Fillers

Dermal fillers are commonly used in plastic surgery and cosmetic medicine – due to Australian law we will refer to them on this website simply as fillers but commercially they are often known by their product names.

Fillers are all different types of a synthetic product containing normal constituents of skin. The most common type of filler is based on hyaluronic acid which is naturally occurring in the skin.

These products are used a volume filler to improve contours of the face and other sites. In the face the addition of facial volume can reverse the signs of aging by reducing:

  • Peri-oral lines (lines around the lips)
  • Nasolabial lines
  • eye bags (via treatment of the tear troughs)
  • acne or facial scars or depressions

They can also be used to add volume to:

  • The cheeks – to enhance cheek definition and produce a pleasing S curve to the cheek. Treatment in this area also reduces the nasolabial lines
  • The lips – to create more volume, improve upper lip show and pout, improve the natural philtral columns and cupids bow (she defining features of upper lip just below the nose)
  • Tear troughs to reduce eye bags and lines
  • Jaw line – to reduce jowls and define the jaw line in women, and to create a squared chiselled appearance in men
  • Chin – to improve nose and chin relationship, improve facial jowls, and improve the facial profile.
  • Temples to improve temporal hollowing
  • Foreheads to smoothen natural contours of the bone
  • Nose to produce a ‘liquid rhinoplasty’.

For all the above reasons, in cosmetic plastic surgery, fillers are a great adjunct for facial rejuvenation. They can be used alone but often in concert with anti-wrinkle injections, skin care and facial treatments can produce a dramatic improvement in facial appearance without surgery. We also often employ them with surgery to enhance and further improve results achieved from face and neck lifts.

The Skill in Filler Injections: Why Come to a Plastic Surgery Practice?

  • The skill in administering filler injections for facial rejuvenation is based on a precise understanding of the underlying anatomy.
  • In a plastic surgery practice the surgeon him/herself may perform the filler injections or they may be performed by experienced practice nurses working in the practice. Nurses working with a plastic surgeon have received direct training from both the surgeon as well as industry leaders to allow them with the skill, knowledge and experience that allows a surgeon to trust them with their patient and reputation.
  • In some cases the filler is placed more superficially (however if placed too close to the skin, the filler can produce a bluish appearance to the region known as the Tyndall effect), and in other areas it is placed close to the bone. The former is usually done to improve tone, lines and wrinkles while the latter is usually performed for structural lifting.
  • In either case a thorough knowledge of anatomy is needed to avoid critical blood vessels, as almost any blood vessel of the face, if injected under pressure, can cause the catastrophic complication of blindness, or skin necrosis.
  • Furthermore the art of filler injection is in subtlety. We firmly believe in the ‘less is more’ approach as excessive filler material can create unwanted appearances as these can look ‘done’ and unnatural.
  • In a plastic surgery practice, we will only suggest filler treatment if it’s the right thing for you – for instance if your wrinkles or facial appearance are the result of loose skin, you may require a different treatment or surgical procedure, in which case spending time and money on filler injections may not be worthwhile.

Procedure Information

  • An initial consultation with Dr Aggarwal is required to determine if you have any contraindications to the treatment (where it may not be safe for you to have filler injections), and to determine the location and total volume of the injections.
  • Most injections are performed by our practice nurse, however you may choose to have Dr Aggarwal perform the injections for you.
  • Most injections are performed the same day except in patients who are taking blood thinning medications, or other over the counter agents that thin the blood.
  • The injections are performed in our procedure room, at our main Gordon practice. Ice is placed over the area to be treated for 10 minutes or so, occasionally some numbing cream is also applied if patients are concerned. The nurse then gently injects the agreed upon area using an needle or cannula.
  • After treatment, you may be monitored in the office for side effects, after which you can return to work. Some bruising and discomfort may occur during injection, and you are best to apply an ice pack to the area to reduce this post-treatment.

The initial consultation and injections take approximately 1 hour.

  • Effects begin immediately. There may be some bruising and swelling which will subside over the following week (it may worsen in the first 2- 2 days); and therefore it can take a week or so to determine final outcome from the filler injection.
  • In general we will ask patients to return at the 2 week mark, to review the effects.

Procedure FAQs

  • Please visit our price list for further information.
  • Initial consultation is $220 plus product cost (for the average patient it is $990). Subsequent top up consultations are not charged if we are injecting the same areas as your initial consultation – you are only charged the product cost.
  • In general injections by Dr Aggarwal will attract a higher fee.

In general the cost per mL of filler is often more at a plastic surgery clinic. This is because:

  • the injections are being performed by the plastic surgeon or by experienced plastic surgery nurses. You are paying for the skill and expertise of the injector and in general you get what you pay for.
  • We will only ever use products from the largest manufacturers of fillers. This is generally Galderma, or Allergan, or Merz. We do not source cheap filler material, or permanent fillers. These reputable filler products are expensive, because they have proven track record with respect to safety.
  • We only ever inject in the safest environment:
    • Legally a doctor must be present on site for the injections. This is often not the case in cheaper clinics or cosmetic surgeries.
    • The procedure is performed in our procedure room under good lighting – some cheaper treatment may be performed in the back room of beauty clinics without any doctor supervision
    • We use appropriate preparation with ice packs or anaesthetic cream reducing your discomfort.
    • We have knowledge of underlying facial anatomy and therefore argue less risk of inadvertent injection of a critical blood vessel. There has been one case of blindness due to fillers in Sydney (not in a plastic surgery clinic). If a critical event was to occur, we have hyalase on site, to dissolve filler material. This can make the difference between a safe and catastrophic outcome. Again, cheaper sites may not stock this at all as hyalase is very expensive.
  • We would encourage you to seek injectables only where they are performed safely, and by an expert practitioner.

Risks & Complications

Filler injections are not recommended for:

  • Patients who are on blood thinning medications
  • Patients taking over the counter supplements than thin the blood such as Fish Oil, Gingko, Ginseng, Turmeric, and Aspirin or Nurofen based medicines.
  • Patients who have previously had a reaction to or significant complications from filler injections

General risks of filler injections include

  • Bruising
  • Discomfort
  • Swelling
  • Infection – the skin is prepped before injection, however there is a small risk of infection.

Specific risks of antiwrinkle injections include

  • Insufficient effect – the desired result is less than what you desired. This may require additional volumes of filler material as not all areas can be treated with a single syringe of filler.
  • Asymmetry – filler can improve or accentuate asymmetries. Furthermore it can create an asymmetry not present prior to injection.
  • Lumps or nodules – from uneven filler material placement however most of these can be massaged away
  • Tyndall effect – if filler is placed too superficially it can create a bluish tinge to the area
  • Over-injection – can create an appearance that looks unnatural, or ‘done’. Remember that initial bruising or swelling can add to this appearance and the end result will not be known until the swelling has subsided.
  • Blockage of a critical vessel
    • The entire face is rich with blood vessels
    • All of these blood vessels have connections to one another
    • Injection of blood vessels especially veins under high pressure can result in a large amount of filler material entering the lumen of that blood vessel
    • This can then be transported to an area where it causes a critical blockage
    • The most significant complication is blindness (till date this has occurred in 1 patient in a Sydney clinic from injection of a filler material) or skin necrosis (such as that near the nostrils or nasal tip).
  • Critical problems, if they occur with hyaluronic acid filler, can be dissolved with hyalase.

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Meet Dr Aggarwal

Dr Aggarwal is a well regarded, respected, highly skilled and experienced Specialist Plastic Surgeon. Graduating at the top of his class throughout his training, Dr Aggarwal has completed fellowship training at some of the world’s most prestigious reconstructive and cosmetic plastic surgery institutions. He continues to publish research is prestigious plastic surgery journals, and is actively involved in the training of future plastic surgeons.

What sets Dr Aggarwal apart from others is his personal, affable and warm nature. Not only does he pay attention to detail, to producing natural, beautiful results but he ensures that the patient’s journey is just as special as their outcome. Dr Aggarwal looks after patients at two of Sydney’s most prestigious public hospital campuses (RPA and POWH/RHW), and operates privately on the North Shore.

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Suite 13, Level 3, 924 Pacific Highway, Gordon NSW 2072

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info@modeplasticsurgery.com.au

Suite 13, 924 Pacific Highway
Gordon NSW 2072, Australia

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