Dermal filler - Hamilton Fraser

We can provide cover for dermal filler within your medical malpractice insurance policy if you are a qualified healthcare professional.

If you are looking for insurance to cover dermal fillers, please contact the team on 0800 634 3881 or email

Who does Hamilton Fraser cover for dermal fillers?

Hamilton Fraser covers doctors, dentists, nurses, dental hygienists, dental therapists, pharmacists, paramedics, operating department practitioners and physiotherapists. We do not offer dermal filler insurance for beauty therapists.

Practitioners must undertake both theoretical and face-to face practical training and they must be presented with a certificate of completion. Regardless as to whether it is CPD approved, the training must be taught by a registered medial professional to meet the eligibility criteria for dermal filler insurance with Hamilton Fraser. Read more in our article on aesthetic training and CPD .

Other requirements include:

● Face to face consultations with relevant signed consent from the patient

● Photographs or digital images of the patient capturing the treatment area immediately prior and following treatment, retained by the practitioner for at least three years after the date of treatment

What is dermal filler?

Dermal fillers are gel-like substances consisting of bio-compatible elements such as hyaluronic acid, calcium hydroxylapatite (a collagen stimulator) and poly-L-lactic acid. Dermal fillers are temporary, minimally invasive injectable treatments that help to restore a fresher and smoother appearance. But what does hyaluronic acid do? Hyaluronic acid is a natural substance that is found in body tissues and keeps the skin hydrated and nourished. Dermal filler helps boost the skin’s supply of hyaluronic acid and is injected into the skin to fill in facial wrinkles, restore lost volume, minimise signs of ageing, and improve the general quality of the skin.

How do dermal fillers work?

Dermal fillers act as a replacement for lost fat, resulting in a more youthful and rejuvenated appearance. Dermal filler treatment involves a gel-like substance being injected into target areas of the face with a cannula or needle. The filler plumps the skin, working in place of lost fat and proteins to smooth lines and wrinkles, and volumise hollow areas. Dermal fillers are available in different thicknesses and viscosity to match the patient’s needs. The thicker products are typically reserved for deep folds or wrinkles, whilst smoother products are for finer lines and wrinkles, and for a more natural, fresh appearance.

What are dermal fillers used for?

Dermal filler injections are generally used to reduce the appearance of wrinkles, smooth the skin and give the patient a more youthful appearance. Dermal fillers can also be used to create fuller lips and shape facial contours, such as the cheeks, chin and nose, as well as to treat facial asymmetry and create balance within the facial features.

What is dermal filler made of?

Dermal fillers can be composed of a variety of both natural and synthetic substances. One of the most common compounds used in dermal fillers is hyaluronic acid. Other compounds include calcium hydroxylapatite, poly-L-lactic acid, polymethyl methacrylate, and autologous fat (fat that is transplanted from another part of your body).

Calcium hydroxylapatite is a mineral-like compound naturally found in human bones. It has been used in dentistry and reconstructive plastic surgery for a long time and has a track-record of being safe. Poly-L-lactic acid is a synthetic filler that helps to stimulate collagen production, with results gradually showing over several months as it stimulates the body to produce collagen. Polymethyl methacrylate is a semi-permanent filler and, while more durable compared to other more readily biodegradable fillers, potential complications include lumps forming or being visible under the skin.

How long does dermal filler last?

Dermal fillers are temporary and how long they last depends on the type of filler used and where it is injected. They usually last between six and 18 months.

Since most dermal fillers are naturally absorbed over time, patients may need to repeat the procedure after a period of time to maintain the desired effect. Successful results will depend on the underlying tissue structure and the volume and type of filler used. Maintaining good overall skin health will improve the results and longevity.

Who can benefit from dermal fillers?

Dermal fillers can benefit patients who are keen to reduce the signs of ageing and want a tighter, smoother and more radiant appearance. Dermal filler is also an effective treatment for patients wishing to balance out their facial features, which could include cheek filler, nose filler and jaw filler. Lip filler is also a very popular treatment, particularly with younger patients. Minimal downtime and immediate results are some of the benefits for patients who are after a quick and pain-free procedure.

What are the different types of dermal filler?

There are different types of dermal filler substances – some are temporary while others last longer, and they vary in viscosity. Some semi-permanent brands of filler – including Radiesse, Sculptra and Ellanse – work by filling out lines and wrinkles, and stimulating the body’s own collagen production. They normally last upwards of one year.

Temporary hyaluronic acid fillers include brands like Juvéderm, Belotero and Restylane, and are the most popular and most commonly used treatments.

What happens during a dermal filler procedure?

Before the procedure, the patient should always have a consultation with the practitioner to discuss their needs. Prior to the start of the treatment, strategic points on the patient’s face may get marked as the appropriate injection sites for the filler, and ‘before’ photographs should be taken. The injection site will be cleaned with an antibacterial agent, and the practitioner may apply a numbing cream to minimise any discomfort.

During a dermal filler treatment, the aesthetic practitioner will inject, massage, and evaluate the area being treated. Depending on the patient’s treatment, the process may take between 15 to 60 minutes.

Following the procedure, leftover markings will be cleaned and an ice pack may be used to reduce any swelling and relieve any discomfort.

What are the side effects of dermal fillers?

After the procedure, the patient may experience dermal filler side effects including red and swollen skin on the treated area, however any swelling or bruising should settle down in a few days. Serious problems are rare but can include:

● Infection

● A lumpy appearance under the skin, which might need to be treated with surgery or medicine

● The filler migrating from the intended treatment area

● Scarring

● Blocked blood vessels in the face, which can cause tissue death and permanent blindness

If the patient experiences any abnormal side effects, it is important they seek advice from the practitioner immediately and call 999 in an emergency.

What is the recovery time from dermal fillers?

Recovery time varies and depends on which filler is being used in a specific area. Generally, the patient can resume daily activities immediately. They should avoid any intense physical activity for the first 24 to 48 hours to minimise swelling and bruising.

Patients should also avoid wearing make-up immediately after the procedure and should steer clear of alcohol, coffee and the sun.

What training is required to administer dermal fillers?

Practitioners need to attend advanced dermal filler training before treating patients. The Level 7 Diploma in Botox and Dermal Filler training course, or an equivalent, is currently the recommended education standard for injectables in the UK. The course covers:

● In depth understanding of facial anatomy including relevant vessels, nerves, muscles and fat pads

● Understanding of biochemistry, pharmacology of various types of dermal filler: permanent, semi-permanent and temporary; replacement vs stimulatory; with or without local anaesthetic

● Understanding and recognition of specific adverse events including hypersensitivity, biofilm, granuloma, nodule formation with suppuration and abscess formation and treat or refer on appropriately

Who can administer dermal fillers?

Although dermal filler treatment is currently unregulated, it was banned for use on under 18s in October 2021 (unless there is an assessed medical need). Dermal filler training for non medical professionals is available, but the procedure requires practitioners to have a detailed understanding of skin anatomy, and therefore should be performed by qualified medical practitioners only. Hamilton Fraser insurance only covers practitioners who have undertaken training carried out by a registered medical professional and who are qualified medical professionals themselves.

What Hamilton Fraser policy conditions should practitioners be aware of?

Dermal filler claims are amongst the most common that we see at Hamilton Fraser, so it is very important that practitioners are aware of and comply with the policy conditions, as we are unlikely to make payment if an incident occurs while policy holders aren’t in compliance. Policy conditions include the following:

· Consultations must be carried out face to face and the relevant signed consent must be obtained from the patient

· Photographs or digital images must be taken of the client capturing the treatment area of their body immediately prior to treatment and after

· These photographs and digital images must be retained by the practitioner for at least three years after the date of treatment

· Hamilton Fraser’s dermal filler cover excludes any work to the genital area unless agreed by the insurers

Dermal filler claims: example scenarios

With any injectable treatments, there will always be potential side effects. All known side effects must be explained to the patient in the consultation and a consent form with the risks must be signed by the patient prior to the procedure.

An example of the type of claim we receive, could be that a patient has been into a clinic to get a lip filler procedure. Best practice is followed and a full consultation is carried out during which all the risks are discussed, and the patient signed the consent form. The treatment was then done a few days later (after the patient has had time to digest what is involved in the treatment and assess the risks). The procedure went well, and the patient was happy with the result. However, the next day, the patient woke with a very dark sore lip, so contacted the practitioner. The practitioner asked for a photo and got the patient back in for urgent review that day. The patient had experienced a delayed vascular occlusion. The filler was dissolved and the patient kept in the clinic until the appearance improved. Following this, the practitioner kept in close contact with the patient.

In this situation the matter can be defended by insurers as vascular occlusions are noted as a possible side effect, and the practitioner acted quickly and efficiently to resolve the issue. The practitioner’s duty of care was fulfilled.

The same scenario could have ended up in a different outcome. For example, if the practitioner had booked her in for a routine check-up the following week, the filler would have been dissolved but the damage to the tissue would have been done. As the vascular occlusion would not have been treated, the patient would have suffered necrosis (dead tissue). In this case, the insurers would not be able to defend the practitioner as they would have been negligent as the duty of care was not fulfilled. Had action been taken sooner, the patient would not have suffered an injury and would not have needed additional treatments to help improve their appearance.

Claims top tip: Manage the patient’s expectations - from the consultation process and throughout the treatment, by making sure they fully understand what result the treatment will realistically achieve. In addition, by talking with them you will be able to understand if they are expecting to achieve the same results.