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Why is there so much facial filler weirdness around?

In a nutshell more is not better. Inexperienced injectors seem completely unaware of facial balance.

Excessive facial volume makes you look old, and can have permanent consequences.

Lip filler when done badly is one of the most obvious signs of work.

Not every lip needs to be big and not every lip shape is suitable for large amounts of filling.

Not every tear trough or nasolabial fold need obliteration.

A youthful face has normal peaks and troughs and even lines. Most people have normal cheek volume into their early thirties. There is no need to go crazy with cheek filler before this time. A cheek double the size it was your twenties when you are fifty also looks very odd.

What is the best way to judge if filler is suitable for my problems?

Filler can correct deep lines, volume loss and correct facial imbalance. When done subtly and placed correctly it can also enhance features.

Looking at old photos is the best way to determine your own amount of volume loss.

People with full cheeks may have always had a nasolabial fold, even in their teens for example.

Like most cosmetic enhancements, a lot of what is possible and what will look good depends on what you start with.

Does a filler injection hurt?

With adequate topical local anaesthetic prior to injection, the filler procedure is typically comfortable. There is a sensation of something being done, however should not be particularly painful.

The filler has local mixed into it as well to further increase comfort.

What brand and type of filler am I getting?

Hyaluronic acid filler is the most common type used, favoured because it is a synthetic version of hyaluronic acid found in our own extracellular tissues.

You should always ask what brand and how much you are getting. It’s always good to know this in the event of any problems with a particular brand.

As well, within any given brand, there are different types of fillers designed for different areas.

Most fillers come in amounts of one ml and in most people the 1ml can be used in its entirety.

Dr Simone has been using brands that have been on the market for over 10 years. This minimises the chances of any side effects which can occur with newer less tested products.

How much experience does your injector have?

With injections now trivialised to every corner medispa, and the industry poorly regulated, there are many different levels of experience (or inexperience) out there.

A precise knowledge of facial anatomy combined with aesthetic judgement are critical in achieving natural looking results. There are filler “courses” for beginners but good taste in injecting is hard to teach.

Fillers are medical devices that can have serious consequences. In many American states, only doctors are allowed to inject. You should at the very least be seen and assessed by a doctor prior to an injection as they are the only ones who can legally prescribe fillers in Australia. It is frightening that all you need to inject filler in some places is a weekend course.

What if I don’t like the filler?

There is a dissolution agent, hyaluronidase available. The sooner after filling this is attempted the better the results.

See here for a guide to dissolving filler.

How long will filler last?

This depends on where the product is placed, the type of product and individual patient factors. It is said people with a faster metabolism or that exercise a lot break down fillers faster.

In a static area such as the nose or tear trough it can last up to 2 years.

In lips as they are highly mobile, it usually lasts 6 months-1 year.

Beware if you are not given a filler consent form…

This is a big red flag. You need to be consented for the risks of filler. Some of these can be extremely serious. If you haven’t had the risks discussed and signed a form, this is not the correct process.

Ask about emergency filler procedures

A proper practice has hyaluronidase on hand, amongst other tools to deal with a potential rare filler emergency. The immediate availability of such products could make a difference to salvaging a serious problem.

How do I know if the filler procedure has gone wrong?

Swelling and bruising after the procedure is normal. It can be significant, especially around the eyes.

Change in skin colour (white or blue) could be signs of a blood vessel occlusion. Redness overlying the injection, pain or large lumps are not normal and should be investigated.

What should I do to minimise bruising with filler injection?

Stop all blood thinners such as aspirin, other anti-inflammatories (such as neurofen) and fish oil.

Arnica started a couple of days before the procedure and continued for a week afterwards can help the procedure.

Icing straight after the procedure is important in minimising swelling and bruising.

When can I expect to look normal after filler injection?

Some patients can walk out and only they will notice something different. Others might swell or bruise up for over a week.

Higher risk sites for bruising are around the eyes.

Even though you won’t permanently look ducky, even with the right injection technique there can be some upper lip swelling that looks odd for a couple of days. Smaller lip injections with minimal swelling may look presentable immediately.

What can I do after the filler injection?

Unlike anti-wrinkle muscle injections which can migrate for the first 4 hours after injection, as a precaution it is best not do vigorous exercise or hang upside down the day of an injection.

Does filler cause permanent changes?

If used excessively it can stretch the overlying skin.

Used to fill lines, especially deep glabellar lines, some can be permanently corrected (due to microneedling technique with injecting).

In my experience, overinjecting never ever truly goes back to zero, even with dissolution some deformity may remain.

With chronic injecting around the upper lip, it can permanently obliterate philtral columns and lengthen the upper lip (which is in itself ageing).

Beware if you’re being pushed several mls of filler on your first visit

Most people don’t need more than a few mls of filler.

Especially when new to filler, I like to ease people into the process and start with 1-2ml. You can always come back for more.

It will swell for a few weeks after injection. If you are overinjected when you walk out, the results be worse when swelling sets in.

And be especially aware if your injector looks strange.

If they look strange, then their aesthetic probably is too.

Read an interesting article here on the consequence of overinjecting.


Follow Dr Simone’s Weekly Facial Weirdit on Instagram @drsimoneplasticsurgeonsydney to see the consequences of bad injecting.