Dr Julia Sen, Consultant Ophthalmic Plastic, Reconstructive & Cosmetic Surgeon
    Dr Julia Sen, Consultant Ophthalmic Plastic, Reconstructive & Cosmetic Surgeon


      What are Dermal Fillers?

      Dermal Fillers are used to lift and sculpt the face to replace lost volume and restore more youthful contours.

      Cosmetic Uses

      • Cheek lifting/ volumizing
      • Lip augmentation
      • Nasolabial (nose to mouth) lines
      • Tear Trough (eye socket line)
      • Jawline definition
      • Frown lines
      • Chin augmentation
      • Crows feet
      • Marionette lines (from corners of mouth)
      • Upper lip “Barcode” lines

      What is Hyaluronic Acid?

      Hyaluronic Acid (HA) is a naturally occurring substance found extensively within our bodies in structures including the eyes, skin, joints and nervous tissue. It is constantly being broken down and replaced within our tissues but from the age of 20 our skin loses its HA content resulting in loss of tissue volume, descent and dehydration, characteristic signs of ageing.

      It has numerous medical applications including as a topical lubricant for dry eyes and skin and by injection into joints, in the treatment of scars and in ophthalmic surgical procedures.

      Dermal HA fillers and Botulinum Toxin injections

      HA fillers are often used in conjunction with Botulinum toxin injections as the effects may be complimentary to each other.

      Injection procedure

      Dermal Filler Injections are administered in a clinic setting. The skin will be thoroughly cleansed and local anaesthetic cream applied to reduce the discomfort of the injection. This is left to take effect for at least 20 minutes. There may be stinging as the dermal filler is injected but this may be further reduced by lidocaine often pre-added to the filler syringe which will result in some numbness which may persist for an hour or so.


      There may be a small amount of localised discolouration or bruising and pin prick-like marks at injection sites. The injected area will usually develop some swelling within 24 hours of injection; the swelling may last several days (longer in some instances). You will be instructed to massage the injected areas firmly in the days following injection in order to smooth the filler distribution. The skin should be kept clean; make-up and vigorous exercise should be avoided for 24 hours. There may be a mild, dull ache and tenderness around the treated area for 1-2 days. The periorbital area (around the eye) is particularly susceptible to swelling and a degree of puffiness may persist for longer especially first thing in the morning.

      Further top-up injections may be administered later as required.


      The longevity of the effect of filler depends on the location and the product used. Typically HA fillers last from 6 months to 2 years. Many who have received injections over a number of years find that they require top-up injections less frequently.
      Whilst there are a number of permanent and semi-permanent filler materials available, they can be difficult to remove without surgery, should removal be required. For this reason only non-permanent, dissolvable HA fillers are used at the Midland Aesthetic Clinic.

      Possible unwanted effects

      Common: Bruising, swelling, over/underfill, nodularity, asymmetry, skin colour changes,
      inflammation, migration of filler from injection site,

      Rare: allergy, infection, tissue necrosis,

      Extremely rare: blindness


      You should not receive HA filler injections in the following circumstances:

      • Previous allergic reaction to HA filler or gram positive bacteria
      • Systemic inflammatory, autoimmune or bleeding disorder
      • Current skin sores, rash, pimples hives or infection
      • Pregnancy or breast-feeding
      • Under 18 years of age
      • Known allergy to lidocaine (lignocaine) if using product containing lidocaine.

      Want to know what it’s like having dermal fillers and Botox? We asked Lisa, aged 49, to review her experience with Dr Julia Sen.

      dermal filler treatment, dr Julia sen
      dermal filler treatment, dr Julia sen, before and after
      I was sitting with a friend a few weeks ago when she confided in me that she’d been having Botox injections for years (her husband had no idea!). As long as I’d known her, she had always looked good for her age – her skin was in great condition and even when she told me she was tired, she still looked well.

      It got me thinking about my own face. Having lost a lot of weight in my mid-40s and with my 50th birthday fast approaching, I was starting to look every bit my age. While I had followed a strict skincare routine for as long as I can remember, no anti-ageing cream or serum was going to tackle the deeper lines appearing at the sides of my nose (nasolabial folds) or loss of plumpness, especially around my mouth and chin.
      I researched and researched injectibles and fillers; read countless pros and cons, and endless dos and the don’ts before deciding I had enough information to tentatively take the plunge. I’d been recommended Dr Julia Sen, a renowned Consultant Ophthalmic Plastic, Reconstructive & Cosmetic Surgeon, and having read her impressive CV I knew I was going to be in very safe hands.

      My appointment was at Bromsgrove’s BHI Parkside, a state-of-the-art medical centre in the heart of the town. Covid-secure measures meant a very short wait outside before I was led to a waiting room and met by Dr Sen. We discussed my issues – pesky marionette lines and dreaded jowls – and her friendly approach and extensive knowledge quickly put me at ease. She suggested a combination of Botox – to relax the lines – and dermal fillers – to plump out the areas I was most concerned about. By having them together it can prolong the effect, as well as working in tandem with each other to achieve a more natural look.

      After cleansing my face and applying an anaesthetic cream, Dr Sen administered a couple of Botox injections to the lines above my lips and along my jaw line. Her skill meant this was done quickly and totally pain-free – I could only feel a few pin pricks.
      For the fillers Dr Sen uses Restylane, a gel made from hyaluronic acid that naturally occurs in the skin, and is designed to be applied deeper than Botox to plump out wrinkles and lines. The injection includes Lidocaine to numb the area and minimise pain. You do feel the first needle going in but after a few seconds it feels no more uncomfortable than a dental treatment. Unlike Botox, which takes a couple of days for the effects to show, dermal fillers work straight away and I was able to see how both the nasolabial and marionette lines had instantly filled out.

      I experienced a small amount of bruising afterwards and the injection site was tender to touch for about 24 hours, but I was prepared for this so I wasn’t alarmed. It’s also normal for the area to feel a little lumpy but this had smoothed out after a couple of days.
      I’m delighted with the results – I’d asked for them to be subtle but so that I’d notice more definition when I looked in the mirror, and that’s exactly what Dr Sen achieved. My jaw line is more defined and the deeper lines coming down from my nose and my chin have disappeared.

      If you’re tempted by the needle then I would say go for it, but do be aware that you may need top-ups every 12 months. The injectables market in the UK is currently unregulated so my advice would be to ensure that you opt for a doctor-led clinic with highly experienced staff. Then you, like me will undoubtedly be happy with the results of your investment.


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