- Safe and easy
- Quick, instant results
- Younger, softer appearance
- Lines and furrows that result from ageing are filled and erased
- Facial scars – and acne scars – can be improved
- Lips natural shape is highlighted, the border more clearly defined.
- Full and sensuous lips.
- Fuller cheeks, reduce under eye circles and tear troughs = less tired looking.
- Nose bumps straightened out (see Nose Reshaping)
DERMAL FILLERS: younger softer appearance by NZ's expert injector since 1992 ..... Auckland and Christchurch clinics.
Often as a first step into cosmetic procedures, dermal fillers can provide a simple and instant cosmetic improvement. Having been injecting dermal fillers since 1992, Dr Robert Beulink has been at the forefront of the ongoing development and use of these products. With a keen eye for detail and the skills of an artist, he is considered to be one of the top injectors in Australasia, creating unsurpassed results. Facts not overlooked by companies such as QMed Sweden, makers of the products Restylane®, Perlane® and Sub-Q®, who have enlisted his services to introduce these products to New Zealand, and help train other doctors in their use.
Dermal Fillers is the term given to treatments such as collagen replacement therapy and other newer, more efficient injectable products for facial lines, wrinkles, furrows, lips and scars. “Dermal” or “dermis” is the medical term for the skin structure just under the skin surface, the area where most wrinkles and damage occurs. These areas are literally able to be “filled up” with these injectable products, hence the name “dermal fillers”. These facial treatments give remarkable results in restoring the skins original appearance or creating a desired image. The most commonly used dermal fillers, collagen or hyaluronic acid (the compounds that form the framework for the skin), are injected just under the skin surface through a line of tiny needle pricks. It is relatively painless, results are immediate, and the look is natural. For most people the treatment needs to be renewed every six to twenty-four months. Other more permanent products are becoming available, but these still remain somewhat controversial.
Dermal Filler treatments can be very flexible. All to often, people and even injectors, focus too much on individual wrinkles, failing to see the bigger picture (the saying:"look at the forrest, not the trees" [or branches or twigs for the matter!] can be quite relevant when assessing the scope of dermal filler application). A wide spectrum of treatments and applications for dermal fillers is possible, ranging from lips to frown lines, from wrinkles to volume replacement. Treatment can and usually does, include a mix of all of these, being tailored and crafted specifically to each individuals needs and requirements. In this way a result can be blended and balanced for a truely natural look.
Not just for wrinkles! Sometimes re-volumisation, rather than a wrinkle treatment,
of the ageing face with dermal filler can make a huge difference to an ageing, tired look.
See below in Personal Comments section for more details
See more on dermal fillers under: Dark Under Eye Ciricles/Tired Look
Dr Beulink’s Personal Comments – Dermal Fillers
Dermal fillers have been a large part of my cosmetic practice from Day One. I began injecting dermal fillers in 1992 and in the mid 1990’s, became one of the first doctors in the world to clinically use the then “new” hyaluronic fillers (e.g. Restylane, Hylaform). As such, I have had vast experience in injecting and using these products.
Dermal fillers are often the first line of choice for people looking for some form of cosmetic improvement. Dermal fillers provide the perfect cosmetic solution for those who wish a subtle refinement, or perhaps a generalised re freshening of their look. For others, dermal fillers are the answer for a specific problem wrinkle, a rebuild or enhancement of their thinning lip, or maybe a specific fashion look. For most, dermal fillers may be seen simply as a routine part of their maintenance programme to help slow down the ageing process or hold the status quo. Dermal fillers are relatively cheap and very user friendly, offering simple, quick and fuss free treatment with instant results.
What is the difference between a dermal filler and Botox?
There is often a lot of confusion for first timers about what this difference is and which one of these may be the more appropriate for their problem.
Botox is injected below the skin into an underlying muscle. That muscles action is causing the overlying skin to crease and wrinkle up. The Botox temporarily paralyses or relaxes that muscle, and thus the overlying skin wrinkles are allowed time to repair and seemingly melt away. So Botox works in a delayed secondary sort of fashion on the skin wrinkles. It would be a bit like stabilising the movements in the foundations of a house to stop further cracking in the walls.
Dermal fillers however, are injected directly into the skin wrinkle, immediately lifting it up. The visible result is immediate. This would be a bit like filling the cracks on the wall of a house caused by sun damage and age, by using some form of putty or gap filler.
Generally speaking, Botox tends to be very good for wrinkles in the upper part of the face where the skin is much thinner and most of the wrinkles are caused by active muscle movement (frown lines, crows feet, worry lines etc), whereas fillers are more suited for areas in the face below the eyes.
Obviously there are exceptions to all this, but at an initial consultation, your doctor should be able to discuss all of this with you and help you to decide which is better suited for your particular needs.
Please remember, a dermal filler is just a product, not a result. Your result will totally depend upon the skill of the person on the other end of the syringe, how and where it is injected into the skin. It’s like a tube of paint in the hands of an artist; the portrait depends entirely on how it is used by the artist, not necessarily on how good the paint is or how much the paint costs. Results of dermal filling from the various clinics and clinicians can be wide and varied, ranging from pure perfection to the absolute abysmal, and since 1992 I’ve certainly seen it all come through my door. Choose your injector carefully; you must live with the result!
In my opinion, a dermal filler treatment should be specifically tailored to each individual, taking into account the patients appearance, incorporating their wishes, and designing and crafting a treatment to give a pleasant, tasteful and natural looking result which compliments that person. Dermal filling is an artistic craft, not a "paint by numbers" treatment. Again, choose your doctor carefully.
In my experience, I have found that the appropriate placement for the various dermal fillers in the skin is critical. For some fillers, if placed too deep, the patient will not get the longevity of the lift, and for other fillers, if placed too superficially, the product can leave tell-tale marks or lumps on the skin surface. Correct placement of dermal filler in the skin is everything. Choose your injector carefully!
Wrinkles on side of cheek before Restylane filler
Immediately after treatment. Correct placement of filler is crucial: this result being achieved with less than 0.5ml of Restylane (not perfect, but a first time on a very lined face, achieved with only 1/2 a tube used on each cheek)
"I don't want big horrible lips like that movie star". Inappropriate or bizarre looking lips are caused by either using an inappropriate product (eg. silicone, permanent dermal fillers) which is probably fairly unlikely here in New Zealand, or far more commonly, a poor injection technique, or just plain bad work or aesthetic judgement. No excuses!!! Bizzare and unusual results are not the fault of the filler (assuming a quality filler has been used). But rather quite simply the fault of the injector. It's what's happening at the blunt end of the needle and syringe that really makes the difference!
Does it hurt?
This procedure requires multiple injections, often in some of the most sensitive parts of the human body. First time patients can obviously be a bit nervous and anxious about this. However, this need not be a painful or dis-pleasurable experience. For all my dermal filler patients I use local anaesthetic nerve blocks to minimise any discomfort.
With no discomfort, the procedure can proceed in a relaxed and timely matter, and enables me to get on with the job of providing the best possible result, without the hindrance of pain, huffing and puffing, and flinching. Virtually every first time patient I have ever seen has commented positively afterwards with such comments as: "not as bad as I thought it would be", "better than at the dentist".
However, some injectors use only a bit of local anaesthetic cream applied to the various areas, or maybe just some locally applied ice. The problem with this, is not only is the pain relief fair to variable at best, but the micro-swelling and puffing in the surface layers of skin that these cause, temporarily obliterates the finer wrinkles. So how they are then supposed to see and hence treat these wrinkles, is still a mystery to me!
Then there are injectors who either use no anaesthetic at all (ouch!!), or rely on the false pretence that some dermal filler products contain a small amount of local anaesthetic in them. The problem with this, is that each injection only goes numb after the dermal filler is put in. In a typical dermal filler treatment session for a face, there may be up to 100 or more tiny micro-injections required to fill the multiple lines and wrinkles.......that is certainly a lot of uncomfortable injection prickles before each one goes numb!
In summary, this procedure need not be an unpleasant experience. Choose an injector who is well familiar with facial nerve blocks and anaesthetic use. Believe me, it will make a big difference.
This treatment is not a “lunchtime lift” as some injectors like to advertise. There is no such thing! You will be most disappointed if you believe this magic wand can have you back to work immediately after the treatment. I have found that most patients need at least 2 to 3 hours to recuperate (that’s some lunch break!) from the immediate effects of the treatment and local anaesthetic to wear off, while some can remain puffy or blushed in the treated areas for up to 12 or more hours. Avoid the stress and give yourself plenty of time after treatment before any appointments or engagements.
How long do dermal fillers last?
This is one of the most common questions asked about dermal fillers. There are many different factors to consider and hence it's difficult to give an exact answer to this.
Earlier collagen type fillers were derived from cattle hides and were degraded relatively quickly (about 3 months) by the human body due to their "foreign" nature. Although still used by some injectors, these have been largely replaced by the much improved newer hylaronic type fillers (eg Restylane) since the mid 90's.
Restylane is said to last on average approximately 9 months. However it can be shorter, but often it can be much longer. Extreme examples of this would be a first time treatment on a very tight or broken down lip, where it would most likely be advantageous to do a repeat top up treatment within 3-4 months following the first treatment. In these cases, the initial recoil and mechanical stress placed on the first treatment filler is very high, with the subsequent lift being somewhat shortened or compromised (not disappeared though). However, as the lift settles, a second stage and perhaps nicer lift can be achieved and this will tend to last much longer. I have found it advantageous sometimes to stage treatments in this sort of way and virtually never have I needed or wished to use more than one tube of filler at a time. I have seen and heard of cases where multiple tubes of filler had been used in the one session, creating probable pressure swelling, inflammation, and even more severe reactions. These problems were not the fault of the filler, but rather, the fault of the injector. I believe staging can also be an advantage to the patient, in that staging the treatments over time can allow for changes to be performed in a subtly stepwise manner, avoiding the anguish of sudden and markedly noticeable change. The other extreme example of Restylane filler longevity, is a lady on whom I did a single treatment to the wrinkles on her top lip area. This women returned 5 years later, not having had any further treatments, and still looking better than she did and obviously very pleased with the treatment. In this example, the superficial depth of placement (see above) was critical and one of the determining factors.
Since I've been using Restylane from 1996, a very interesting observation came to light. I noticed over the years, that what would start as a typical repeat treatment at 6 months for somebody, would then become 9-12 months for the next treatment, and then 12-15 months and beyond. I have numerous patients who after a decade use of Restylane, now only require a touch up every 2-5 years. Not bad for a temporary filler!
What about the longer lasting permanent fillers?
I do not use or recommend permanent products. If you are contemplating one, be very careful what you wish for. The “look” of today may not be the same desired look in years to come. Larger fuller lips on a 30 or 40 something may look fantastic, but on a 60 or 70+ year old, those same lips may appear totally ridiculous! I also explain to my patients that over time it can be a bit like the “melting snow” scenario. The rocks under the snow is your permanent filler, with the snow being your overlying softer skin. As we get older, our skin looses elasticity and structure, and tends to thin and sag or “melt away”. However, the permanent rocks (filler) do not change, effectively rising to the surface and becoming visible as the snow (skin) melts. With time you can be left with tell tale signs, lumps and bumps or a somewhat disproportionate appearance.
And what if the lip or look you have been given, has been poorly done or is not what you thought it would turn out like........ unfortunately you're stuck with it!
Cosmetic results aside, there is also ongoing controversy over the tissue effects of permanent dermal fillers, with reports of short term and long term delayed reactions and rejection problems in the medical literature. Several of my colleagues, after initial enthusiasm, have since stopped offering these products due to such problems.
It is virtually impossible to entirely remove an injected permanent product. Permanent products can create permanent problems, so why would you want a permanent filler?
All the products I use at my clinic are biologically compatible natural materials, not synthetic permanent fillers. With Restylane®, I have personally experienced 21 years (and no, that's not a typo error!) of excellent safety and performance history. In 1996 I used 2 of the first pre-release/production tubes of Restylane. That arguably makes me first in the world to have clinically used the new hyaluronic type filler, and it literally was one of those defining "OMG" moments that simply changed everything from that point on. This was at least 10 years before the rest of the planet started to catch on to this new revolutionary product and a good 15 years before they started using it in the United States. 21 years later, nearly all of the dermal filler products (at least the safe ones!) on the market are merely "copy cat" versions of Restylane.
Which brings me to matter of Juvederm, Restylane's main competitor in the cosmetic marketplace, and why I don't use it. Juvederm (in particular the Voluma version) has become very popular in the last 5-8 years, and it's got nothing to do with it being a better dermal filler. In fact quite to the contrary, it is worse, having problematic side effects (lumps and reactions which are quite specific to Juvederm only!). So why is it popular? It's simple marketing. A big boy pharmaceutical company bought a small and struggling Juvederm company and then went out and launched an aggressive and bullish marketing campaign, hitting up all the existing injectors but particularly focusing on nurses and the then new and up and coming Warehouse type Clinics: "Buy one Botox wholesale, get one Juvey free!". Wow, a deal not to be missed perhaps? The problem with all this, is if you'd been around long enough you would have known the history of Juvederm. A small Swedish company that actually started out in about 1998 as a break-away from Restylane: literally 2 or 3 Restylane scientists and a couple of admin workers walked out the door one day and set up shop down the road. They started producing a hyaluronic dermal filler that was an earlier Restylane prototype with no patent issues and called it Juvederm. Now at least the old Juvederm filler was safe, albeit rather lacking in performance and longevity. But as such, the company struggled to make any real market impact over the years. Fast forward to a few years ago and the quickest and most cost effective way for Big Company to break into the billion dollar global dermal filler market, is to simply go out and buy an existing struggling Small Company. So Juvederm changed ownership and within 3 years, after paying hundreds of millions of dollars a year for naming royalties to Small Company, Big Company decided to get their R&D department to produce their own "Juvederm". So Juvederm changed, from inert, safe, but ineffective, to a completely different new product that is robust but not so inert. In the quest for much improved longevity, unfortunately the "natural" characteristic of hyaluronic acid was traded for a more "synthesised" characteristic in the new Juvederm, and quite simply the body doesn't like it. The problem is that this Juvederm forms a "Biofilm": essentially bacteria hide in the product and the body can only keep them in check at the surface interface of the implanted filler. That's usually fine if you're young and fit with a good immune system, but for older people whose immune system starts to wane, or younger people who get run down, or get the flu etc trouble can start when the surface flares up. I don't use Juvederm but I have herd of numerous cases of reactive lumps and seen several cases come my way looking for a fix, and unfortunately in longer standing cases it can be virtually impossible to resolve. It is interesting, about 10-15 years ago there was another very, very popular product called Aquamid. It was an extremely long lasting dermal filler (possibly permanent, made out of some form of new technology plastic and water I believe) that caused exactly the same problem. The company denied and side stepped for a long time, then blamed the injection technique claiming a Biofilm problem caused by ill skin preparation and assured the masses that correct skin sterility at injection time would prevent it. What a load of rubbish! No matter how much the skin is swabbed, prepped, and sterilised, there is always going to be a bacteria or two along for the ride with any injection. That's normally not a problem as the body is well prepared to deal with them....... but not if those bugs are able to hide in a blob of filler that is able to shield itself from the body.
Needless to say, Aquamid and it's company eventually failed and is consigned to history but unfortunately not without first leaving it's marks (this is nothing new as it is actually the 4th dermal filler I have seen fail in my 25 years in cosmetics due to similar problems). Again, I never used the product, doubting it's integrity from the outset, and managed to shield my clients from the problem. Is history simply repeating, in such a short cycles, all over again? I can only stress yet again, choose your injector wisely and be well aware and versed with what is being injected into your face.
I am thoroughly comfortable with the safety of Restylane, having used it without problem for 21 years. And very interestingly, in that time I have personally witnessed its ability to fully integrate and complement the bodies immune, healing and regenerative properties. Restylane doesn't shield and Biofilm, but rather instead, it encourages stem cells to move in use the Restylane as a Bioscaffolding. Simply put, Restylane "turns on" stem cells, and over time, as I tell my patients, the body essentially "auto-reboots", regenerating and rebuilding the tissue. In other words, what I have consistently seen over the years is, the more someone has over time, the less they need due to this regeneration effect That's right, I have many patients who over the years, despite getting older, require less Restylane, and often tell me they don't look as bad as they did when they first came to see me!
So, summing up: I believe Restylane auto-reboots tissue in a positive way and so is not as 'temporary" as some may think. It does this in a very natural way through tissue integration and stimulation of stem cells. Juvederm on the other hand, bioshields and thus most likely doesn't integrate and as such is unlikely to stimulate stem cells and most probably long term will not auto-reboot tissue. Juvederm is not so temporary simply due to being synthetically manipulated but at a price of being more foreign to the body. I believe this is why I have seen many Juvederm lips that just always look a bit puffy and sausage shaped, lacking any finesse. I think this is low grade reaction and looks very similar to the puffy, ill defined sausage lips of the old Aquamid. I guess time will tell whether I'm right or not, but over the last 25 years I've picked it right each time and I believe I've got it right yet again.
OK... here we go!
Recently there is a lot of talk about a possible serious side effect occurring with dermal fillers. It's appearing on the web and currently in numerous glossy magazines, even on their front cover/photo (recent North and South magazine). It makes for sensational headlines, and great ratings and sales....the "Botched" mentality has always been a good seller and I/we have seen it all before: "Botox saved my life" followed months later when that became old news, by "Botox ruined my life", all so very typical of the early 2000's. The misery of beauty always grabs attention.
I am of course particularly referring to the current report/s of blindness caused by the injecting of dermal fillers.
So let's break this down and put it into a bit of realistic perspective.
Firstly, this is nothing new! 25 years ago we already knew that there had been one or two reports worldwide, that injecting the old dermal filler Collagen products were associated with a remote risk of arterial injection, particularly in the frown (glabellar) region (leading to visual problems eg. blindness). The problem with this region is that it is very vascular, with lots of little arteries and blood vessels running deeply in the sub skin layers, so awareness of the region's anatomy is vital if injecting this area is determined necessary.
My point here is that if someone is injecting skin wrinkles with dermal (by definition meaning to be injected into the skin dermis) filler, why on earth are they placing it so deep where the arteries lie?!! Injecting dermal filler at that depth for a frown line, will struggle to have any oomph to actually lift the tight skin wrinkle anyway, and down there it becomes a game of Russian Roulette with the arteries!!!! Now don't get me wrong, there are times when injecting deeper into these types of areas is possibly desirable, and I have performed hundreds of such injections over the years. BUT the area must be prepared properly first. There are ways to temporarily tightly close down the vessels, making them impossible to inject into and thus safe to perform treatment without the risk of blindness. Correct preparation and anatomical awareness is paramount.
This actual current event of blindness that everyone is talking about occurred here in New Zealand early 2017 and is certainly generating an element of misplaced fear of dermal fillers. I have a few issues and points to make about this particular case of blindness caused by a dermal filler (and I believe it was Restylane). DON'T BLAME THE FILLER! It's not the filler's fault, filler will always do what it simply should do....fill. What it actually fills, is entirely determined by what is happening at the other, blunt end of the syringe, that's where the cause of all the problems is determined! Who is placing it, where they are placing it and how they are placing it there determines the outcome. In this particular case, IT WAS A NURSE (supposedly under the supervision of a plastic surgeon, which really is a joke because the doctor in these supposedly supervised roles are never in attendance, but rather at best, have signed a piece of paper called "standing orders" that essentially lets the nurse operate entirely independently). I should rest my case there but unfortunately it gets worse. Because dermal fillers have been registered as medical devices (not a medication), now there has even been whispers that Beauty Therapists, Dentists, and maybe even your neighbour, are now offering dermal fillers. OMG, the problems that will follow! Please choose your injector wisely!
A further important point about this case of blindness caused by a dermal filler, is the technique that was used. The area injected was the high top of nose/low glabella (frown) region, accessed from the tip of the nose aiming upwards (and that's a long passage of travel through blood vessel "Tiger Country"!), using a plastic cannula. Now, plastic cannulas were heavily marketed to injectors several years ago as a "safer" alternative to needles when injecting deeper tissues and potential problem blood vessel regions. These were embraced by inexperienced injectors including nurses, to essentially gain license to inject into potential areas around the eyes etc, without needing to give any regard to blood vessels and blindness. So lets get this straight, technology apparently compensates for lack of skill?
Well, the end result has been a case of blindness, caused by a nurse, injecting into a known potential problem area, with no adequate preventative preparation, using a piece of plastic that's supposed to keep it safe. Yeah right!
The big problem with these people using cannulas is a misguided sense of security. Cannulas will and do penetrate blood vessels (current point of case) and when they do, they are much more difficult to get out of the blood vessel when compared to a needle. The result then becomes a large bore size plastic pipe (as compared to a small bore needle) stuck in a blood vessel, and due to it's large size, a large "blob" of filler can be pushed very freely into the blood vessel. In this case it was estimated that 1/5 -1/4 of a tube was dumped into the artery. That is a ridiculously large amount of filler to be injecting as a single blob into a nose for shape anyway (very, very bad technique for any type of filling). The consequence of all these factors, was an artery to the eye being hyper-loaded with filler, and at that rate it was never going to be a good outcome.
TO BE CONTINUED SHORTLY, INCLUDING WHAT COULD OR SHOULD HAVE BEEN DONE TO FIX AND PREVENT THE BLINDNESS
Other side effects of dermal fillers include temporary swelling, puffiness and discomfort; bruising (uncommon with correct preparation, injection technique and avoidance of certain medications and foods); lumps (rare but certain areas such as under eye tear troughs can be a problem); activatiion of cold sores (preventative anti-cold sore medication should be taken post treatment in those with a history).
Dermal fillers come as pre-packed ready to use syringes. They have a limited volume, usually somewhere between 0.5 – 1 ml. I tend to exclusively use 1ml syringes as I find this is usually the minimum amount required to adequately treat a series of fine lines and provide a degree of structural support to the problem area. Without this structural support, the wrinkles will tend to break down much quicker. Often, for example, fine lines on the top lip will be treated in conjunction with the structural corners of the mouth and edge and body of the lip. However, a major disadvantage of dermal fillers is their limitation by pre-packaged volume. If larger hollowed areas need filling, then the volume of dermal filler required, and hence the costs, starts to become more expensive. In these cases, the newer stronger forms of Restylane such as Sub-Q, which comes in a 2ml syringe, may be more appropriate. Sub-Q must be placed much deeper and is not appropriate for fine lines and wrinkles. It is particularly good for enhancing or lifting hollow or sagging cheeks or making the "cheek bones" more prominent. My "Q Lift" is a specific combination treatment that has become particularly popular. It addresses the very common problem of hollowing in the upper mid-outer cheeks associated with hollowing of the tear trough (this is often seen as a tired look, as bags under the eyes or as dark circles under eyes). For the "Q Lift", Sub-Q is used for replacing volume in the cheeks, with the standard softer Restylane being used to fill the tear troughs. This treatment can have a dramatic rejuvenating effect in 30 and 40 something's who may otherwise have very little in the way of wrinkles. If hollowing in the face is more generalised, then Facial Lipo-Filling, also known as Fat Transfer may be more appropriate (volume and duration of result is virtually unlimited). Dermal filler treatments and their results can be volume dependent and volume limited, but for the usual wrinkles and lips a 1ml syringe can be ideal. For dark circles under eyes and flat or hollow cheeks, the "Q-Lift" (2ml of Sub-Q plus 1ml of Restylane) can provide remarkable results.
Re-volumisation of the ageing face with larger volumes of dermal filler. Here I have used dermal filler to re-instate mid face cheek volume. By giving back some of the lost volume of youth, the restored face has more vitality, looks stronger and has improved wellbeing. Gone are what I call the "negative curves" (the dips, hollows and troughs), to be replaced "positive curves" (typical of the flowing, smoother, fuller curves of youth). Note that attention has also been given to addressing some of the asymmetry of the face (the flatter [left side of photo] outer cheek). Nearly everyone has asymmetry, and often there is a small side and a large side to the face - our face is not a mirror image down the centre line. Often this asymmetry is boney and can not be changed. However, with tactful volume replacement, these asymmetries can be softened or blended to create or restore a natural look that is more "easier on the eye".
See also under Fat Transfer for more on volume replacement.
THE DERMAL FILLER PROCEDURE
Before any procedure can go ahead, informed consent must be given. An initial consultation and assessment with Dr Beulink is required before treatment, during which time he goes over your concerns, outlines different procedures available to you that you may benefit from, what they do, how they work, downtime, results, before and after photos, costs, etc, etc. It is essential to have this initial consultation and assessment with the doctor who is going to perform the procedure, as it is important for you to know exactly what the procedure is, products used, what results can be expected and what problems or side effects can happen. Once you are well aware of all these details, and all your questions are answered, treatment can proceed.
Contact us NOW to see what Dermal Filler can do for you!
Ph (09) 523 2560 or Ph (03) 3555 712