Most people who enquire about dermal fillers arrive with a picture in their head and a question they are slightly embarrassed to ask. Will it look obvious? The fear of an overfilled, unnatural result is the single most common reason people delay treatment, and it is a perfectly reasonable concern given how much poor work circulates online.
What rarely gets discussed is that the consultation, not the injection, is where the outcome is largely decided. A careful assessment determines whether filler is the right tool for what you want, where it should be placed, how much is appropriate, and whether you should be treated at all. This guide explains what a proper consultation involves, so you know what good practice looks like before you book anywhere.
What Dermal Fillers Actually Are
Hyaluronic Acid: The Most Common Filler
The majority of dermal fillers used in the UK are made from hyaluronic acid, a substance the body produces naturally and which helps skin retain water. In filler form it is manufactured as a gel of varying thickness. Firmer gels provide structure in areas such as the cheekbones or jawline, while softer, more fluid gels suit delicate areas like the lips.
Hyaluronic acid fillers are regulated in the UK as medical devices rather than medicines, which is why they do not require a prescription. This is also why an important safety feature exists: hyaluronic acid filler can be dissolved using an enzyme called hyaluronidase. If a result is not what you hoped for, or if a complication occurs, there is a route to reverse it. Not all filler types share this property, which is one reason hyaluronic acid remains the standard choice.
What Fillers Can and Cannot Do
Fillers restore or add volume. They work well for deepened nasolabial folds, flattened cheeks, hollowing under the eyes in suitable candidates, thinning lips, and softening a weak jawline or chin.
They are less useful for concerns that are not volume-related. Fine surface lines from sun damage respond better to resurfacing treatments such as peels or micro-needling. Skin laxity — genuine sagging — is not corrected by adding volume, and attempting to do so by filling is what produces heavy, puffy results. Pigmentation, texture and acne scarring each need different approaches entirely.
A consultation that does not distinguish between these is not doing its job. Sometimes the honest answer is that filler is the wrong treatment, and a good practitioner will say so.
Why the Consultation Comes First
Assessing Facial Structure, Not Just the Area You Mention
Faces work as a whole. Someone who asks for lip filler may actually be reacting to a loss of support around the mouth, in which case treating the lips alone will not achieve the balance they are after. Conversely, someone convinced they need a great deal of volume may need very little, placed precisely.
This assessment involves looking at your face at rest and in movement, from several angles, and often in different lighting. Photographs are usually taken so that there is a clear record to compare against later.
Medical History and Suitability
Some factors make treatment inadvisable, either temporarily or permanently. Your practitioner should ask about:
- Any history of allergic reactions, particularly to lidocaine, which many fillers contain
- Autoimmune conditions and immunosuppressant medication
- Blood-thinning medication, which increases bruising risk
- Recent or planned dental work, which is generally spaced apart from filler treatment
- Active skin infections or inflammation at the intended site
- Pregnancy and breastfeeding, during which filler treatment is not offered
- Previous filler, including where and when, and whether any of it may still be present
That last point matters more than most people expect. Filler does not always behave predictably over time, and knowing what is already in place changes the plan.
It is also worth stating plainly: in England it is illegal to administer dermal fillers for cosmetic purposes to anyone under 18, regardless of parental consent. Any clinic willing to do so is one to walk away from.
Agreeing on What Success Looks Like
The most valuable part of a consultation is often the least clinical. Bringing reference photographs is genuinely useful, but so is a frank conversation about what is achievable on your face specifically. Facial anatomy differs, and a result that looks natural on one bone structure will not transfer to another.
Be wary of anyone who promises a precise outcome or guarantees results. Responsible practice involves describing a likely range, explaining the limits, and being clear about what cannot be achieved with filler alone.
What Happens on the Day
If you proceed to treatment, the process is usually straightforward. The area is cleansed thoroughly and a topical numbing cream may be applied and left for around twenty minutes. Most modern fillers also contain a local anaesthetic, so discomfort is typically described as brief pressure or stinging rather than significant pain.
Treatment itself often takes less than half an hour. Your practitioner may ask you to sit up, smile, or speak during the process to check how the filler sits in movement. Small amounts are usually placed and assessed rather than everything being injected at once.
Conservative treatment is good practice. Adding more later is simple; removing an excessive result means dissolving and starting again, with weeks of waiting in between.
Recovery and Aftercare
Expect some swelling, and possibly bruising, for the first few days. Lips swell more noticeably than most other areas and can look considerably fuller than the final result for the first 48 hours or so. This is normal and not a reason to panic.
General aftercare advice includes:
- Avoid strenuous exercise, saunas and steam rooms for 24 to 48 hours
- Sleep with your head slightly elevated for the first night or two
- Avoid alcohol for 24 hours, as it increases swelling and bruising
- Do not massage or press the area unless specifically instructed to
- Keep makeup off the treated area for the first 12 to 24 hours
Filler settles over roughly two weeks. Judging the outcome before then, or booking a top-up too early, is a common mistake. A review appointment at two weeks is the sensible point to assess whether anything needs adjusting.
Risks, and How They Are Managed
No injectable treatment is risk-free, and any clinic that suggests otherwise is not being straight with you.
Common and minor effects include swelling, bruising, tenderness and small lumps that usually settle within days. Less commonly, filler can migrate or produce visible irregularity, both of which can generally be corrected.
The serious complication is vascular occlusion, where filler enters or compresses a blood vessel and restricts blood supply. It is rare, but it is a genuine medical emergency, and it is the reason practitioner training matters far more than price. Warning signs include blanching of the skin, severe or escalating pain that is disproportionate to the procedure, and a dusky or mottled discolouration appearing over the following hours.
A properly equipped clinic keeps hyaluronidase on site and has a clear protocol for managing this. When you ask a clinic what happens if something goes wrong, you should receive a specific, confident answer — not reassurance that it never does.
Questions Worth Asking Any Clinic
Before committing anywhere, it is entirely reasonable to ask:
- What are your qualifications, and are you on a recognised register such as the JCCP or Save Face?
- Which product will you use, and why that one for this area?
- Do you keep hyaluronidase on site, and what is your complications protocol?
- What does aftercare and follow-up involve, and is a review included?
- Can I see before and after photographs of your own work on similar cases?
A practitioner who welcomes these questions is showing you something useful about how they work.
A Note on Cost
Filler pricing varies widely, and unusually cheap treatment is a meaningful warning sign. Price differences generally reflect the product used, the practitioner's training and experience, and whether proper follow-up and complication management are in place. Treatment priced significantly below the market is usually economising on at least one of those.
That said, transparency matters too. You should know before you commit what you are paying, what it includes, and whether review appointments are extra.
The Bottom Line
Good filler work is unremarkable. People notice that you look well rather than that you have had something done, and that outcome comes from careful assessment, conservative technique and honest conversation about what is achievable.
If you are considering treatment, book a consultation before you book a procedure. A consultation carries no obligation to proceed, and a practitioner who is willing to tell you that filler is not the right answer for your concern is precisely the one worth trusting when it is.
Our clinic on Clapham High Street offers consultations for dermal and lip fillers, including assessment, discussion of suitability and a clear treatment plan. Treatment is never carried out at the same appointment as your first consultation, so you have time to consider your options properly.