A flat, tired-looking face has usually lost structure: from the mid-30s the bone and deep fat that hold the face up shrink, so the cheekbone flattens, the chin recedes and the temples hollow. The skin then has less to drape over and the face reads as tired or sad at rest, even when you feel neither. This is deflation, and it is restored with reversible filler placed deep on the bone. It is different from a face that has dropped, which needs lifting with threads, and Dr Nish Shah MD tells you which yours is at your assessment.

Filler restores a face that has deflated; a thread lift repositions a face that has dropped; Dr Nish decides which at consultation. If your cheekbone has lost height but the cheek sits where it should, filler rebuilds it. If the cheek has slid down off the bone, filler adds weight and a thread lift is the answer. Many faces from the mid-40s have both, and are treated in order: filler to rebuild the frame, then threads to lift onto it. Dr Nish performs both, so the recommendation follows your face.

Usually less than people expect: most cheekbones need 1 to 2 ml per side and most chins 1 to 2 ml, because the filler goes deep on the bone where a small amount changes the structure. Dr Nish maps your face from three angles at consultation and tells you the total before anything is injected. Filler at Medisha is £350 per ml. The aim is a face that looks rested and in proportion, with nobody able to say why.

At Medisha Clinic in Mayfair, structural filler is £350 per ml for the cheek, chin, jawline and temple, and tear trough filler is £450. A typical cheek restoration of 2 to 4 ml is £700 to £1,400; a chin is usually 1 to 2 ml, £350 to £700. Where tissue has dropped, a PDO thread lift is £750 per area. A 2-week review is included. Consultation with Dr Nish is £50, redeemable in full against treatment. The clinic is at 58 South Molton Street, Mayfair, London W1K 5SL, 3 minutes from Bond Street station.

Not when it is placed deep on the bone in the right amount; the overdone look comes from filler placed in the soft tissue, in a face that has dropped, or in too great a volume. The Medisha Method™ is designed to avoid all three: mapping from three angles, product chosen per area, deep placement on the bone, and live recontouring with you watching. Where a cheek has dropped, Dr Nish recommends threads instead of filler, which is the single commonest reason faces look overfilled elsewhere.

The Medisha Method™ is Dr Nish Shah’s 4-step protocol for structural filler: three-angle facial mapping and goal definition, product selection per area, deep anatomical placement on the bone with each deposit checked clear of blood vessels, and live multi-angle recontouring. It is applied from the cheeks to the chin and taught by Dr Nish to other doctors at Derma Medical. On this page it decides what has deflated, what has dropped and what simply needs defining, so only what has gone is restored.

Yes — Medisha uses only reversible hyaluronic-acid fillers, which are dissolved by an enzyme kept on site, and no permanent or semi-permanent fillers are ever used. Side effects are mild and temporary for most patients: swelling, a small bruise or tenderness for a few days. The rare but serious risk with any filler is injection into a blood vessel, which Dr Nish is trained to recognise and manage immediately with the dissolving enzyme. All risks are explained at consultation.

Cheek and chin filler lasts 12 to 18 months, because it sits deep on the bone where there is little movement to break it down. Temple filler lasts a similar time; tear trough filler 12 to 18 months. The structure fades gradually rather than disappearing, and most patients top up once a year or so. Dr Nish reviews you at 2 weeks and sets out a maintenance schedule.

Yes — a receding chin makes the nose look larger in profile, and restoring the chin rebalances the whole line from lip to chin to neck. This is the basis of profile harmonisation at Medisha: chin, jawline and, where needed, nose filler planned together so that each needs less. In many patients chin filler alone is the answer, and it is one of the single most effective filler treatments for a profile.

Yes — where a face has both deflated and dropped, filler and threads are planned together, usually in order: filler first to rebuild the frame, then threads to lift what has dropped onto it. Whether they are done on the same day or staged a few weeks apart depends on your face and is decided at consultation. Dr Nish performs both, so one plan covers the whole face with one review.

Filler is not suitable where the problem is tissue that has dropped rather than deflated, which needs a thread lift; where there is significant skin excess, which may need surgery; during pregnancy or breastfeeding; with an active skin infection in the area; or with a known allergy to hyaluronic acid. Blood thinners need a medical review first. Dr Nish will tell you at consultation if filler is not the answer for your face.

Medisha Clinic treats lost volume with reversible structural filler planned with The Medisha Method™, and because Dr Nish Shah MD also performs PDO thread lifts, you are never sold filler for a face that has dropped. He is Brand Ambassador and Key Opinion Leader for dermal fillers, the Senior International Clinical Trainer at Derma Medical who teaches structural filler to other doctors, and has performed over 30,000 non-surgical treatments, making him one of the most experienced aesthetic doctors in the UK and London. The dissolving enzyme is on site at every appointment. Rated 5.0 on Google from 128 reviews. 58 South Molton Street, Mayfair, London W1K 5SL, serving Mayfair and Marylebone.