Deep Plane Fillers: The Anatomical Approach to Natural Facial Rejuvenation

BY DR. DAVID JACK
Deep Plane Fillers: The Anatomical Approach to Natural Facial Rejuvenation
AESTHETIC ARCHIVES

How structural, deep filler placement restores facial support without the tell-tale signs of overfilling

 

Dermal filler has acquired a slightly unfortunate reputation of late. Mention it at a dinner party and your fellow guests will inevitably picture overinflated cheeks, oddly geometric jawlines or lips that arrive several seconds or longer ahead of the rest of the face. That reputation days a great deal about the techniques that have become so commonly used (often without a great deal of thought by practitioners) to inject these surprisingly useful aesthetic tools. The truth is that where the product was placed, how much was used, which type of filler was used and whether anyone paused to plan the treatment around the patient’s anatomy before reaching for a syringe matters significantly affects how natural the results from filler treatments will be.

Our signature Deep Plane Filler technique was built around a single, faintly obvious principle that a surprising amount of injecting manages to ignore: facial ageing begins deep beneath the surface of the skin, so meaningful volume replacement should begin (and more of them than not, end) there too.  Rather than adding visible fullness to superficial tissues or dutifully injecting every line that appears, I aim restore structural support in carefully selected deep anatomical planes, most often at the deep level (known as the supraperiosteal plane), close to the facial skeleton.

This allows small quantities of hyaluronic acid filler to replace lost projection and support, so the soft tissues above settle into a more balanced position. The aim is a fresher, better-rested face that remains entirely and recognisably your own. There should be no obvious sign that filler has been used. No sense that the dreaded ‘mar-a-lago’ face has been imposed on top of the one you were born with.

 

What are Deep Plane Fillers?

 

I coined the term ‘Deep Plane Fillers’ to relate to the depth of placement of the dermal fillers I tend to perform in clinic. Generally speaking this would be hyaluronic acid fillers (although other types such as collagen stimulators may be used), placed on the deep plane of the face, deep to the superficial musculoaponeurotic system (the ‘SMAS’) - i.e. the layer of muscles and connective tissue that moves the face, which sags with age, and is lifted in the ‘deep plane facelift’ that has become increasingly popular in recent years.  In practice that means precise supraperiosteal placement directly over bone, as well as treatment deep to the deep fat compartments that sit beneath the SMAS.  It deliberately does not mean injections into the superficial fat pads which sit superficial to the SMAS which are very commonly performed in aesthetic clinics. The term describes an anatomical philosophy, not a particular brand or formulation.

That distinction is the whole point of the treatment, so it is worth being precise about it.  The superficial fat pads sit above the SMAS. Place a hyaluronic acid filler there and two things tend to happen. Hyaluronic acid is a humectant, so it draws water and can produce a puffy, oedematous look rather than a crisp, lifted one. It also sits within a mobile layer that moves with the muscles of expression, so it shifts every time the face animates. Neither effect replaces the bony volume that has actually been lost - it also tends to give the dreaded puffy, odd ‘filler’ look when the face is animated.  Fillers in this layer also have a tendency to cause swelling in other parts of the fat pads where they are injected.

Placing filler on the deep plane, beneath the SMAS and against bone, works in the opposite direction.  It rebuilds the structural, skeletal foundation that ageing erodes. It also changes the mechanics of the result. When the product sits under the SMAS, the SMAS glides over it, and the soft tissue above is supported and lifted rather than pushed outwards. Filler in the superficial layer projects tissue forwards and travels with the muscle.  Filler on the deep plane holds still and lets the face move over it.

Cadaveric imaging work has quantified this lifting effect and confirmed that fillers, routinely thought of as simple volumisers, genuinely lift the tissues when they are placed correctly (Haidar et al., 2021).

This deep plane technique rests on restoring facial support at its foundation. Every injection should have a clear structural purpose, whether that is replacing projection in the midface, supporting the chin or improving the relationship between the jawline and the lower face. A face is a layered arrangement of skin, fat, muscle, ligament and bone with each of those layers plays its own part in ageing (Cotofana et al., 2016).

 

What are dermal fillers made of?

 

The vast majority of dermal fillers used in clinics are made from hyaluronic acid. This is a naturally occurring glycosaminoglycan found throughout the body, where it contributes to hydration, extracellular matrix structure and organisation and tissue function.  Injectable hyaluronic acid fillers are manufactured with different degrees of cross-linking and varying rheological properties (ie density and bounce). Those characteristics determine how firm, elastic or cohesive a filler is and they dictate the anatomical plane for which it is best suited (Kapoor et al., 2021).

A product used close to bone needs enough elasticity and projection to resist compression from the tissues sitting on top of it. A softer filler designed to be used near the skin behaves very differently. Choosing the right product is therefore inseparable from choosing the right depth (Bass, 2015).

 

How does the face change with age?

 

Facial ageing is usually described as a problem of loose skin. The biology is a good deal more interesting than that.  Indeed, every anatomical layer changes over time, including the skin, the superficial and deep fat compartments, the retaining ligaments, the muscles and the facial skeleton itself (Cotofana et al., 2016).

Bone remodelling gradually alters the underlying framework. Changes occur around the orbit, the maxilla, the mandible and the pyriform aperture, reducing projection and the support available to the soft tissues. The opening of the orbit widens, the central midface loses anterior projection and the lower facial skeleton becomes less defined.

The facial fat, which itself is arranged into distinct superficial and deep compartments, each with its own boundaries and function, don’t age uniformly. Some lose volume, some descend and others stay relatively full, which is why ageing can carves a hollow in one area (for example the temples) but add heaviness to another (for example the jowl fat pads) (Cotofana et al., 2019).

Retaining ligaments anchor the soft tissues to the skeleton and deep fascia and their relationship with the surrounding fat compartments shapes many of the folds and contours that become more obvious with the years (Alghoul and Codner, 2013). Skin ageing then adds its own layer of change through reduced collagen organisation, elasticity, hydration and repair capacity.

The result is a slow rearrangement of facial architecture. The transition between lower eyelid and midface loses its smoothness, the central face flattens and the jawline softens.  

Nasolabial folds, marionette lines and prejowl hollowing all become more apparent as the scaffolding around them shifts. Treating any of this purely at the surface confuses the symptom with the cause.

Why superficial filler can look unnatural

 

Superficial filler has some legitimate uses. Fine lines, selected scars, lips and certain contour irregularities may genuinely need treatment close to the skin. The trouble starts when the superficial fat pads become the default answer to structural ageing, because they are the wrong layer for the job in a number of different ways.

Firstly, hyaluronic acid is a humectant. It binds water. Placed in the superficial fat, above the SMAS, it tends to hold fluid and read as puffiness or oedema rather than clean, restored structure. Secondly, that superficial layer is mobile. It moves with the muscles of expression, so filler placed there shifts as a person speaks, smiles or laughs and can become more visible with every animation. Thirdly, and most fundamentally, superficial volume does nothing to replace the bony loss that drives so much of facial ageing.  It sits on top of the problem rather than rebuilding the foundation underneath it. The final major issue (and more anatomical consideration) is that the superficial soft tissues of the face contain most of the blood vessels and nerves of the face, so injecting in this layer is potentially more hazardous than injecting deep on the bone surface, which, aside from a few landmark areas, is relatively spare of blood vessels.

The cumulative effect of chasing lines with superficial product, year after year, is a face that grows heavier and loses the shadows that gave it character. The result can be smooth, full and strangely hard to place age wise. You know the face has changed (often not for the better) and you often cannot say quite how.

Our Deep Plane Filler approach begins by asking where support has actually been lost, rebuilding it on the deep plane. A nasolabial fold may reflect diminished midface projection. Prejowl hollowing and marionette lines may trace back to the shape of the chin and mandible. Tiredness around the eyes may involve the deep midface and eye socket as much as the lower eyelid. Restore the deeper structure and the tissues above are supported and lifted, without every visible line being chased and filled individually.

 

Deep Plane Fillers for the midface

 

The midface governs facial proportion, the way light falls across the cheek and the relationship between the lower eyelid and everything below it. Age-related change here produces an appearance of tiredness that bears no relation to how much sleep anyone has had. 

The deep medial and lateral midface compartments sit beneath the superficial tissues and contribute much of the structural projection of the cheek. Volume loss in these areas flatten the face and deepens the transition beneath the eyes and skeletal remodelling compounds the effect by removing the foundation underneath (Cotofana et al., 2019).  Careful supraperiosteal placement using a needle allows filler to be positioned close to bone, replacing projection where it belongs and supporting the tissues above.

This should never produce a rounded, conspicuous midface. The recent fashion for very full, anteriorly projected cheeks has given filler its rather cartoonish public image and it comes from projecting tissue outward in the superficial layer.  Good structural treatment does the opposite.  Placed deep, against bone and beneath the SMAS, it restores existing proportions and lifts, improving the way light travels across the face without inventing a new feature that nobody asked for or really wanted.  A small change at depth can influence a much larger area at the surface. This is why strategic deep placement achieves much more with less product.

Restoring lateral support can improve contour right across the midface. Central support softens hollowing and helps the lower eyelid blend smoothly into the cheek. The lifting effect of correctly placed deep filler on the overlying tissues is well described in the anatomical literature (Kapoor et al., 2021; Haidar et al., 2021) and it is the reason a thoughtful clinician reaches for structure and the deep plane before surface.

 

Deep Plane Fillers after weight loss and on GLP-1 medications

 

Facial volume loss has become an unavoidable topic in the era of GLP-1 weight loss medications such as semaglutide and tirzepatide, and the phenomenon that the press insists on calling ‘Ozempic face’. The medication does not selectively remove facial fat: significant or rapid weight loss reduces adipose tissue across the whole body and the face is simply one of the places where the change shows first and most commonly.

Loss of deep and superficial facial fat that accompanies GLP-1 use can reveal skeletal contours, deepen shadows and remove support from the skin. The temples and midface hollow, the lower face loses definition and any pre-existing laxity becomes far more apparent, often quite suddenly.

Deep Plane Fillers suit many patients after weight loss precisely because they restore structural support without trying to refill every area that has become leaner. Attempting to replace all lost facial volume tends to look unnatural and fails to respect a patient’s new body composition so a sensible aim is restoring proportion. 

Indeed, restoring a degree of midface projection or chin support is frequently enough to make a face look healthier and better balanced. Skin quality can then be addressed separately, with fractional laser, radiofrequency or regenerative injectables as required.

 

Deep Plane Fillers for the chin and jawline

 

The chin is a small structure with an outsized influence over the face.  Its projection, height and width shape the profile, the jawline, the lower lip and the apparent relationship between face and neck.  A chin with limited projection unbalances the lower face and exaggerates prejowl hollowing. Deep supraperiosteal filler can strengthen structural projection and improve proportion in a way that superficial injection cannot. The goal is not automatically a sharp or exaggerated jaw. Masculinised jawlines and pointed chins have enjoyed a long run on social media and they are neither universally flattering nor especially related to most patients’ underlying anatomy.

Treatment may involve the chin, the angle of the mandible or selected points along the jawline and the plan depends on the shape of the facial skeleton, the distribution of soft tissue and the patient’s natural proportions. A well-treated chin looks as though it has always belonged to the face and it improves balance from the front, the profile and the three-quarter view without ever becoming the first thing anyone notices.

 

Can Deep Plane Fillers improve nasolabial folds?

 

Nasolabial folds are a normal part of facial anatomy, marking the transition between the midface and upper lip and giving the face much of its natural contour. As the deeper support above them changes with age, the folds can become more pronounced. Midface volume loss, shifts in fat distribution, ligamentous anatomy and declining skin quality all contribute to this deepening.

Direct treatment can be useful in carefully selected cases, although the fold should always be considered in the context of the wider face. Adding volume to the crease without first restoring the support around it can make the central face appear heavier and less balanced. Our approach begins with the deep midface, where replacing lost structure can soften the fold indirectly and improve proportion across the face. Any remaining treatment can then be precise, conservative and tailored to the individual. The aim is refinement. Faces need folds, shadows and movement because these are part of what makes them look alive, expressive and human.

How Deep Plane Fillers differ from traditional dermal filler

 

There is no single method that can accurately be described as ‘traditional filler’, because injectable treatment varies considerably between practitioners. The most meaningful difference lies in the philosophy behind the treatment and in the anatomical depth at which it is carried out.

An area-by-area approach can encourage the face to be viewed as a series of separate concerns: midface, nasolabial folds, marionette lines, jawline and chin. Treatment may then focus on placing volume close to the visible line or hollow. Our Deep Plane Filler method begins with the understanding that the face is one interconnected anatomical structure and that a change in one region inevitably influences another.

The rationale is that support through the midface affects the lower eyelid, nasolabial region and lower face. Chin projection influences the jawline, profile and balance of the mouth. Similarly, lateral support changes the way the central face is perceived.  Assessing these relationships as a whole allows treatment to restore the structures with the greatest influence on facial balance, creating a result that feels coherent across the entire face.

The depth of placement is equally important. Superficial filler sits within tissues that move directly with facial expression and can add visible projection to the surface . Deep filler is placed beneath the superficial muscular aponeurotic system (SMAS) against bone, where it can recreate elements of lost structural bony support. The soft tissues can then glide naturally over this deeper foundation.

This changes both the purpose and the appearance of the treatment. Deep Plane Filler is designed to rebuild support, improve proportion and restore the architecture that has altered with age. The result should show as a better-supported face, with familiar contours, movement and expression intact.

A whole-face assessment also helps prioritise the injections that offer the greatest structural value.  It reduces the temptation to use filler as facial Polyfiller, chasing every line until the features begin to lose their individuality. Lines, shadows and transitions belong to the face. The skill lies in understanding which ones reflect natural anatomy and which ones have become more pronounced because the support beneath them has changed.

 

How long do Deep Plane Fillers last?

 

The longevity of hyaluronic acid filler is influenced by several factors, including the formulation used, the depth and location of placement, the amount of movement in the surrounding tissues and the patient’s individual biology. Deep structural fillers are often described as lasting around twelve to eighteen months, though this remains a broad guide rather than a fixed expiry date.

Recent imaging studies have made the picture considerably more interesting. Magnetic resonance imaging (MRI) suggests that hyaluronic acid filler may remain detectable in the midface for far longer than previously assumed. In a 2024 review of thirty-three patients, filler was visible on MRI in every case, with persistence documented for as long as fifteen years in some individuals (Master, 2024).

The presence of filler on a scan does not necessarily mean that its original aesthetic effect remains unchanged. Product can persist within the tissues after some of its initial structural benefit has softened and longevity varies considerably between patients and treatment areas. The wider lesson from this research is the importance of restraint.  When filler may remain in the face for many years, conservative volumes, precise placement and careful reassessment before further treatment become essential.

Maintenance should therefore be guided by the face itself. Some patients may benefit from a modest adjustment after eighteen months, whereas others require no further treatment for several years. An in-person review provides far more useful information than an automatic annual timetable.

 

Are Deep Plane Fillers reversible?

 

The technique uses hyaluronic acid filler, which can be broken down with the enzyme hyaluronidase when clinically appropriate. Hyaluronidase may be used in the management of certain complications or electively when filler has produced an unwanted result.  Its use requires careful medical judgement, as the dose and treatment strategy depend on the formulation involved, the anatomical area and the clinical circumstances (Murray et al., 2021a).

This reversibility provides an important safeguard, though treatment should always be planned with the expectation that the filler will remain in place. Dissolving filler is a medical procedure in its own right and carries its own risks, variables and potential for incomplete correction.  Precise placement, conservative volumes and sound anatomical judgement remain the most reliable way to avoid problems that could have been prevented at the outset.

 

Are Deep Plane Fillers safe?

 

Hyaluronic acid fillers have a well-established role in aesthetic medicine and most side effects are short-lived, including swelling, tenderness and bruising. More serious complications are uncommon and include infection, vascular occlusion, tissue injury and, in very rare cases, visual loss (Goodman et al., 2020).

The anatomical plane of injection is an important part of reducing risk. In carefully selected areas, the deep supraperiosteal plane contains relatively few blood vessels and provides clear skeletal landmarks against which the injector can work. The superficial fat compartments contain a more extensive vascular network, with vessels that can change course and depth between patients. These arteries and their branches also travel through mobile soft tissue, making their precise position less predictable from surface anatomy alone (Surek, 2019; Koziej et al., 2019).

Deep placement can therefore offer a more controlled anatomical route when it is used in appropriate regions and guided by a detailed understanding of the underlying skeleton.  This relative vascular sparsity is one of the principles behind our Deep Plane Filler approach. It allows structural support to be restored close to bone, avoiding unnecessary passage through the more vascular superficial fat pads.

This being said, every injection plane still carries vascular risk. Important arteries emerge through facial foramina, cross between anatomical layers and run close to bone at particular points. The practitioner must understand where the deep plane is relatively sparse and where a vessel, nerve or foramen makes it a danger zone. Detailed knowledge of the facial skeleton, vascular pathways and individual anatomical variation remains essential.

Vascular occlusion occurs when filler enters or compresses a blood vessel, reducing the blood supply to the surrounding tissue. Early recognition and prompt treatment are critical. Current clinical guidance supports the use of hyaluronidase when an occlusion involving hyaluronic acid filler is suspected, alongside urgent assessment and appropriate follow-up (Murray et al., 2021b).

My background, along with that of many members of my clinical team, in anatomy, plastic surgery and facial reconstruction informs every stage of our Deep Plane Filler treatment.  This begins with consultation and three-dimensional facial mapping and continues through product selection, injection depth, volume and aftercare.  Anatomical knowledge allows risk to be assessed intelligently, the safest appropriate plane to be selected for each region and complications to be recognised and managed with far greater precision.

 

Deep Plane Fillers and natural facial movement

 

A natural result depends on how the face appears both at rest and in motion. Faces are dynamic and individual. They smile unevenly, crease around the eyes and form folds around the mouth, all of which contribute to expression, warmth and recognisability.  Treatment should preserve these qualities, since removing every visible sign of movement can leave the face looking less youthful and more constructed.

Deep Plane Filler supports this natural mobility because the product is placed beneath the tissues responsible for most visible expression. Structural support can be restored without restricting surface movement or adding unnecessary fullness. The skin and soft tissues remain free to move over the deeper foundation, allowing the face to retain its familiar expressions and character.

A successful result is often perceived as a general sense of freshness, health or restfulness, rather than as an obvious alteration to one particular feature. The face looks better supported and more balanced, yet still entirely its own: this subtlety is central to the treatment.

Deep Plane Fillers, skin quality and combination treatments

 

Deep Plane Filler is designed to restore structure. It can replace support, improve proportion and strengthen the framework of the face, though the skin itself may still carry a separate collection of age-related changes. Pigmentation, enlarged pores, fine surface lines, redness and collagen loss all sit within a different anatomical layer and require treatments chosen specifically for them.

A patient with volume loss and photodamage may benefit from Deep Plane Filler alongside IPL or fractional laser. Early laxity may be addressed with radiofrequency or laser-based collagen remodelling. Polynucleotides and skin boosters may be useful where hydration, repair and regenerative signalling are the principal priorities. Each treatment has its own biological purpose, and the plan becomes more effective when those purposes are kept clear.

This layered approach reflects the way facial ageing actually develops. Bone, fat, ligaments, muscle and skin change at different rates and in different ways, so a single treatment is rarely able to address the whole picture. Adding volume beneath thin, sun-damaged skin may improve support, yet the surface can still appear uneven or depleted.  Improving the skin alone can leave the deeper architecture under-supported, giving the face a polished surface without the structure beneath it.

The most convincing results usually come from combining modest interventions, each selected for a specific anatomical role. Deep Plane Filler restores support, energy-based treatments improve texture and firmness and regenerative treatments help strengthen skin quality over time. Used together, they create a result that feels balanced, coherent and entirely natural looking.

 

Deep Plane Fillers or a Facelift?

 

Deep Plane Filler restores lost support, improves proportion and strengthens the underlying framework of the face. A facelift works by surgically repositioning descended soft tissues and removing or redistributing excess skin but generally doesn’t add volume (unless combined with surgical fat transfer). The right treatment therefore depends on the degree of structural ageing, tissue descent, volume deficit and laxity present.

Patients with early to moderate volume loss often achieve an excellent result with carefully planned filler. Where jowling has become pronounced, skin excess is substantial or the deeper tissues have descended significantly, surgery is likely to provide a more effective and anatomically appropriate correction. The key is good clinical evaluation.

Continuing to add filler once the face requires surgical repositioning can create heaviness, blur natural contours and gradually distort the features. Recognising when an injection will add little value is an essential part of responsible aesthetic and surgical practice. Good treatment planning includes knowing when to stop and when to recommend a surgical opinion.

Deep Plane Filler can support the face through the earlier stages of ageing and may delay the point at which some patients choose surgery. A well-performed facelift achieves a degree of tissue repositioning that filler cannot replicate. Honest assessment allows each treatment to be used for the purpose it serves best, which is ultimately how the most natural and enduring results are achieved.

 

Who is suitable for Deep Plane Fillers?

 

Deep Plane Filler may be suitable for adults experiencing age-related volume loss, reduced support through the midface, limited chin projection, changes following weight loss or naturally unbalanced facial proportions. Suitability is determined through a detailed consultation that considers the face at rest and in motion, viewed from several angles and assessed as one connected anatomical structure.

Previous filler treatments, medical history, skin quality and long-term goals all shape the plan. Active infection, certain medical conditions or expectations that cannot be achieved safely may mean treatment should be postponed or that another approach would be more appropriate.

The amount of filler required is guided entirely by anatomy. Syringe numbers are simply a practical consequence of the treatment plan and say very little about its quality.  Some patients benefit from support in one carefully selected area whilst others achieve the best result through a staged full-face programme carried out over several appointments.

A staged approach over a few session allows each change to settle before the next decision is made.  It also preserves the distinction between restoring what has been lost and altering the face beyond recognition. The aim is always to improve proportion, support and balance while keeping the patient’s identity firmly intact.

 

The Dr David Jack approach to Deep Plane Fillers

 

Our Deep Plane Filler technique grew from my training in anatomy and plastic surgery, alongside a long-standing frustration with the way facial filler is often discussed and performed in the aesthetics industry. It is frequently reduced to millilitres, syringes or whichever line appears most prominent on the day.  Its real value lies in restoring specific elements of facial structure with precision.

Treatment begins with the skeleton and the deep tissues, then considers how the skin, fat compartments and individual features are supported above them. Each injection has a clear anatomical purpose: to replace lost support, improve proportion or correct a defined imbalance. This may mean leaving certain lines untouched, preserving natural movement and accepting that a youthful face still contains folds, shadows and expression.

Volume is kept purposeful and restrained. The aim is to use the smallest amount capable of creating a meaningful structural change, allowing the face to remain familiar, mobile and entirely individual.

Deep Plane Fillers are unique to our clinics as both a signature technique and a wider treatment philosophy. They combine detailed anatomical assessment, carefully selected hyaluronic acid fillers and precise placement within the deep plane to create results that feel balanced, subtle and personal.

The best dermal filler treatments should leave the impression that the face is well supported, rested and somehow enjoying a particularly favourable chapter. 

 

Frequently asked questions

 

Do Deep Plane Fillers hurt?

Discomfort is generally modest. Most hyaluronic acid fillers contain local anaesthetic, and topical anaesthetic is applied beforehand. Deep supraperiosteal placement involves fewer, more strategic injection points than surface techniques, which tends to make the experience more comfortable rather than less.

 

How much downtime should I expect from deep plane dermal fillers?

Most people return to normal activities the same day. Swelling and the occasional bruise are the usual after-effects and typically settle within a few days to a week. Deep placement can produce firmer initial swelling in some areas, which resolves as the product integrates.

 

When will I see the final result?

There is an immediate change from the volume placed, then a settling period of around two weeks as swelling subsides and the filler integrates with the tissues. Assessing the result at two weeks, rather than on the day, gives a far more honest picture and guides any small refinement.

 

How is this different from a liquid facelift?

‘Liquid facelift’ is a marketing term for using filler to lift and restore the face. Deep Plane Fillers describe the specific anatomical method behind that idea: structural placement on the deep plane, beneath the SMAS and against bone, rather than superficial volumising.  Because the product sits under the SMAS, the tissue is lifted over it rather than pushed outward, which is where the sense of a lift comes from. The emphasis is on foundation and proportion, not on filling lines.

 

Can Deep Plane Fillers be dissolved if I dislike the result?

Yes. Because the treatment uses hyaluronic acid, it can be broken down with hyaluronidase where clinically appropriate (Murray et al., 2021a). This is a medical procedure with its own considerations, so accurate placement and conservative volumes from the outset remain the better strategy.

 

Are Deep Plane Fillers suitable after Ozempic or other weight loss medication?

Often, yes. Facial volume loss is common after significant weight loss on GLP-1 medications and structural filler can restore support and proportion without attempting to refill everything that has changed. The plan focuses on balance rather than replacement and pairs well with skin-quality treatments where laxity is a concern.

 

How long do the results last?

Deep fillers have traditionally been quoted at twelve to eighteen months. MRI studies now show hyaluronic acid can remain detectable for considerably longer (Master, 2024).  Detectable is not the same as visibly effective, so review is best done in person rather than on a fixed annual schedule.

 

Written by Dr David Jack.  Dr. David Jack is an aesthetic doctor practising across Harley Street, Belgravia, the Royal Exchange, Liberty London, Edinburgh and soon in Stow-on-the-Wold, Cotswolds.  Deep Plane Fillers are available by consultation. To arrange an assessment, please book a consultation with one of our expert injectors.

 

Last medically reviewed: July 2026

 

References

 

Alghoul, M. and Codner, M.A. (2013) ‘Retaining ligaments of the face: Review of anatomy and clinical applications’, Aesthetic Surgery Journal, 33(6), pp. 769–782. Available at: https://doi.org/10.1177/1090820X13495405 [Accessed 26th July 2026]

Bass, L.S. (2015) ‘Injectable filler techniques for facial rejuvenation, volumization, and augmentation’, Facial Plastic Surgery Clinics of North America, 23(4), pp. 479–488. Available at: https://doi.org/10.1016/j.fsc.2015.07.004 [Accessed 26th July 2026]

Cotofana, S., Fratila, A.A.M., Schenck, T.L., Redka-Swoboda, W., Zilinsky, I. and Pavicic, T. (2016) ‘The anatomy of the aging face: A review’, Facial Plastic Surgery, 32(3), pp. 253–260. Available at: https://doi.org/10.1055/s-0036-1582234 [Accessed 26th July 2026]

Cotofana, S., Gotkin, R.H., Frank, K., Koban, K.C., Targosinski, S., Sykes, J.M., Schlager, M., Schlattau, A. and Schenck, T.L. (2019) ‘The functional anatomy of the deep facial fat compartments: A detailed imaging-based investigation’, Plastic and Reconstructive Surgery, 143(1), pp. 53–63. Available at: https://doi.org/10.1097/PRS.0000000000005080 [Accessed 26th July 2026]

Goodman, G.J., Liew, S., Callan, P. and Hart, S. (2020) ‘Facial aesthetic injections in clinical practice: Pretreatment and posttreatment consensus recommendations to minimise adverse outcomes’, Australasian Journal of Dermatology, 61(3), pp. 217–225. Available at: https://doi.org/10.1111/ajd.13273[Accessed 26th July 2026]

Haidar, R., Freytag, D.L., Frank, K., Rudolph, C., Hamade, H., Schenck, T.L., Green, J.B., Giunta, R.E., Gotkin, R.H. and Cotofana, S. (2021) ‘Quantitative analysis of the lifting effect of facial soft-tissue filler injections’, Plastic and Reconstructive Surgery, 147(5), pp. 765e–776e. Available at: https://doi.org/10.1097/PRS.0000000000007857 [Accessed 26th July 2026]

Kapoor, K.M., Saputra, D.I., Porter, C.E., Colucci, L., Stone, C., Brenninkmeijer, E.E.A., Sloane, J., Sayed, K., Winaya, K.K. and Bertossi, D. (2021) ‘Treating aging changes of facial anatomical layers with hyaluronic acid fillers’, Clinical, Cosmetic and Investigational Dermatology, 14, pp. 1105–1118. Available at: https://doi.org/10.2147/CCID.S294812 [Accessed 26th July 2026]

Koziej, M., Trybus, M., Hołda, M., Polak, J., Wnuk, J., Brzegowy, P., Popiela, T., Walocha, J. and Chrapusta, A. (2019) ‘Anatomical map of the facial artery for facial reconstruction and aesthetic procedures’, Aesthetic Surgery Journal, 39(11), pp. 1151–1162. Available at: https://doi.org/10.1093/asj/sjz028[Accessed 26th July 2026]

Master, M., Azizeddin, A. and Master, V. (2024) ‘Hyaluronic acid filler longevity in the mid-face: A review of 33 magnetic resonance imaging studies’, Plastic and Reconstructive Surgery – Global Open, 12(7), e5934. Available at: https://doi.org/10.1097/GOX.0000000000005934 [Accessed 26th July 2026]

Murray, G., Convery, C., Walker, L. and Davies, E. (2021a) ‘Guideline for the management of hyaluronic acid filler-induced vascular occlusion’, Journal of Clinical and Aesthetic Dermatology, 14(5), pp. E61–E69. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8211329/ [Accessed 26th July 2026]

Murray, G., Convery, C., Walker, L. and Davies, E. (2021b) ‘Guideline for the safe use of hyaluronidase in aesthetic medicine, including modified high-dose protocol’, Journal of Clinical and Aesthetic Dermatology, 14(8), pp. E69–E75. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8570661/[Accessed 26th July 2026]

Sito, G., Manzoni, V. and Sommariva, R. (2019) ‘Vascular complications after facial filler injection: A literature review and meta-analysis’, Journal of Clinical and Aesthetic Dermatology, 12(6), pp. E65–E72. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6624005/ [Accessed 26th July 2026]

Surek, C.C. (2019) ‘Facial anatomy for filler injection: The superficial musculoaponeurotic system (SMAS) is not just for facelifting’, Clinics in Plastic Surgery, 46(4), pp. 603–612. Available at: https://doi.org/10.1016/j.cps.2019.06.007 [Accessed 26th July 2026]