Dermal fillers

Written by Dr Jill Tomlinson on .

Why consider dermal fillers?

Dermal fillers can be used anywhere on the face, body and hands to correct lines and wrinkles, to add volume and to improve definition.

What can dermal fillers be used for?

female lower face hand and neck

When done with an expert hand and artistic eye, dermal fillers can be used to

  • soften wrinkles and lines in areas including the forehead, brow, or between the nose and mouth
  • correct scars and depressions in the skin
  • add definition to the lip line, create a "pout" and reduce lip lines 
  • provide a "lift" to the corners of the mouth
  • raise the outer eyebrows
  • reshape the chin
  • enhance the cheekbones
  • add volume to the lips, cheeks, the "tear troughs" under the eyes and the back of the hands
  • smooth out irregularities in the contour of the nose or enhance the bridge of the nose (a "non-surgical rhinoplasty")

What dermal fillers do you use?

The dermal fillers that I use in office-based procedures are hyaluronic gel, calcium hydroxylapatite and polyacrylamide hydrogel. They are synthetic products that are not derived from animals.

Hyaluronic gels are made of natural polysaccharides that are found in connective tissue, synovial fluid and other body tissues. The product used has a low potential for allergic reactions and was approved by the Therapeutic Goods Administration in 2008.

Calcium hydroxylapatite is the primary mineral in bone and teeth. In the filler product the calcium hydroxylapatite is suspended in a gel made primarily of water and glycerin, with a small amount of sodium carboxymethylcellulose (to make the gel consistency). Once the product is injected your body gradually replaces the gel with collagen and the calcium hydroxylapatite remains at the site of injection, providing long-term but non-permanent volume restoration.

Polyacrylamide hydrogel is a non-absorbable, permanent soft tissue filler. Once injected it maintains its size and shape, becoming a stable part of the tissue. Over time the hydrogel becomes vascularised which allows access for immune cells. Available safey surveillance shows a complication rate of less than 1 per 1000 syringes (<0.1%) based on over 400,000 treatments over 10 years.

In the day surgery setting I also offer volume replacement with fat grafting. Fat grafting can provide long-term enhancements. Because your own cells are used much greater volumes replacement can be performed although the duration of the effect is less predictable than with hyaluronic gel fillers. Fat grafting is performed in an operating theatre under anaesthetic and is most commonly performed at the same time as other surgical procedures on the face, such as blepharoplasty or facelift.

Which dermal filler should I have?

eyesglabellaI will recommend a filler to you based on my assessment of the area you are seeking treatment on. The calcium hydroxylapatite filler lasts longer than the hyaluronic gels but is not suitable for very superficial areas of the body. For instance, in lip enhancement I recommend a hyaluronic gel filler. Using calcium hydroxylapatite in the lips would have an unacceptable risk of lumps.

If you wish to have permanent results then a permanent filler may be the best option for you.

In the day surgery setting I also offer volume replacement with fat grafting. Fat grafting can provide long-term enhancements. Because your own cells are used much greater volumes replacement can be performed although the duration of the effect is less predictable than with hyaluronic gel fillers. Fat grafting is performed in an operating theatre under anaesthetic and is most commonly performed at the same time as other surgical procedures on the face, such as blepharoplasty or facelift.

How long do dermal fillers last?

 

The duration varies according to the site of the injection and the type of dermal filler used. Generally the effect of hyaluronic gels is visible for 4-8 months; sometimes the effect lasts up to 12 months. Calcium hydroxylapatite fillers tend to last longer, with 12-18 months being a reasonable estimate. Even if you have had the same product in the same site before the duration is not guaranteed to be the same the second time - although it's likely to be a reasonable estimate. The polyacrylamide hydrogel dermal filler is a permanent filler, so the effects do not wear off.

Dermal fillers are absorbed more quickly from areas that are mobile (such as the lips) and from very superficial areas (such as the lip line). Lip enhancement can be repeated as often as is desired. Photographs of your treatment area are taken before and after treatment to provide you and I with clear reference points.

Who should not have dermal fillers?

Patients who are taking blood thinners (such as aspirin, warfarin and clopidogrel) are more susceptible to the complications of bleeding and bruising. If you are allergic to dermal fillers you should not have these products. Patients who are extremely needle phobic are not advised to have dermal fillers. If you have an infection at the site of the proposed injection you should not have dermal fillers injected into the area until it has completely resolved. The safety of dermal fillers in pregnant and breastfeeding women has not been established. Permanent dermal fillers are not suitable for individuals who regularly take corticosteroids or anti-inflammatory medications (such as ibuprofen), and individuals who are allergic to antibiotics.

Are dermal fillers painful?

No one likes injections but I find that most people who are very worried about the pain of dermal filler injections overestimate the amount of pain that they will experience. There are a number of options available to you to minimise the pain of the procedure. I recommend that patients take paracetamol before the procedure. Additional pain control options that will be discussed with you at your consultation include the use of nerve blocks, local anaesthetic cream and/or ice application. Local anaesthetic cream takes approximately 45 minutes to take effect; if you wish to use this option please advise at the time of booking your appointment so that we can schedule you a two-part appointment.

What can go wrong (complications)?

enquiringwomandecolletagefaceIt is normal to have some swelling for 48 hours after the procedure. You can minimise this by i) avoiding aspirin and other blood thinners in the week before the procedure, ii) by applying cool packs to the area after the procedure, and iii) by avoiding strenuous exercise for 24-48 hours after the procedure.

Unexpected complications include:

  • significant bruising and bleeding;
  • significant swelling and redness at the injection site;
  • persistent itching;
  • skin discolouration;
  • bacterial or viral infection*;
  • ulceration of the skin around the injection site;
  • lumps or nodules at the site of the injection; and
  • an allergic reaction.

What does it cost?

The cost of a consultation plus injectables varies according to what product is used, who administers the injectables and how long your treatment consultation is. If you have not had dermal filler treatments previously we recommend that you schedule an initial consultation with one of our practice nurses to discuss treatment options and the effects of different treatments. If you have not had an injectable treatment within the last 12 months at our practice you will need to be seen by Dr Tomlinson prior to the administration of any injectables as these are prescription medications. 

Treatment / Injector Dr Jill Tomlinson Nurse Beth or Selina
Moderate facial wrinkles

1mL $540

2mL $830

1mL $355

2mL $645

Deep facial wrinkles

1mL $575

2mL $900

1mL $390

2mL $715

Facial reshaping

1.2mL $600

2.4mL $950

1.2mL $415

2.4mL $765

Lip enhancement

1mL $580

2mL $910

1mL $395

2mL $725

Dermal rejuvenation

1mL $440

2mL $630

1mL $255

2mL $445

Tear trough

1mL $540

2mL $830

1mL $355

2mL $645

Like to find out more?

woman searching newspaper on phoneCall us to arrange an appointment to discuss how we can help you to achieve your desired goals. We ask that all patients who receive dermal fillers return for a no-charge review appointment approximately 2 weeks after the procedure to assess the results so please plan your schedule to accommodate this.

*NB If you get cold sores a lip enhancement procedure with dermal fillers may precipitate a cold sore infection. Antiviral treatment with tablets or ointment will minimise this. If you have frequent cold sores I recommend taking preventative medication at the time of lip augmentation. If you have a pre-existing active infection of any type at the site of the proposed injections I recommend that the procedure be delayed until the infection has been cleared for 2-4 weeks. Dermal filler treatment will not be performed while you have an active infection at the treatment site.

Website Disclaimer

This website is authored by Dr Jillian Tomlinson, a fully qualified plastic, reconstructive and hand surgeon who practices in Melbourne, Australia. This website aims to inform patients and health professionals about hand surgery, illness prevention and the practice philosophy of Dr Jill Tomlinson. This website's content is designed to complement, not replace, the relationship between a patient and his/her own doctor. The information is not intended to replace the advice of a health professional. This website does not host or receive funding from advertising or from the display of commercial content.