Dermal Fillers: For Wrinkles, Lips & Facial Shaping: Melbourne

Facial volume loss is one of the key factors in the ageing process, and dermal fillers can help to replenish this lost volume and rejuvenate the face. Fillers can also be used to shape and enhance areas of the face, for example fillers can be used to straighten a nose,  or enhance a chin.

The Victorian Cosmetic Institute offers a wide variety of dermal fillers, each suited to different applications. We will advise you on which dermal filler is best for you at the time of consultation. We use a combination of fillers lasting from 4 to 24 months. We do not advocate the use of permanent fillers as we believe that there is an increased risk of serious complications with these fillers including infection, granuloma formation (permanent lump formation that can occur even years after administration) requiring surgical removal, and filler misplacement.

Due to TGA regulations, the exact name of some of the dermal fillers used cannot be mentioned. Instead they will be termed;

NB: Lidocaine is a local anaesthetic that is mixed with the filler to make it less painful to inject.

Dermal fillers, type R and P  are made from a clear gel composed of a substance that is naturally found in skin. They are usually injected into deeper lines or folds around the mouth, from the nose to the corners of the mouth, and are commonly used for lip enhancement and facial shaping e.g for cheek enhancement, nose shaping, chin shaping,  and around the eye socket/tear troughs to fill out any hollowness there. This filler generally last for about 4 to 24 months depending on the area treated.

Dermal filler, filler type JU and JU+ from Allergan is made from a similar substance to type R and P. It is an excellent filler as it is softer than filler type R/P and has a more natural feel. It can be used in all the areas that filler type R/P can be used in, and it is especially suited to lip enhancement, as it tends to cause less swelling than other fillers and last for around 3 months longer than filler type R in the lips. It creates natural and soft lips and can be easily used to define and/or enlarge lips.

Allergan and Q-MED also have versions their fillers type JU, JU+, type R / P that have the local anaesthetic lidocaine blended into the filler.  This significantly reduces the amount of pain during a filler procedure in those areas that are not anaesthetised with nerve blocks. It also allows fillers to be performed without nerve blocks should this be a preference of the patient. For example, it is possible to fill lips/nasolabial folds with minimal discomfort even without a nerve block.

For areas that need more volumising, such as the cheeks, and for a longer lasting filler, fillers type RSQ or filler type V can be used. It is made of a similar substance to filler type R/P/JU/JU+, but tends to be thicker and more volumising. It is therefore suited to enhancing chins and cheeks in particular. 

Case Study 2

This before and after case study is one of our doctors. She had her naso-labial lines (the lines from the corners of the mouth to the nose) filled with filler type JU+  0.8mL. The after picture was taken approximately 2 weeks after the treatment.

 

For fine lines, including vertical upper lip lines, especially, lines around the mouth and eyes, we can use a product JRefine / RVL  that is injected very superficially. These fillers are very fine and can be placed superficially in the skin without causing lumps. 

Furthermore, there is a substance called hyaluronidase that can very quickly dissolve and remove all of the above filler types (except for Radiesse) , should there be any misplacement of product, undesirable effect, or lumps. For more information on hyaluronidase, click here.

 

Radiesse is filler that is based on calcium microspheres that usually lasts for around 18 months. It is particularly suited to facial volumising in areas such as the cheeks, nasolabial lines, and mouth corners. It can be used for chin and cheek enhancement, and even to shape noses (for those who don't want to undergo surgery). Radiesse is an excellent filler for the nose, as it can last for a long period of time here and feels natural in this area. It is not suited to lips, or fine lines. Instead it is more suited to enhancing volume in larger skin folds, or areas of fat loss.

Dermal fillers are most commonly used in the lips, jowls, marionette lines, brows, cheeks, chins, naso-labial folds (the fold from the nose to the corners of the mouth), and in permanent frown lines.

Other commonly treated areas with dermal fillers include nose reshaping for those who do not want to undergo surgery, and also just under the eyebrows to give an eyebrow lift or to fill out any hollows there.

Tear troughs, or the hollows that occur under the lower eyelid, can also be filled with fillers type JU/R. They help to smooth the transition between the lower eyelids and the cheek, and therefore reducing the appearance of under eye hollows and/or fatty buldges.

One of the most popular reasons for dermal filler use is lip enhancement. Dermal fillers can be used to outline the border of the lips to enhance the definition of lips or in the body of the lips to enhance lip size and pout. Filler type JU/JU+ is an excellent filler that is particularly suited to the lips due to its soft and malleable nature. It tends to last slightly longer than other equivalent fillers in the lips also. It tends to create less of a 'trout pout' or 'duck' look than other fillers in the lips.

Cheeks and naso-labial lines, or the lines that go from the corners of the mouth to the corners of the nose are usually filled with type R/P,  JU/JU+/V/RSQ or Radiesse. Type R/P/ JU/JU+ tend to last a shorter time in this area (around 6 months) and are reversible, whereas Radiesse tends to last longer. Although more expensive, Radiesse tends to create more volumising of the fold, and lasts longer.  RSQ and type V can also be used, and these fillers provide superior volumisation and the option of reversibility.

For more information on the use of dermal fillers for non-surgical facial shaping, click here. 

Treatment usually involves the application of local anaesthetic cream to the treated area or a nerve block prior to injection. The dermal filler is then comfortably injected into the treated area to fill out the line, wrinkle or fold. For those who are nervous about the procedure (this is very normal!) we can provide nitrous oxide or 'laughing gas' to help settle your nerves and to help reduce any discomfort.

Treatment times vary depending on the amount of fillers required and the areas treated, but generally take from 30 to 60 minutes.

After treatment, it is possible to apply make-up if applicable, and to go about your normal activities. We usually ask you to refrain from heavy exercise however.

Treatment with dermal fillers sometimes does take more than one session to get the best results. The first treatment lays the foundation for the subsequent treatments, and future treatments allow for any adjustments to be made.

What are the side effects of filler treatments?

There is usually some transient redness after the injections. Swelling is also present after the procedure, especially with any lip enhancement procedure. Swelling of other areas post-treatment tends to temporarily enhance the effect of the dermal filler, and it often takes 3 or more days to see the actual real improvement without swelling.

Bruising can also occur, and if it does, it can take normally take a week or two to completely disappear. Make-up/lip stick can be worn (if applicable) soon after treatment should there be a need.

Asymmetry is also possible, but correctable on a subsequent visit.

Small lumps can occur, and these will either dissipate in a few weeks, or may require dissolving with hyaluronidase.

Note that if you have a history of cold sores and the treatment area is around the mouth, then you should notify your treating doctor as filler treatment can cause cold sore flare ups. You may be instructed to take anti-viral medications prior to treatment if this is the case. 

Yes, there are few risks associated with the use of dermal fillers and few long-term side effects with the (temporary) fillers used at The Victorian Cosmetic Institute. Most fillers comprise of substances that are naturally present in the body. Dermal fillers have been used safely for cosmetic reasons for over 20 years.

Our opinion of permanent fillers is that their safety profile is not as high as temporary fillers. Permanent fillers have previously been fraught with complications such as severe infections and lump formation that requires surgical excision. No permanent fillers are used at The Victorian Cosmetic Institute.

The cost of dermal fillers depends on the amount injected and the number of syringes injected per session.

Table: cost of multiple syringes (done in one session)

Syringe no.  / filler type	JU .8mL JU+ .8mL JUR 0.6mL R / P 1mL Radiesse 0.3mL JRefine 0.6mL RVL 2mL	V 2mL RSQ 2mL Radiesse 1.3mL	R 0.5ml
1	740	1650	420
2	592 (20% off)	1155 (30% off)	336 (20% off)
3	518 (30% off)	825 (50% off)	294 (30% off)
4	444 (40% off)	825 (50% off)	252 (40% off)
5	370 (50% off)	825 (50% off)	210 (50% off)

• Prices inclusive of GST
• Most expensive fillers counted first.
• The discount is only applied for multiple syringes of filler in one session, not across different sessions.
  
• After 5 syringes, price of additional syringes is equal to price of 5th syringe
• When using V, RSQ, Radiesse 1.3mL in conjuction with the other fillers, V/RSQ/Radiesse 1.3mL count as 2 syringes of other fillers in the pricing structure e.g price of 1V + 1JU = 1650 + 518
• The amount/type of dermal fillers required is listed in the