You Do Not Need Filler — Just a Better Protocol – by Dr Anjali Mahto, London Dermatologist
For over a decade, I have been quietly guiding patients toward results that lift, refine and rejuvenate without the overuse of dermal filler. While there is nothing inherently wrong with filler when used strategically, the aesthetic goal at Self London has never been volume for volume’s sake. We believe in restoration, not reinvention. And increasingly, the most impactful results come not from injecting more, but from activating the body to do the work itself.
The Problem with a Filler-Led Aesthetic
A certain aesthetic has dominated for the last ten years: sharp cheeks, overly full lips, and an often disproportionate balance to the face. Though popular on social media, these outcomes rarely align with what most of our patients want which is to look good for their age, to preserve what they have, and to avoid obvious signs of work.
Filler has a role. I use it sparingly and with precision. But when misused or over-relied upon, it can distort facial proportions, create unnatural contours, and lead to long-term issues such as filler migration or lymphatic congestion. More importantly, standard fillers do not address the root causes of facial ageing: loss of collagen, elastin, and dermal integrity.
A Better Strategy: Encourage the Skin to Do the Work
The most elegant aesthetic outcomes occur when the body regenerates itself — when new collagen and elastin are produced, when tissue is lifted through deep structural support, and when skin tone and texture improve from within. At Self London, we refer to this as intelligent aesthetics: protocols that strengthen the skin’s own ability to maintain youthfulness.
This is where non-invasive devices like Sofwave, fractional lasers, and regenerative injectables such as polynucleotides or Profhilo come in. These treatments, used in combination or as standalone procedures, can achieve visible, natural-looking lift and rejuvenation without distorting the underlying facial architecture.
Why Sofwave is Our Protocol of Choice for Lifting
Sofwave uses parallel beam ultrasound to heat tissue at a precise depth of 1.5mm, the mid-dermis, where fibroblasts reside. These fibroblasts are responsible for producing collagen and elastin. By triggering controlled thermal injury at this level, Sofwave stimulates new collagen formation over a period of 12–16 weeks.
Unlike older ultrasound technologies that penetrate more deeply (and risk damaging fat pads), Sofwave is shallow enough to preserve volume while firming skin. There is no downtime, no bruising, and no need for anaesthesia beyond topical numbing cream. This makes it ideal for the lower face, jawline, neck, and brow, the areas most prone to sagging and which we notice first.
We have seen excellent results in both women and men, particularly those in their 30s to 60s who wish to delay more invasive interventions.
Combining Technologies for Precision Rejuvenation
The best results often come from layering treatments. In patients with mild upper eyelid heaviness or early eye bags or swelling, we combine Sofwave with laser coring around the periorbital region and polynucleotides to improve dermal quality. For the neck and jawline, Sofwave may be paired with UltraClear resurfacing or regenerative injectables for textural improvement and lifting.
Each protocol is carefully curated based on individual needs. We do not believe in packages or standardised offerings. Our approach is more akin to tailoring a treatment plan the way a couturier might cut a garment – precise, considered, and never excessive.
My Personal Philosophy
I have been undergoing skin tightening with ultrasound-based technologies annually for seven years. This has allowed me to minimise filler use in my own face while maintaining lift and structure. My preference has always been to encourage my body to regenerate what it needs. This philosophy underpins everything we do at Self London.
While the industry shifts toward regenerative aesthetics, this is not a trend for us. We have long believed that subtle intervention, guided by biological processes, is preferable to masking change with volume. Our patients, often professionals, parents, creatives, and business leaders, and those in the public eye, do not want to look different. They want to look like themselves, rested and well.
Who Benefits Most from These Protocols?
- Women and men in their 30s to 60s noticing early laxity in the lower face or neck (jowls, nasolabial folds deepening) or changes around the eye area
- Patients who want to avoid filler or have had poor outcomes with injectables elsewhere
- Individuals seeking a long-term plan rather than quick fixes
- Patients on GLP-1 agonist medications who have lost facial volume and wish to preserve lift
- Endurance athletes (e.g. runners or triathletes) experiencing volume loss from low body fat
We are also seeing increasing demand from patients in their 20s who want to delay the ageing process before it begins. These individuals are not interested in chasing youth, they are focused on prevention and maintenance, a mindset we share.
What About Profhilo and Polynucleotides?
Profhilo and polynucleotides are injectable, but they are not dermal fillers. They work not by adding volume, but by improving the quality of the dermis.
Profhilo is a high-concentration hyaluronic acid that spreads beneath the skin to hydrate and stimulate collagen. It is ideal for dull, crepey, or dehydrated skin. Polynucleotides, on the other hand, are DNA fragments derived from salmon that activate tissue repair, calm inflammation, and improve skin thickness. Both are often used as adjuncts to skin tightening, not as replacements for it. When combined thoughtfully with devices like Sofwave, they can enhance outcomes without adding bulk.
Why This Matters
The goal of any aesthetic treatment should be to restore balance, preserve identity, and support skin health. At Self London, we believe that the best outcomes come from restraint, precision, and deep understanding of facial anatomy and ageing.
Too often, we see patients who have undergone piecemeal treatments at multiple clinics: filler in one place, resurfacing elsewhere, and a product-led skincare routine that does not match their actual needs. This fragmented approach leads to suboptimal results.
When you are treated by a clinic that offers diagnosis, planning, and execution under one roof, particularly one led by a consultant dermatologist, the entire process is elevated. We do not just deliver treatments. We offer strategy.
Final Thoughts
You do not need more filler. You need a plan.
Whether that involves ultrasound-based lifting, regenerative injectables, laser treatments, or skincare, our job is to guide you with care and clinical integrity. The difference lies in the protocol and the philosophy behind it.
If you are ready to take a different approach, we are here.
