Aesthetic Medicine
Aesthetic Medicine


Fillers does product choice matter?

In my clinic, I see a lot of initial resistance to the idea of fillers, based on a range of concerns. The greatest of these is that the result will look “unnatural”. Other concerns are that the product will move or cause a reaction over time; that they’ll be tied in to repeat treatments for the rest of their lives; or that they will lose control of their appearance through becoming reliant on treatments – often the word “addicted” is used in this context. Addressing these concerns can be challenging, especially when we know filler treatment can play such a key part in successful medical aesthetic outcomes.

There appears to be a gradual appreciation among the public of the potential risks of filler treatments. Rarely are these concerns based on a filler that I would recommend but, nevertheless, this can mean that the patient journey, from first contemplating an aesthetic treatment to eventually undergoing it, can be a long and complex one.

For a patient the first decision is in whom to base their trust. What is considered important here will vary from patient to patient. I find most patients appreciate a medical context for assessment and treatment, objective advice; and a focus on their individual needs above other considerations. They also want to know how the risks are going to be minimised and that follow-up advice will be available.

“I find most patients appreciate a medical context for assessment and treatment”

The first concern my patients have is that their results should look natural, which is completely understandable. Most readers would agree that choice of practitioner is crucial to achieving this, but, in my view, choice of filler brand should come a close second.

Very few people can recall which filler they have been given in the past and many patients (and even some practitioners) think that all hyaluronic acid fillers are largely the same. It seems that once our patient has decided to put their trust in us they are happy to accept whatever filler product we recommend.

It is interesting to speculate on what drives a practitioner’s choice of filler. It is largely down to chance which product someone will receive training in and then use.

Hearsay from colleagues may suggest they like a filler because it is easy to inject, flows smoothly or gives a good immediate result. To this, I would argue that water would meet these criteria but would clearly be a poor filler. Qualities like these may make an injector’s life easier, but it is far more important to know how the filler will behave in the tissue and what may happen months or even further into the future thereafter. The durability and integrative properties of modern fillers mean that “temporary” fillers do not simply reabsorb after a few months, and so our patients’ relationships with their filler should be considered a long term one.

Tissue compatibility and filler mechanics should therefore be a key concern of any patient undergoing treatment, and our recommendations should be based as far as possible on rigorous clinical evidence.


For me, the following features are most important, and there is strong supporting evidence that the BELOTERO range meets these criteria: 1 Firstly, our filler should provide effective volumisation and good durability.1 2 A filler should restore shape and move naturally with the tissue – in order to do this it must integrate well and be suitable for use at various depths of the dermis and subcutaneous tissue. Evidence of good integration should include homogeneous spread of filler product and little disruption to the normal architecture of the dermis. 3 Our filler should resist migration – it is going to be subject to distortion from numerous mechanical forces every day over a long period, so it must be cohesive enough to resist any tendency to separate or disperse.

For my patients’ well-being, my peace of mind and also my reputation, I want to use a filler that presents as low a risk as possible of provoking an inflammatory response, which can lead to delayed inflammatory swelling, fibrosis or foreign body reaction (granuloma6,7


1 Kerscher, M et al 2017:10. Effectiveness evaluation of two volumizing hyaluronic acid dermal fillers.

2 Micheels, P. PRS Journal. October 2013. A Blanching Technique.

3 Micheels, P. (2017) Two Crosslinking Technologies for Superficial Reticular Dermis Injection.

4 Micheels (2012) Superficial Dermal Injection of Hyaluronic Acid Soft Tissue Fillers.

5 Flynn TC et al. Dermatol Surg 2011. Comparative Histology of Intradermal Implantation.

6 Micheels, P. (2017). Ultrasound and Histologic Examination After Subcutaneous Injection of 2 HAs.

7 Tran et al. Dermatol 2014. In vivo Bio-Integration of Three HA Fillers in Human Skin.

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M-BEL-UKI-1047 Date of Preparation: March 2021 This article has been sponsored by Merz Aesthetics

This article has been sponsored by Merz Aesthetics

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This article appears in the April 2021 Issue of Aesthetic Medicine

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This article appears in the April 2021 Issue of Aesthetic Medicine