Dermal fillers can help restore volume and fullness to the skin. Learn what happens in this cosmetic procedure as The Victorian Cosmetic Institute gives an overview on facial volume loss and dermal fillers.

1. Facial Volume Loss
and Dermal Fillers

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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,

16. 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

17. 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

18. 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.

19. 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.

20. 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

21. 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.

22. 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,

23. and you've got really hollow backs of hands, really wrinkly,
filler can be injected and soften out the back of your hands.

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