What you should know about fillers......

It has been a while since I wrote anything about fillers. However, recently during one of my socializing events I was faced with a lot of questions regarding fillers and botox. There was a great confusion between the two, still, despite both being very separate and totally different entities in terms of chemical compound and function.

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1. So what Are Fillers?

Fillers are substances you use to fill up areas of your face or body which has underwent volume depletion and is also used to reduce static lines. It can be from any substance like silicone gel, collagen, hyaluronic acid, calcium hydroxypatite, PLLA, PMMA or even biological fillers like heated PRP or fats. The most commonly used in a medical aesthetic practice are the hyaluronic acid fillers which are non-permanent and lasts between 6 months all the way to 24 months depending on how the cross-linking and molecular weight of the filler.

2. Are All Fillers the Same?

Definitely not. Different chemicals form different fillers. Therefore it is really important to know what type of fillers were used on your face. Some may not be reversible. Always ask your doctor what he or she is using. Not only it is good for you to know, but it also helps the subsequent treatments if you require any.

3. If I do not like the filler effect can I remove or change it?

Only Hyaluronic acid fillers can be diluted with hyaluronidase. The other fillers are almost impossible to remove without any surgical intervention. So make sure you know what you are putting under your skin.

4. How much does fillers usually cost?

Fillers are usually quoted by per syringe of usage. An original high-end filler product can cost anywhere from RM 1600-RM 3600 per syringe. Some other lesser brands cost between RM 800- RM 1500 per syringe depending on where it was made and specifications. Anything sold cheaper than that would either be non-original products or maybe expired fillers? Or sometimes the doctor is not so experienced that they give cheaper pricing to practice. Honestly, who would charge super cheap for well trained hands? The training itself requires a lot of money.

5. Does it hurt?

Honestly, any procedure involving needles would hurt to some extent, but depending on the type of filler, some fillers hurt more than the rest. It also depends on whether there is any lidocaine inside the filler that will reduce pain tremendously. Local numbing like creams can be used although it doesn't really make much difference physically (maybe psychologically) and local infusion of lidocaine does help to reduce pain effectively although very specific filler work would be impaired as there is already tissue distortion. You can discuss with your doctor pain management techniques that can make your experience much tolerable. So apparently, you do not need to suffer too much pain for beauty. If, in event the doctor injects and suddenly there is severe pain, please speak up and tell him or her. Severe pain might mean that an artery is being hit, or other crucial vessels, or even allergy to the filler.

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6. What can fillers do for me?

I always tell my patients, imagine fillers are like cement or plasticine. You can create volume which is not there like nose, cheeks or chin. You can redefine areas of your face and make contours, you can even smoothen deep lines. You can redefine your lips to make it more prominent or replenish the younger look. You can put it at your tear trough areas and reduce the sagged eye look and make you look fresher. You can reduce appearance of scars and improve photo angles (if your doctor is really really good). 

7. If I use a good filler, will it guarantee a good effect on me?

A good filler is always recommended to get the best effect. However, the other more important component is the doctor. How good is he/she at creating the effect you want? A lot of people think that filler injecting is just about injecting, but actually it is not. The best filler injectors in the world can put fillers on to a persons face and make him or her look more attractive but at the same time make it look as natural as possible that to most people, it doesn't look like any fillers were done. (Until you compare the before picture).

8. So say that I am interested, how sure can I be safe to do the procedure?

For newbies and virgins, I usually tell them to stick to hyaluronic acid fillers for any work because at least if you do not like it, we can dissolve it or wait for the effect to go off. The other most important thing is how well the doctor is trained because not all doctors are trained to do fillers. In my years of training other doctors practical filler techniques, I notice that even the way a doctor holds the syringe is enough to tell me how experienced they are. It is not the same as blood taking or other hospital procedures. Furthermore, to train the hand to be steady enough to evacuate the product from the syringe equally is quite a task if you are not use to it. To create beautiful natural looking work requires an additional artistic eye to detail which not all doctors have. Furthermore, if any problems from the procedure were to arise, a trained aesthetic physician would know what to do. Beautician filler injectors are the worst because for 1, you do not know what are they really using (they have no access to original medical grade products), 2. They are not trained to understand surgical anatomy or deal with complications, 3rd, if you allow a beautician to inject you, you cannot take any action on to them if the job is not done well, as they are not regulated by law, and you would have committed the first offence of going to a non-professional. Furthermore, there is a science and mathematical equation when we put fillers on to a person's face that is being taught in our training so that you remain looking like a human (and not some weird alien from star trek or some other sci-fi movie).

If you have any more questions on fillers, feel free to contact us at drmmclinic@gmail.com or 03-21106608.

Know Your Injector........

Fillers and BTA (botox/dysport) are still perhaps the bread and butter of medical aesthetics despite the emergence of new technologies and machines. It is a simple technique requiring injection of products into the skin layers/muscle to create a more appealing youthful look almost instantly. It is a very lucrative business too. Because of this, a lot of people try to learn to inject. Even if they have no medical background. Hence you will see that in certain places, beauticians or aestheticians as they call themselves injecting fillers and products into customers and so-called 'cheaper' price than doctors. (Really?)

What most people do not realize is that hypodermic needles and syringes are only licensed to be used by doctors in this country (and also most other countries as well). Even nurses or MAs are not licensed to use needles unless under the supervision of a doctor or in Emergency cases. I remembered this so well because during my practice in the government sectors, the nurses at that particular hospital refused to do any blood taking and kept quoting this rule in the nurse/MA handbook. Funnily, when you move to the private sector the nurses are all so willing to do injections, especially fillers and BTA.

The thing a lot of people do not get about doing injections to your face, although you can get really good results with minimal downtime, you can also have very bad results that would last you quite a bit and for some cases of those using semi permanent or permanent fillers it can be life long and would require surgery. A lot of people know this, but why do they still risk going to beauticians or other unqualified injectors to do their face? The most common reason is peer pressure, second would be cost and third would be some bad experience with an untrained doctor somewhere that made them lose confidence with professionals. Between fillers and BTA, fillers are worst because usually the beauticians use illegal products that lasts too long and has no reversal.

So for those who wish to indulge in injection rejuvenation, I will give you a few tips:

1. Know your injector - Are they a qualified injector i.e. a real doctor? (A lot of fake ones parading in my country). Are they really trained to do the injections? Not all doctors are trained to do aesthetic injections so they maybe a licensed doctor but may not have the skill. Going for 1 workshop does not quite cut it as being trained. Are you comfortable with the doctor? Has he/she answered all your queries and doubts? Will he/she be following you up? Will he/she be responsible for the work done if any problem arises? 

2. Know your product. What is it that the person is injecting into your face. Is it hyaluronic acid filler? Is it Radiesse or Aquamid? Is it collagen - if it is collagen - purely collagen/bovine/marine or porcine? A lot of the collagen fillers from beauticians are mixed with liquid silicons hence why it just does not disappear. Is the product safe? Just because the person says so, doesn't mean its safe. Ask for safety profile. Are you sure its the product claimed by the injector or did they take out another product from a different box for the injection. Google information about the brand.

3. Are the products sterile? The last thing you want is getting an infection under the skin from using products already contaminated. In my clinic, I open a new syringe in front of the patient to show its sterile. Infections due to contaminated fillers are a nightmare and may take weeks to heal. It would require high end antibiotics, dilution of filler or even excision. In some cases, we would be giving steroids to stop inflammation from the infection. It can cause you to have a mark or a scar from a so-called suppose to be very safe procedure.

4. Is the premise you are receiving an injection a proper medical facility with license? Beauty salons are not licensed to do injections, nor are hotel rooms, cars nor boutiques nor spas. So if it is not a clinic, better think twice because likely the hygiene of the place is not up to par and you cannot sue the person if anything went wrong since it is not in the right premise. You'll just be bombarded by the defense lawyer, stating that you agreed to be injected in the premise when you know its illegal.

5. Check the current market price for services before deciding on having it done to give you a rough idea of what is the normal range. Usually for promotions, the price of the service would not be discounted more than 30% in view the cost to acquire original products is expensive. If the clinic or center is giving too cheap a promotion, you should bear in mind a few things. Its either the product is expiring (already expired) or they've reduced the amount of filler/bta given but charged at a cheaper price. The end result would be unsatisfactory results or treatment not lasting what it should. And this would not only cause disappointment but also reduce confidence towards the treatment altogether.

Courtesy of http://www.plasticcelebritysurgery.com/2011/09/worst-celebrity-plastic-surgery-before.html

For more info you can email us at info@faceworks-clinic.com / faceworksclinic@gmail.com. For appointments, please call us at 03-21440080 or text 014-2233268.

The perfect nose........

The nose has always been one of the most concerned aesthetic areas of the face. Depending on your ethnicity, the problem with the nose would differ from a Caucasian wanting to perfect a defect, or an Asian whom are more likely to have a flatter nose bridge. The nose, being the center of your face would be among the first thing a person would notice when they look at you. Therefore, most people would want a perfect nose.

There are many techniques of improving the nose from rhinoplasty to implant insertion, reduction of the ala nasi and fillers. Filler injections have shown to be the easiest non-invasive method of nose augmentation and reshaping. When we mention fillers, most people will relate to hyaluronic acid fillers such as Juvederm, Teosyal, Perlane or the calcium hydroxypatite based i.e. Radiesse. Although these fillers give wonderful results in the hands of a skilled injector, many patients would start thinking about the hassle of having to come back and reinject every few months. If the fillers were in the cheeks or folds, it will be less noticeable when it becomes smaller, but the nose? It would be kind of funny to have the perfect nose in the beginning of the year, and by christmas it is reduced again. 

Hence, the appearance of semi-permanent fillers into the market such as collagen fillers, Bioalcamid and Aquamid. Collagen fillers although shows promising results has increased the worry of practitioners as to allergic reactions towards the animal component. In a few religions like Muslims and some Hindus, the use of bovine or porcine collagen is not preferred. Furthermore, results last up to 3 years only or even less. Hence we have non-animal products such as Bioalcamid and Aquamid.  Bioalcamid is more like an implant in gel form. When placed under the skin in the right manner will encapsulate and stay for 3-5 years with minimal change. It is removable by expressing out the capsule. However, it does require a good injecting skill and knowledge of the doctor to understand the gel implant and identify any risks early. For the nose, it can be placed at the bridge and will likely stay there, but there has been reported cases of migration (which I believe is due to the injector's technique). The only downside is that it needs bolus injections of the substance, hence fine sculpting of the nose may not be achievable.

Which comes to the next filler which is Aquamid. Aquamid is also a semi-permanent filler which has a lasting profile of 3-5 years but recently cross-section studies have shown that even after 10 years it is still there. It is 97% water based and does not form capsules. Usually after the 2nd month, the patient could not even feel the filler anymore because it integrates with the skin. It requires multiple injection techniques and a lot of local is given during each sitting. Because of this, usually 2-3 visits is required to achieve the best results. As far as anyone is concerned, Aquamid is the most preferred non-surgical nose augmentation technique for plastic surgeons and advanced filler injectors. In fact, the rate of surgical rhinoplasty has declined with the advancement of this product because it allows the surgeon to tailor the nose according to the patient's face, less aggressive and invasive, minimal downtime, and the best part, no sutures. It allows the doctor to fix defects in the nose in the clinic, and the patient can resume work the very first day with minimal redness or bruising compared to doing a rhinoplasty. 

How I usually consult a patient who wants to get their nose done will depend on how much the patient knows about fillers and what it does. For virgin noses, if the patient is unsure, I'd ask them to choose between HA or Radiesse first, then later plan for Aquamid. For Aquamid, I would normally only inject 1 syringe at a time with a 2 weekly follow-up for the 1st 3 months to ensure no signs of infection. Remember, it is almost irreversible, so doing 1 syringe at a time would be the best approach. As for pain, usually the first few injections to numb the nose will be felt. Some people do complain of a slight pain sensation after doing the filler for a few days and gradually improves. Most patients are happy with the filler and the results. Even a review after 1 year showed that there was not much change in the filler shape.

So what is the perfect nose? It depends on the individual patient's perception. At this moment a lot of people are interested in getting a Korean nose as how the Korean drama series actors and actresses look. Is it achievable? To a certain extent, yes, and the best part it does not involves surgery.

For more information or further inquiries, kindly contact the clinic for a proper consultation at 03-21440080 or email to info@faceworksclinic.com

Radiesse Workshop......

Last Sunday, I was at Pantai Hospital, Bangsar for the Radiesse Workshop organized by Servicom. The guest speaker was Dr Peter Huang, a well-known aesthetic plastic surgeon from Taiwan. It was my second encounter with Mr Huang, and both times I have been very impressed with his technique and work. Previously, it was a workshop on hyaluronic acid fillers, this time its Radiesse.

What is Radiesse? Radiesse is also a type of filler that you can inject into the face to fill up spaces or add volume to areas you need adding. It is made out of calcium hydroxypatite, which is almost equivalent to your bone. Compared to hyaluronic acid (HA) fillers (such as Restylane, Juvederm, or Teosyal) Radiesse is much harder and last approximately 15-18 months.

It is really good for nose bridges, because it does not expand as much as HA fillers do and it lasts longer. It can also be used for chin, nasolabial folds, marionette lines and for midface areas and enhancing cheek bones.

The injections are similar to HA technique where ideally you are given nerve blocks or analgesia to reduce pain initially. The process takes around 15 minutes to 1/2 an hour depending on how many areas you are doing. In terms of pain, some say that it is more painful than HA fillers, but nothing unbearable, and its only for a few hours after the blocks run out. Swelling is more than HA and usually it goes off after 2-3 days. Bruising is a complication and you may consider having the procedure done during the less busy days just in case, or use concealer if needed. The filler is soft and moldable within the first week - but I would usually ask my patients to wait until the swelling is gone before they try to remould the filler. Top-ups usually 2-4 weeks later, depending on suitability.

The only down side of it, is that you can't remove it once its in - so I would suggest that unless your mind is already set on having the filler done, you should keep to HA fillers which lasts shorter and can be dissolved with hyaluronidase. Another more important aspect is to be confident with your doctors injecting skills, which would make a difference to the outcome.

Interested to know more? You can email me at info@faceworksclinic.com or book an appointment for a chat at Faceworks Clinic - Tel : 03-21440080.