Facial Volume Loss

and Dermal Fillers

Let's talk about volume loss. I like the idea of a deflated

balloon. Everyone's obsessed with looking at their lines, but if I

took a photo of a ninety year old, if I airbrushed her wrinkles

off and showed you a picture of her, do you think you would

look at the photo and think she looked twenty-one again? No.

Why? She's got no fat left in her face. When we see people

and how our mind ages them, we see these contours and

hollows. That's why people start to look older or tired.

So what's the solution there? You can put on ten kilos, that

helps. Not really, it relocates after a certain point, doesn’t it?

That's right, it doesn't go in to your face. That was my theory.

After a certain point, my backside ate my cheeks. Everything

started to head south and sucked it all out.

These are the fat pads we have on our face, you can see

they’re everywhere. Some shrink at faster raters than others

and it also depends on your genetics. Others hollow out faster

than others and it also depends on how much you exercise. If

you go and watch the Melbourne marathon, you'll see that

some of those people there aren’t aging that well because

running really takes it off the cheeks and the temples.

So dermal fillers have come to save us. I used to think and I

think this is an evolution of the collective female conscience, I

thought if I could just suck it out off my bottom and put it back

on my cheeks. The answer is we can, at least Dr. Chan can

and it is one of his main specialties every Thursday and Friday.

But not everybody wants to go to those lengths, not everyone

wants to have a liposuction and a fat reinjection. So this is

where dermal fillers come into it. Dermal fillers are like re-

inflating the balloon.

Dermal fillers that we use here are largely made of hyaluronic

acid which is a glyco protein or a sugar that's found in our

bodies already and in all of the animal kingdom I think. The

ones we inject now are actually harnessed from bacteria. It

was found that the basic sub-unit is the same, no matter which

organism is producing it. So to make a lot of bacteria, they

harness it in the lab. They found that there is a very low rate of

allergy because it’s essentially the same as we've already got

in our skin and it makes up the jelly in our eyeballs.

It’s a lot safer than the fillers were twenty years ago. They had

huge problems with allergic reactions twenty years ago and

many of the fillers were irreversible. So once they were in, they

were in. If you had a reaction, it was almost too bad. If they

were permanent and you got an infection, you know it could

end up in surgery, scarring, it was a bit of a disaster.

So, that is why these new fillers have such a huge uptake

because they're low allergy, very safe and completely

reversible, which is fantastic. If you don't like the way you look,

we can actually inject an enzyme and completely dissolve the

filler, and you’ll go back to exactly the way you were.

Here are commonly asked questions about our dermal fillers.

How do we do it and does it hurt? There are two main ways

dermal fillers can be injected. You can either place it straight

into the skin with a needle or you can make a little entry point.

For example if I was going to fill a cheek, I could make a little

entry point out here and normally, I'd put a little bit of

anesthetic on the skin. Then, I would make a tiny little entry

hole. Then I would take that little needle out and I would use a

cannula which is a blunt needle. I could just gently slide that

under the skin to deposit the filler which significantly reduces

your chance of bruising and swelling.

Does it hurt? Again it depends which technique is being used.

Also I think anti-wrinkle injections hurt more than having filler

done. Things that can be used to help keep you comfortable

are nitrous gas, ice and topical anesthetic. The dermal fillers

themselves have anesthetic in them now, so you can't have it

if you have an allergy to local anesthetic. But as you inject,

you find that area becomes more and more numb and more

and more comfortable. That numbness usually lasts anywhere

from thirty to forty minutes.

So is it reversible? As I've said, absolutely, that's why there's

such a huge uptake of these products now.

When does this start to work? Compared to anti-wrinkle

injections, it starts to work immediately because we're re-

inflating the area.

How long does it last? This depends on where it’s being

injected, your metabolism and which kind of filler is being

used. But generally, we will say a filler will last six months if

you're unlucky. Depending on which filler you use it actually

can last anywhere up to two years now, so, usually twelve

months to two years.

I think this is a good thing because permanent procedures are

scary to me, that's why I'm comfortable working with this

reversible product. If you're in your late thirties and you decide

to have a cheek implant, right up here, up nice and high, what

is that going to look like when you're seventy when everything

else is sagging around it? It’s going to look a bit weird. I like

the idea that we can tailor things to your age as we go. I think

it improves our chances that we're going to get nice, natural,

fresh results.

When should I start? This will depend on whether we're using

it for beautification or rejuvenation. When do I start with

rejuvenation? It’s as soon as I start to get hollowing. If you're

unlucky, it might be in your early twenties. If you're lucky, you

mightn’t start until your mid thirties or late thirties.

What are the risks involved? A dermal filler is incredibly safe

but at the end of the day, we're still putting an implant into the

skin. So, we always warn there is a risk of swelling, a risk of

bruising that can last up to two weeks, a risk of infection

because we're working with needles. That risk is low and we

would normally cleanse the area with alcohol before you do

any procedure. But if you got an injector who is not

cleanliness-conscious, you want to be a little bit nervous about

that sort of thing.

Then there are a few very rare risks that I won't go into now,

but do include things like potential auto immune reaction that

can lead to a permanent little lump under the skin. But these

are very uncommon with the new fillers that are out; they were

lot more common with the older fillers. I certainly wouldn't let

it stop you because the rates are incredibly low. Most women

will have these procedures done without any problems at all.

As I said, if there was any complication it’s usually a treatable

one because we can reverse the products with a dissolver.

How much do I need? It’s self-examination time. You are going

to draw your own little diagram on your face chart, and I'll

teach you few of the tricks and describe some of the changes

we see as we age.

So start with the upper face, your forehead. When we're

young, our foreheads are usually convex and have a nice

curve through there. That keeps our eyebrows up and stops

these wrinkles from forming when we lift our brows. As we

age, if I come back to that picture of the fat pads, as these

disintegrate, as these shrink, you end up with a flattening in

the forehead and there's less support when you raise your

brows, so we see the wrinkles then.

From a side profile particularly for a woman, it can start to look

a bit masculine. If your brow starts to look bigger here, and

you’re flatter here, that's actually more a masculine

characteristic. Men can get away with a bit of a heavier brow

and a flatter head, but women generally do look more youthful

with a curved forehead and that keeps to help your eyebrows

up. That’s another reason our eyebrows start to drop down,

because we lose the fat in the forehead there.

Our temples. This is something that I struggle with because

normally, when I'm not pregnant, I have a very scrawny upper

body, face and neck. Any weight loss means that I take weight

off my forehead and my temples. That's a really aging look

when you've got hollow temples. It happens to all runners. It

means that a after certain age, your eyebrows are going to

start to turn the corner, and rather than seeing them like this,

they literally will follow your temples around to the side. Then,

your cheekbones can look a little bit different because you've

got a bit concavity sitting right through there.

Filling your temples is something that needs to be done by a

very advanced injector for safety purposes. But it can make a

huge change to an upper face and again, helps to support

those eyebrows, helps to support the crows’ feet and really

rejuvenate that upper face.

Eyes. You'll find your eyes will age in one of two main ways.

Either you're going to be a sagger, and your lids will start to

sag down over your eyes, or you're going to be a receder. I'm

I'm a receder and I'll show you, to make it a little bit more

clear.

When I lose weight on my face and as I get older, this fat pad

up here shrinks and I get what we call the A- frame deformity

forming right above my eye. It makes my eye sockets look

really hollow. If you have a look at Miranda Kerr and any of

those models, you'll see they've got a nice full upper lid there.

So for a receder like myself, that's a really great trick. It’s an

area that gets missed in a lot in dermal filling and it needs to

be done by very experienced injector. You wouldn't let your

friend who’s done a two hour evening course come at you in

in that location. That really makes a beautiful difference to the

upper face.

Coming around to your mid face now, under the eye, tear

troughs worry almost everyone. It can be a tricky area to fill,

and it can't be overdone or you will end up with a big, puffy

eyebag. You need to be able to assess whether you have a

true tear trough or whether you're missing your cheek under

the tear trough. A lot of people will fill a tear trough and not

their mid-cheek and they end up with a big puffy eye and a flat

face and it’s not a good look. So often the two areas need to

be done in combination.

When we're young, the junction between our lower lid and our

cheek is really short and as we age it gets longer and longer

and longer. You've probably seen pictures of ninety year old

men and it’s all the way down here, the eyelid there, the cheek

starts there. Once again, these are things we can use dermal

filler for to keep everything lifted and to soften those

transitions, between those few areas. Again, this is an area for

very experienced injectors. If the Botox hasn't lifted your

eyebrows enough, this area here can start to sag down and in

and we can actually use a little bit of filler through there to lift

that glabella again and support those tissues. That helps your

anti-wrinkle injection to work better because it rejuvenates that

mid face area.

We can put dermal filler in noses. A lot of people choose to do

this instead of having a full rhinoplasty procedure. Those who

are scared to go under the knife, might have a bit of a hump

on their nose and we can actually blend it in with dermal filler.

It’s another area for advanced injectors.

Cheeks, one of my favorite areas to do are mid cheek, lateral

cheek because I find that's one of the key areas that flattens

out in a lot of people. People who have really high, wide

cheekbones age a lot better than everyone else; they’re really

lucky. If you're not, we get to cheat and we re-inflate you there

and there. When people look at you, they see that middle

of your face first. So there's no point having big lips and a flat

cheek, you’re not going to do yourself any favors.

We can fill the sides of the cheeks, if these buccal fat pads

here start to deteriorate. We can fill the hollowings that appear

down under your lips and above the chin. Nasal labial folds,

these lines here, courtesy of my grandmother, are a concern

for a lot of people. But if you overfill them, you'll look like a

monkey. So I would say treat your cheeks and soften these

gently but don't overdo them, because I have seen a few

patients, not under my own work, but they have come in

looking a bit like a monkey.

Lips can be done with filler. A lot of women are really scared to

have their lips treated, but with the new fillers in particular that

are out now, they're really hydrating to the lips. As we age, our

lips turn in and if you treat every other area on your face and

you leave the lips, you've really giving yourself a way a little

bit. A little bit of filler into the lips if nothing else, just hydrates

and plumps and just gives you that little bit of softness that you

used to have in there, which is great. You'll find your lipstick, if

you're female, will sit a lot better.

Now I think, I've covered all those areas. We can use filler to

fill the back of your hands in. If you get everything else done,

and you've got really hollow backs of hands, really wrinkly,

filler can be injected and soften out the back of your hands.

Visit our webpage if you’re

searching for an excellent option to

beat facial volume loss.