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Achieve the effect of youthful and hydrated skin

As a surgeon with a background in plastic surgery, I know that one of the major signs of ageing that I see in my patients is loss of volume.

In part this is due to the fact that as we age our bodies produce less collagen and elastin, the protein structures that give skin their youthful firmness and bounce. But it’s also because the levels of a substance called hyaluronic acid start to decrease, leaving skin less supported, allowing lines and wrinkles to develop and our facial structure to drop.

While smoking, sun exposure and pollution can all accelerate the pace at which this happens, unfortunately it will happen to us all in the end.

In fact, research shows that this sort of volume loss actually happens around seven years before gravity takes hold, so it’s not sagging that is the initial concern, but the loss of the contours that used to be there. That’s where facial fillers can help.

Facial fillers – substances injected under the surface of the skin – can be used to help shape the face and restore youthful volume. While there are some permanent fillers on the market, like most practitioners I tend to prefer temporary products that break down over time. That’s because a patient’s face evolves over time, so putting something permanent in just ends up looking unnatural.

In the past, fillers have included substances such as transplanted fat that has been removed from another part of the body and then reinjected into the face, and collagen usually derived from animals.

But both these approaches had their limitations in different ways. If you wanted to inject fat, it required a surgical intervention to remove it from the body first. While if you wanted to inject collagen, this required allergy testing so patients often had to pay multiple visits to the clinic.

Now I use a facial filler based on hyaluronic acid, which is why I use Juvéderm facial fillers.

But what exactly is hyaluronic acid? Often shortened to HA, it’s a naturally occurring sugar that has incredible moisturising powers, thanks to its amazing ability to hold water. In fact, HA can bind up to 1,000 times its own weight in water. You’ll find more than 50 per cent of all the body’s HA in the skin, where, in both the top layers and lower layers, it helps to maintain moisture levels. But it also cushions and lubricates joints, and it even helps your eyeballs to keep their shape.

That’s why I really like to use HA for facial rejuvenation. Because when you inject HA into the skin, you’re using something that is as close as possible to what was there before.

As well as being a bit of a hero in the body, in recent years HA has become something of a buzzword in the cosmetics world, thanks to its moisturising abilities and water-attracting properties. Because, of course, when it comes to skin, water equals plumpness, which equals skin that looks healthy and youthful – it’s the difference between a raisin and a grape.

Whether you’re worried about fine lines around the lips or want to regain volume in the cheeks, there’s a filler that can do it

But while there’s no doubting that applying a topical product that contains HA will help the top layer of your skin, and there’s some suggestion that some of it could even go deeper into the skin, to get significant amounts of HA into the lower layers of the skin you need to inject it.

The beauty of HA is that it doesn’t just replace volume, it also draws moisture to the area so the overall effect is dewy, luminous, hydrated and youthful. And should you have second thoughts, this is also a reversible process because, as well as containing HA, our bodies also contain an enzyme called hyaluronidase, which naturally breaks down HA.

The HA you’ll find in facial fillers, such as the Juvéderm range, has been formulated in such a way that they are not instantly broken down by this enzyme. Juvéderm fillers are temporary and you can expect results to last approximately up to 18 months before the hyaluronic acid is broken down by the body naturally, depending on the area treated and the product used.

Whether you’re worried about fine lines around the lips or want to regain volume in the cheeks, there’s a filler that can do it.

The Juvéderm Vycross range comes in a number of different viscosities, which allows me to layer subtly different types of filler to create a really natural result. For example, I would use Voluma in the deep fat compartments where more volume is required, then the slightly less viscous Volift for the more superficial fat pockets, and finally, around the mouth – those lines that lipstick often bleeds into – I’d inject a little Volbella that fills very lightly, but crucially really helps hydrate the skin and achieve fullness in the lips.




Sherina Balaratnam - Surgeon and medical director S-Thetics, medical aesthetic clinic, Beaconsfield

How do I find a practitioner?
Finding a qualified and experienced practitioner is essential. Search at to find one close to you, alongside before-and-after photographs and customer testimonials.

What should I expect from a consultation?
A good consultation should last a minimum of 30 minutes. Your practitioner should understand why you want treatment, carefully examine and assess your face and skin, and explain what they can, and can’t, do. They should also run through your options, answer all of your questions, discuss costs, side effects and what to expect from your treatment.

What does the treatment itself entail?
Your practitioner will go over your treatment plan and mark where on your face they plan to inject before starting. Some practitioners will numb the area they’re injecting with an anaesthetic cream, but as some fillers also contain anaesthetic, it’s not always necessary.

Are there any side effects?
You may get some temporary tenderness, redness, swelling or bruising where you’ve had the injections, but this all clears within a few days. Your practitioner will advise the best way to care for your skin after treatment. Most will suggest that you avoid make-up for 12 hours and stay out of the sun for two weeks.

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