Dermal Fillers

The TGA have said that showing before and after pictures of dermal filler treatments is a way of advertising the substances used to achieve the results from the dermal filler injections. Because dermal fillers are prescription only substances, then advertising by showing before and after pictures where dermal fillers were used is not allowed. We have seen some of our colleagues posting before and after pictures of their filler treatments and they are saying it is OK to do so as long as the substance (dermal fillers) used is not mentioned. The problem with this, is that not describing the details of the amounts, costs and types of filler used might be considered by a different regulator – The Australian Health Practitioner Regulation Authority – to be misleading.

If you see any before and after pictures on our website, they won’t be on our wrinkle relaxer or dermal filler webpages. They will depict the results of treatments that do not require the use of any prescription only substances. We might, for example, feature before and after pictures from our laser treatments. To see our before and after pictures for dermal fillers, you will need to come in for a consultation, so that when we show you our work we can do so in the context of a personalised consultation where we can explain how the before and after pictures might be relevant to understanding your unique features and the treatment options that might be relevant for you.

Its very important to understand that our answer to this question is always going to be “You don’t need any dermal filler”. The formation of the physical signs of aging is not a disease and these physical changes should not be discussed as if they are anything to be ashamed of. That’s why when you come to MIRA Clinic we will not judge you and we place no expectations on you about what you should or shouldn’t do to change your appearance.

Well, there are two important exceptions, you really should avoid smoking and you should observe good sun protection habits. Doing both of these things are important for your health, reducing cancer risk and reducing the damage done to your skin that results in accelerating the appearance of the physical signs of aging.

But apart from this, we promise to respect your right to choose which treatments are within your comfort zone and we promise not to pressure you or coerce you to consider treatments that address different concerns from those you present to us during your consultation.

When you come in for a consultation, and we provide you with some recommendations as a part of your treatment plan, we encourage you to consider all of the steps in the plan as optional. Our goal is to assess your features and expectations and educate you about what is possible so that you can decide on how much treatment you want to consider. The steps that we recommend can be taken as slowly as you feel comfortable with, and not all of the steps need to be taken. Despite what we have seen other practitioners say, we believe that satisfaction can be possible with very limited and minor treatment plans (so long as the expectations are correspondingly realistic).

Before treatment can commence, your medical history will need to be reviewed and it will need to be determined whether dermal fillers can help you achieve your desired outcome. From there, the area will be prepped and a light anaesthetic will be applied to alleviate any discomfort. However, discomfort is minimal during treatment anyway. A specific amount of filler will then gradually be injected into the area of concern. While it depends on how many areas will be treated, the average filler session won’t take longer than 30 minutes to complete, making this an ideal lunchtime treatment.

Dermal filler can be injected to almost any part of the face or body, the decision to do so should only be made after a thorough medical consultation with someone with significant experience and training in performing these types of procedures. There are many risks to be aware of and these risks vary according to the location of the face that is injected.

When we assess your particular concern, we use our experience and the understanding of your motivations that we gain during our consultation with you to determine which treatments will be most suitable for you. These recommendations may or may not involve a prescription medications such as dermal fillers, and if our experience has been that your particular concern is difficult to improve in a meaningful way, then we may recommend that you have no treatment with us or perhaps consider treatment options that we don’t offer at our clinic.

You can read more about some common facial concerns that we are able to address with our tailored treatment plans:

• Tired under eyes
• Nasolabial (smile) lines
• Crow’s feet
• Sunken temples
• Forehead lines
• Sunken cheeks
• Thin lips
• Undefined chin
• Hands that look gaunt or veiny
• Chest wrinkles
• Nose humps

Dermal fillers have two main mechanisms by which they can create results. They occupy volume, therefore changing the shape, volume or flexibility of the region into which they are injected, or they have a biological effect on the tissue such as by stimulating fibroblast activity or by attracting water to an area. Both of these effects can be beneficial or detrimental to one’s appearance, so when dermal fillers are injected they should be done by someone with significant training and experience as a part of a treatment plan tailored to each person’s unique characteristics.

A more detailed discussion on the merits (and the drawbacks) of dermal fillers might be considered “advertising”, so we have removed these types of conversations from our website and social media. But we are happy to discuss these topics with you during your consultation in the clinic when we can do so with an understanding of your specific circumstances.

Before treatment can commence, your medical history will need to be reviewed and it will need to be determined whether dermal fillers can help you achieve your desired outcome. We will also consider other treatment options which may include the option to have no treatment at all.

More specific information about any potential treatment will be discussed with you in more detail during your consultation. If the decision is made to proceed with treatment, we will also provide you with advice on what to expect after your treatment, the approximate chances that each possible side effect might occur, as well as the mitigating steps we would recommend in the event that there are any side effects.

The answer to this question is complex and attempting to answer it here might be considered “advertising”, so it’s better to seek the answer to this question in your private consultation where we can answer it based upon your unique circumstances and with reference to the type of filler you are contemplating.

If you see any information about the longevity of dermal fillers when looking at other websites and social media, (especially if it’s based outside of Australia where there are no restrictions on advertising dermal fillers), you will usually find fairly specific lengths of time mentioned. It’s important to keep in mind that these durations actually vary enormously between individuals based upon each person’s unique biology. The results will also vary depending upon the injection technique and the exact location within the face that is injected.

The reason you might find certain periods of time mentioned for expected filler duration is that providers and brochures will usually quote findings from the clinical trials that were used by the manufacturer to gain regulatory approval in the relevant country.

These studies generally run for a limited period of time, and if a significant portion of participants can still see an improvement at the end of the study, this will be reported as the longevity of the product usually with wording along the lines of “At 9 months, 75% of the [insert dermal filler name] treated [insert area that was treated] maintained a clinically significant correction” (Example taken from Pinsky et al 2008). A conclusion such as this might get simplified by the manufacturer to say that the dermal filler “usually lasts about 9 months”. But don’t forget that in this example 25% of subjects got less than 9 months worth of results.

We know from an excellent study published by Dr Mobin Master that dermal fillers often last much longer than most providers advertise. In his study, he was able to demonstrate dermal filler injected more than 6 years ago was often still visible on Magnetic Resonance Imaging (MRI) scans (Master, M 2021).

There is likely to be a big difference between how long filler provides the results our patients hope to achieve, and how long they actually remain in the faces of our patients. That’s why you mustn’t choose to have dermal fillers according to a schedule such as “every twelve months”. The decision to perform dermal filler injections should only be performed after a thorough assessment and evaluation.

I believe it is from patients being misled to believe that they need to repeat their fillers on a set schedule that many patients who don’t have body dysmorphia end up getting overfilled and looking unnatural. We will only recommend a treatment if we believe it is in your best interests based upon our personalised assessment and consultation.

Swelling, bruising and redness are the most common side effects but they are usually mild and subside quickly. More serious side effects are possible which is why it is important to find an experienced practitioner with whom to discuss these treatments before making any decisions about whether or not to proceed with treatment.

Dr Clark volunteers with several organisations to help patients who have suffered from side effects of cosmetic medicine treatments and to help educate medical practitioners and registered nurses to become better at avoiding these side effects and at diagnosing and treating these side effects if they do occur.

Be very cautious about proceeding to treatment with any practitioner that doesn’t discuss possible side effects or tries to ignore their potential significance.

During our consultations we will describe side effects in detail and answer any questions you have and we encourage you not to proceed with any treatment if you are not comfortable.

This is dependent on the type of filler that is used, and how much of the filler product is required and how many areas will be treated during your session. The TGA has said that advertising the cost of dermal filler treatments by referring to the cost per syringe would be an example of “advertising” that is not allowed under their advertising guidelines. Therefore, we are unable to describe our pricing in any detail, nor can we talk about the different products that we use. We will, of course, describe the exact costs involved during your consultation once we’ve discussed your concerns and assessed your features. Remember that our consultations are offered with no obligation to proceed with treatment.