Mountford of The Cosmetic Skin Clinic, who has been injecting faces for some 28 years

‘Also, they don’t understand the new concept of strategic multiple syringe filling, which helps to generate lift, not “puff”, in the face

‘People still see celebrities who look weird and overdone and, therefore, they just don’t believe treatments can look natural

‘However, once they see our before and after case study pictures, they understand what we are doing and how we achieve natural results’

There’s no need to feel scared about treatments as long as you choose the right kind of products and have the work done by an experienced, super-competent practitioner

Not just someone who knows technically how to use the stuff, but someone who can work with it like an artist

This means re-sculpting your face to add the softness, volume and structure it needs, so that afterwards you just look like yourself only fresher

Botox vs filler – What is the difference?

Aren’t fillers much the same as Botox, you might ask? No. They’re utterly different substances, injected into different parts of the face to do different things

Botox is a nerve toxin that is injected into the muscles to reduce their ability to contract. A filler is a gel made (usually) from hyaluronic acid, which is injected to add volume or structure to the face

The confusion comes about as people often use the phrase ‘Botox and fillers’ as a kind of shorthand to describe non-surgical cosmetic treatments and perhaps also because patients can receive both Botox and fillers in the same session

Botox is frequently used on the forehead to soften frown lines. Fillers are often injected into cheeks and lips to stop them looking deflated

If you wonder why I’m spelling out something as basic as this, it’s because people still confuse the two even those who know quite a bit about aesthetics

One friend told me she had been for treatment and had had Botox in her lips

When I said that I thought it was filler she’d had, not Botox, she got quite cross. I hadn’t been there, she said

But she was wrong. I checked with the doctor, and she’d had fillers but the point is that she had got as far as having the treatment without fully understanding what went where or did what

How fillers can refresh your face

Under the eyes 

Eyes bags and the hollows under the eyes, known as the ‘tear trough’ can often be helped by filler, but only if they are the right sort of tear troughs and eye bags and that takes an expert to assess

Oculoplastic surgeon Sabrina Shah-Desai, who does masterly work around the eyes both surgically and non-surgically, describes the area as ‘a snake pit’ because it is full of tiny veins and is a tricky place to inject. So choosing a top practitioner is really key here

Nose to mouth lines

You can have these lines injected to soften their appearance, but most nurses and doctors prefer to soften the look of your face by adding filler to the upper parts of your cheeks. This will lift the skin up your face a little and reduce these lines as if by magic


The nose is the area where fillers can have the quickest and most rewarding effects. Why? Because they can disguise a bump on the bridge of the nose or lift the tip of a droopy or hooked nose. You’d think it couldn’t be done but if you look at the before and after photos on the social media feeds of people who do this often, such as Dr Ayad Harb’s Twitter ( or Dr Zack Ally’s Instagram (@dr.zackally), you will see the huge difference this can make


Filler can have several uses when it comes to lips. You could have their shape defined, increase volume, or simply add below-the-skin hydration without making them any larger. More so than with other areas of the face, discuss this carefully with your practitioner, to ensure you understand and agree with what they are planning

Marionette lines

Injecting filler into the vertical lines that run down from the sides of the mouth towards the chin softens their appearance and takes away the grumpy look they can give to a face


Careful placement of filler can strengthen a weak chin and reduce the puckering of slackening skin that starts in middle age


Defining the corner of the jaw with a touch of filler adds an instant youthful look. For men, using filler to make the jaw look stronger and more masculine is particularly popular


The fat pads in your cheeks shrink as you get older, and adding filler to restore this lost volume is one of the first and most obvious things to do to soften an ageing face. A skilful practitioner will carefully assess just where to inject filler to enhance your looks. You might need it in the mid-face, under the apples of your cheeks (or where they used to be) or a little higher up and further out towards the edges of your face, to restore the shape of your cheekbones


You scarcely notice – until it is pointed out to you – but your temples, at the sides of your head just above the level of your eyebrows, begin to hollow with age. Adding filler here softens this and has a happy knock-on side-effect of lifting the tail of the eyebrow, which helps to open up the eye area nicely

Which fillers are the safest? 

Most people who have fillers don’t seem to ask – or remember being told – what brand was used. But it is always worth knowing. The most common are temporary hyaluronic acid (HA) gels, the best-known being Juvederm and Restylane. Teosyal, Hylaform and Belotero are also widely used

These last for six to 18 months before the body breaks them down. Exactly how long they last depends on how much was injected and the metabolism of the patient – Some people’s bodies appear to break down fillers much faster

Hyaluronic acid fillers come in different densities for different tasks and that affects how long they last, too. A runny gel that works well in the lips doesn’t have the staying power of a thicker gel that builds volume mid-face or strengthens the jawline

No Needle Filler

Fillerina treatment (Dermo Cosmetic Filler Treatment Grade 3, £79, is a kit containing gel which comes in a vial with a syringe type applicator. But there is nothing injectable about it. You put the stuff on your wrinkles for ten minutes before bed, then wipe off the excess and it does make a difference

You may also be offered a so-called ‘stimulating’ filler, such as Sculptra, Ellansé or Radiesse. Although temporary, these last longer than hyaluronic acid fillers – two years – and contain a second substance that stimulates skin to create supportive collagen. You may feel this is a more economical option, given that they last longer, but if you don’t like the results, you’ll also have to wait longer for the filler to be absorbed by the body

Finally, if you are offered permanent fillers, say ‘no’. You don’t want anything injected into your face that will stay for good

Permanent fillers might appear a great idea – No need to go back each year for a top-up! So much cheaper! But the potential problems are huge. With anything that is injected into your face, there is always a risk the body will, at some point, decide it doesn’t like this foreign material and ‘encapsulate’ it, growing collagen around it in a hard lump to shut it off from the rest of your skin tissue. If that happens, the only way to remove the growth and the original filler is to have it surgically removed

Encapsulation isn’t the only problem. As your face changes over the years, and some parts of it sag and descend, the blob of permanent filler may no longer be exactly where you want it to be. So avoid permanent fillers particularly in your lips

How you can look younger and never feel bad about your neck again!

The skin on your neck is thinner than that on your face, which means it will collapse more easily into wrinkles and folds

This is made worse by the fact that we are constantly twisting, turning, stretching and compressing our necks. There are also few oil glands there to keep skin supple

And it all goes downhill as you hit the menopause when, thanks to the reduction in oestrogen, your skin becomes drier and loses elasticity. But help is at hand. Here are treatments that have worked for me . . .


Radiofrequency treatments, known as ‘shrink-wrapping’, make the collagen within the skin contract and tighten. Intracel combines radiofrequency tightening with microneedling

What is it? The Intracel machine has a treatment head that has heated needles and electrodes to dispense radiofrequency and needling together. An intensive procedure, it needs 30 minutes of numbing cream beforehand. But it generates good results, both in boosting collagen in lower skin layers and smoothing the surface thanks to the microneedling

What it feels like: Not too bad. It took 40 minutes. My skin went quite red afterwards and took a day to calm down

Pain level: Six. I needed numbing cream

Verdict: The effect is not as noticeable as other more intensive, and more expensive, radiofrequency treatments. But my face looked a little tighter immediately and would have improved further if I had gone back for follow-up treatments


Ultracel adds ultrasound to the Intracel treatment. Ultrasound waves heat the SMAS (superficial muscular aponeurotic system), the muscle-like layer of tissue under the skin, causing it to tighten

What is it? Three technologies deliver a triple-whammy: ultrasound for deep muscular lifting; radiofrequency to tighten skin in the dermis (lower layers); and microneedling for resurfacing.

What it feels like: The radiofrequency device, which is moved round the face, feels warm on the first pass. Then the temperature is turned up, and I feel like it will burn, but it moves on before it does. Ultrasound follows, using a handpiece with a 2 x 1cm nib

Pain level: Five. Moderately uncomfortable

Verdict: There was a small, instant result from the way the collagen is forced to contract. A month on, there’s a little less slackness of skin under my jaw. There is minimal downtime, but it is eye-wateringly expensive


Ultherapy is the only U.S. Food and Drug Administration-approved technology that lifts the face and neck in one go

What is it? Ultherapy Skin Lifting and Tightening uses high-intensity ultrasound waves that pass deep into the skin, targeting collagen

The usual procedure is to do two ‘passes’. Ultherapy can tighten and lift the face and skin under the jaw, as the treatment is targeting and tightening the skin so deeply. The ultrasound also boosts the formation of new collagen and elastin

What it feels like: I take ibuprofen beforehand. Aesthetician Esther Loughran marks out the treatment areas in white pencil, then works the treatment head of the Ultherapy machine over these. Each blast of ultrasound delivers a zinging little pulse. It takes about 45 minutes to treat my whole neck-to-jaw area

Pain level: Seven. Particularly painful as the treatment head works over the jawbone. The Cosmetic Skin Clinic offers ibuprofen before the treatment, along with diazepam (Valium) if needed

Verdict: I can see an instant lifting and tightening along my jawline and neck. That’s just from the immediate collagen shrinkage. I’ve had this three times and it has helped stop my lower face and jaw drooping

Source: The Daily Mail

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