When it comes to dermal fillers, nearly everyone has an opinion. But, regardless of what camp you might sit in (pro, anti, or "it's complicated"), we want to ensure you have access to all the information.
So, we decided it was time to get an expert involved and play our very own version of 'Dermal Doctor' (if you will). Enter: Dr Giulia D'Anna, founder of Dermal Distinction, who kindly (and very patiently) answered our myriad of questions.
Keep reading for everything — and we mean, literally everything — you need to know before you let someone with a needle get within ten meters of your face.
First, What Exactly Are Dermal Fillers?
Dermal fillers are an aesthetic based gel that is injected into an area to enhance or reshape it. They are specifically made for the enhancement of your features and the reduction of folds and wrinkles. Typically in Australia, Dermal fillers are made of Hyaluronic acid. Hyaluronic acid (HA) is found in our skin and is a naturally occurring sugar chair that gives our skin plumpness and attracts water to the skin, creating hydration, however, the HA in dermal filler is made in a laboratory. HA levels in our skin do change over time, as our body modifies or breaks it down with enzymes as part of our metabolic processes. Over time, this can lead to sagging of the skin and folds that never used to be there.
What Different Types of Fillers Are There?
There are many types of filler and many brands available on the Australian market. As mentioned the most common type is made of HA, and within this class of dermal filler, there are many different thicknesses. Thicker fillers are highly cross-linked or chemically woven together, this makes the filler very firm to the touch, but also stable over a longer period of time as it takes longer for your body to wear it down. The thicker fillers are best used for enhancement of bone like structures, for example; this type of filler can be used to replicate or enhance the cheekbones, the jawline and similar areas.
Thinner fillers are used for a much softer type of tissue. Typically this might be used in the under eye area or lips where a soft result is desirable. Using a filler that is hard in these areas would just not look right and would show up as lumps and bumps. Thin types of fillers do not last quite as long as the thicker type but are best suited to delicate areas.
Are Dermal Fillers Safe?
Dermal fillers are relatively safe when your injector understands your wishes and has a deep understanding of anatomy. However, no medical procedure is without risk. It is important that those risks are discussed with you.
Dermal fillers used should be listed by TGA, who test and research all drugs used in the Australian market. Their policies on approval are amongst the strictest on the planet. This exhaustive process is important to keep the public as safe as possible when the drug reaches the approved status.
On Average, How Long Do Dermal Fillers Last?
One of the great advantages of a dermal filler treatment is that the effects are long lasting but not permanent. Thicker fillers can last for around 12-24 months. This varies according to the filler brand as each has its own unique structure or cross-linking signature. Your metabolism will also dictate the turnover, as highly fit people will break down the filler more quickly than less fit people. Other factors include "wear and tear". What I mean by this, is that high traffic areas will wear down filler faster (for example, we use our lips every day to speak and laugh and eat), whereas if the same filler was placed in the cheek it will last longer as the cheek doesn't move quite so much.
To ensure an optimal and long lasting result, a top-up treatment is sometimes recommended 6-12 months after your initial treatment. However there is no real time line or guideline, as it varies so widely from area to area, and person to person. Your injector will be able to give you some kind of guideline as to the expected lifespan. As a general rule of thumb, lip filler lasts around 4-6 months, and cheek filler lasts around 12-18 months. But often the trigger for re-treatment will be when you see the volume created starting to fade. Speaking to your injector about re-treatment is the best thing to do.
What Areas of the Face and Body Can Dermal Fillers Be Used?
Almost any area of the face can be treated. This includes the nose, lips, cheeks, jawline and chin. I have even treated earlobes from time-to-time. Some less considered areas are the temples and forehead. As women get older, our temples can appear hollow and the forehead tends to slope backwards away from the brow bone. This can make us look angry. Treating these areas may not seem obvious, but can truly be transformative.
In terms of the body, many areas can also be treated too. Commonly treated areas are the back of the hands and décolletage. A Hollywood injector once told me that he injects the knees and elbows of celebrities before they walk the Oscars red carpet. This puts the spotlight on the gown or the jewellery rather than the photographer's glare being on a wrinkly elbow. I have also heard of filler being used in the pads of feet as a cushion for high heels. Bother these ideas are not something I would recommend, but an interesting use!
What Should You Know Before Getting Dermal Fillers?
Dermal fillers are a medical procedure and should be treated as such. You should make sure that you have a face-to-face consultation with your doctor or dentist that is performing the treatment. These are the only two individuals who can undertake consultation with you. This ensures that you feel confident with your injector, that you understand the procedure, understand the risk, but also that the cosmetic injector understands what you want out of the treatment. It is also important that you know who the injector is. Sometimes, a doctor will undertake the consultation with you, but then delegate the treatment to someone else, for instance, a nurse. This is very common and you should make sure you know who will be looking after you.
Another really important aspect of treatment is to discuss the risks. All medical treatment carries some risk, and it is important that you truly understand this too. Finally, dermal filler does come at a cost, and the financial aspect should also be discussed before you go ahead.
Great questions to ask before your treatment are:
- What is involved in treatment?
- If you are considering lip filler, will you have dental anaesthesia or just numbing cream?
- There is a huge difference between the two.
- How much filler will I need? Is the filler listed/approved with TGA?
- How long will the filler last?
- What are the risks?
Is there any downtime? For example, if there is bruising or swelling, how long might this last?
- What are the costs?
- Who will do my treatment?
The best questions to ask are whatever questions that come to your mind. No question is too simple, silly or not right. It is very important that you feel comfortable and confident before going ahead.
Is Getting Dermal Fillers Painful?
Most fillers have anaesthetic included, which helps to eliminate discomfort. An option that works really well for my patients is the use of a cannula which helps to reduce bruising and discomfort markedly. A cannula is able to weave its way around the face, under the skin, reducing the needle for multiple needles. Medical grade numbing creams can help reduce discomfort around the face, along with the use of ice to reduce sensations.
Lip enhancement, on the other hand, is an entirely different story. I highly recommend and always use complete dental anaesthesia to numb my patients prior to lip enhancement. This area is incredibly sensitive, and creams or distracting vibrating tools just do not cut it. With dental anaesthesia, my patients do not feel anything at all. I believe that this gives them a comfortable experience, but also enables me to do a better job as my patient is at ease. I find that this also reduces the risk of bruising as my patient is not wincing or moving around in pain. Once you try it this way, you will never go back to a cream!
What Does an Average Procedure Involve?
Step 1: face to face consult, discuss risks and run through the treatment process
Step 2: photos and measurements of the face to record proportion (or lack of)
Step 3: The areas to be treated are marked out and then treated. This may involve the use of more than one thickness of filler to achieve the result discussed
Step 4: once treatment is completed, I will give post treatment instructions (the dos and don'ts), and also take photos
Step 5: I will set up a review appointment. This may be to assess the treatment, but we may also do additional treatment too.
What Risks or Complications Can Occur?
The most common risks are discomfort or pain, bruising and swelling. These risks are often minimal, transient but also sometimes unavoidable. Sometimes some fillers create lumps and bumps under the skin or in the lips. If dealt with early — usually within a week of filler placement — they can be manipulated by the cosmetic injector and they will easily dissipate. A much more serious risk, but also much less common, is vascular occlusion. Vascular occlusion is the medical term for a blocked blood vessel. Your injector should understand the anatomy of your face intimately and also the best techniques to avoid this. This also includes not placing too much filler in any one area in one sitting.
What Type of After-Care Is Involved?
Aftercare is pretty low key actually. I ask that my patients do not massage the area injected as this has the risk of moving the filler around. It is also wise to avoid sleeping on the area for around a week too. This is for the same reason. Heavy pressure can change the result. I do prefer that my clients only use mineral makeup. Mineral makeup sits on top of the skin, so there is less chance of makeup making its way into the injected area through the injection site.
Finally, I always review my patients a week after treatment. This allows me to review the treatment area, modify the result, and possibly add further filler if required. I am a little OCD about my patients, and I like to make sure that everything sits just right. This is particularly the case with lips, which move a lot between my treatment appointment and my review appointment. I really want to be able to make sure that both my patient and I am happy with the final result.
Can Fillers Make the Skin Sag?
Improperly placed filler or too much filler can add weight to the face, where we just don't want it. An area that often gets overtreated can be the under-eye area, the jowl area along the jaw line and also the naso-labial folds — the lines that start at the corner of your mouth and run down under the cheeks. If a little too much filler is used in these areas, particularly if the skin is thin and stretchy, the filler will weigh the skin down and create more folds as the skin stretches to accommodate the filler. A great cosmetic injector should be able to recognise this and avoid treating these areas or undertake supportive skin treatments first.
It is really unfortunate when I see a new client who has had previous bad experience with filler. Invariably this is because the filler has been placed inappropriately or far too much filler has been used by their last cosmetic injector. Dermal filler can be a brilliant treatment that looks natural and enhances the features. It is a real shame when the confidence of a client is lost.
What Are Your Options If You Don't Like How They Look?
Definitely speak to your injector about your wants and the expected outcomes before you go ahead. I would highly recommend that you speak to your injector if you don't like what you see. Whenever you have filler, there is a settling in period, where the filler can look uneven as it begins to attract water. There is also a period of time where your injector can modify the placement of the filler, so talking to your injector can alleviate some of these early concerns.
However, if this still is not quite right for you, you can also discuss the option of using a dissolving agent where the HA filler has been used. Keep in mind that permanent types of fillers cannot be dissolved, and should only ever be used in the office of a plastic surgeon. You have very limited options if you are not satisfied with the results of these types of filler.
How Long Does It Take to See Results?
Dermal filler results are immediate, but can sometimes be magnified with swelling. The best time to truly assess the outcome is about 14 days after treatment where the tissues have settled, hydration is improved and any swelling or bruising has resolved. Often I stage treatment. In other words, where there are multiple areas to treat and multiple fillers required, I will do sections of treatment at a time to slowly reach my end result. This helps my patient see the result take shape, and less dramatic to friends and family that are often left in the dark about procedures that are taking place.
How Much Do Dermal Fillers Cost on Average?
Filler costs vary widely from injector to injector. Aside from that, the cost of thicker styles of filler is generally higher too. Reputable injectors use fillers that are sourced from TGA listed suppliers. We also use filler brands that are well established on the Australian market and have a great safety record.
Filler is not a cheap treatment. Most cosmetic injectors will have price guides listed on their websites, but should really give you more precise outlines of costs when you have your consultation. The cost will also vary based upon the amount of filler needed to achieve the end result. To give you a rough idea, lip filler can be anywhere between $450-700, depending upon the injector and the technique they employ. Ask questions to see what you are getting.
What's the Difference Between Dermal Fillers and Botox?
Anti-wrinkle injections — a.k.a. Botox — is a neuromodulator. This means that it is a pharmaceutical that is injected that alters the way a nerve works. So if the nerve is unable to send a message to a muscle, the muscle lies flat and cannot contract. This is great news for the skin, as the skin does not wrinkle when you smile or raise your eyebrows. Anti-wrinkle injections do not work like filler. They will not enhance your proportions or fill out a wrinkle. However, they do work extremely well with dermal fillers. By relaxing the muscles, the skin will become smoother so that the filler will have a nicer effect on the skin.
Aside from this, in some areas, anti-wrinkle treatment can extend the lifespan of the filler, as the filler is less mobile. An example of this is the use of anti-wrinkle injections to create what has become known as the "lip flip". Part of the muscle around the lip relaxes so that the lip sits lower and fuller in the middle. This makes the lip less mobile, and therefore reduces the "wear and tear" on the lip itself. Keep in mind that this may not be for everyone, but it is certainly worth discussing with your cosmetic injector.