treatments

The amount of treatment depends on three main factors-

• Your natural volume deficits in the context of optimal proportions
• Age related volume loss
• Your goals & expectations

This varies tremendously from person to person, but as a guide-

• 20s-30s: 1-2 mls
• 30s-40s:2-3 mls
• 40s-50s+: 3mls or more

As a guide, for lips, a one ml syringe distributed appropriately is usually the right amount for most people to start. You will get all-over enhancement while still maintaining a natural appearance. Slowly building volume is very important.

Our injectors are skilled in the most effective techniques to deliver results with minimal discomfort.  We inject treatments containing local anaesthetic, in addition to preparing the treatment areas with topical anaesthetic where required. 

Results are immediate, but results will continue to improve for 2 weeks. For locations like the lips, your best results are seen at day 10+ as the swelling is reduced. 

Our injectors also use collagen stimulating treatments. These treatments take 3-4 months to achieve maximum results.

Our injectors are mindful of the ‘overfilled syndrome’. This means some patients lose sight of reality, in part due to the injector. 

Develop a professional relationship with your injector & be guided by them. Your face is our signature, so rest assured, we’re not going to stuff it up. We will pace you according to your volume loss, your expectations & importantly what we see as aesthetically pleasing.

At Cutis Dermatology we offer 14 grades of treatments that can last from 6 to 24 months. The duration of effect depends on several factors including facial structure, your metabolism, & the product selected. 

treatments used in Australia are not permanent. They are naturally absorbed over time, meaning you can choose whether to continue to maintain the effects in the future. Hyaluronic acid treatments are also completely reversible using an enzyme to dissolve them. 

Our dermatologists may consider fat transfer in some patients with large volume deficits- typically requiring 10-15 ml of treatment. 

Fat lipotransfer uses your own fat that is obtained from the thigh, flanks or abdomen & repurposed back into key areas of the face. A patient’s fat is the most “natural” treatment, and the fat has a much better longevity. There is more swelling than with other treatments, but the results are natural & often long lasting. The biggest drawback is the unpredictable nature of fat resorption. We will discuss if this treatment is suitable for your goals. 

Yes, we do, but we perform it only for patients who have suitable tear troughs. If your anatomy is not suitable, you will develop lumps & bumps. 

Important concepts to grasps are-

1. Only some patients are suitable
2. Support of the mid cheek is often required for most
3. Under correction is your friend
4. The area takes in water over time, especially with some brands of treatment

treatment migration means that your treatments have moved or spread unintentionally over time. This is rarely seen, but it is more common in areas such as the tear troughs, & lips (especially if treatment is placed in the upper lip). 

If your treatments have migrated, it is not always noticeable. Migration can present in many ways, a lack of a defined border between the lip edge, blue under the eyes or lumps & bumps. 

treatment migration can happen for a number of reasons, including- 

• Brand of treatments used: Use only the best brands on the market.
• Placement of treatment, always know who you are allowing to inject your face. 
• Quantity of treatment injected: Too much treatment injected into an area can cause “bleeding” elsewhere
• Aftercare: Always follow the correct aftercare procedure

In short, HA treatments are reversible & give an immediate one to one correction, meaning what you see is what you get. Collagen stimulating treatments are not reversible & give better results over time, typically 3-4 months post injection.

90% of our patients receive hyaluronic acid treatments, & 10% collagen stimulating treatments. Collagen stimulating treatments are useful in-

• Older patients requiring collagen stimulation
• Large volume defects & volume loss
• Areas such as the jawline where we require more structure

The most common treatments are made with hyaluronic acid, a sugar molecule that attracts water. Hyaluronic acid treatments can:

• Smooth out lines around nose & mouth 
• Restore volume to sunken cheeks or temples
• Reduce vertical lip lines 
• Volumize, define & enhance the lips
• Smooth out a chin creases
• Enhance the jawline
• Improve symmetry among facial features
• Remove acne scars

The common side effects of treatments can include redness, tenderness, swelling, & bruising. Asymmetry is another common side effect that is easily corrected.

Serious complications including nerve damage, arterial occlusion & infection are extremely rare.

Lumps & bumps after treatments typically subside within 72 hours. For thicker treatments it’s common to feel lumps but not see lumps for up to 2 weeks. 

Migration of treatments can occur with incorrect placement or the use of certain brands. It is reversible with hyaluronidase. 

Delayed nodules are more common than reported. Our dermatologists see at least one case every week referred from other clinics. Most can be settled down without the requirement for dissolving them. 

Arterial occlusion is a very rare side effect of treatments, early & appropriate intervention is required. 

After treatment injections: avoid touching, pressing, or manipulating the filled areas for 12 hours after treatment. You can apply an ice pack to alleviate swelling & bruising. 

Avoid drinking alcohol or doing strenuous exercise on the day. You can resume your activities the very next day. 

If there is a visible bump, you can massage the area, however our injectors will inform you if this is required. Depending on the areas treated and the product used, you may feel “firmness”. These areas will settle within 1-2 weeks.

Our injectors use both needles & cannula techniques to deliver treatments. 

The benefits of using blunt tipped micro cannulas include:

• Minimal downtime: A blunt cannula technique reduces the likelihood of swelling & bruising, requiring less downtime compared to sharp needles. 
• Safer technique: A blunt tipped cannula has a much lower risk of piercing an artery. This ensures that it is a much safer option for treatments in key locations. 
• Decreased risk of bleeding & bruising: While sharp needles can pierce blood vessels below the skin, a blunt cannula can push them aside – hence less swelling, bleeding and bruising.
• Better comfort levels: Having multiple sharp injections with needles feels painful & uncomfortable. A cannula is more comfortable.

Tindall or blueing under the eyes is common with hyaluronic acid treatments. It occurs because of light refraction & is due to either too much HA concentration or too superficial placement. 

We tackle this problem by dissolving your treatment, then either re-filling with another low concentration HA treatment or a special technique of collagen stimulating treatment. 

The temples are one of the first places to lose volume, especially in women around the age of 30-40.  treatments in this area can-

Provide balance to the face, reducing the ‘pinched’ look of the upper ⅓ of the face.

Provide lift of the outer ⅓ of the eyebrow. This frames the face.

We use one of three techniques to fill this area. The choice depends on your injector & your anatomy / volume deficit. 

1. Shotgun method with a sharp needle. Great for low volume correction. 
2. Above the superficial fascia. More advanced method, used for temples with high volume loss. It can marginally lift the cheek. 
3. Between the superficial and deep fascia. This technique provides a better blend compared to above. 

These are superficially placed treatments that address skin quality issues over volume. Hyaluronic acid placed in the upper layer of skin either manually, with a V2 Injector gun or Aqua Gold microneedling mesotherapy is a perfect steppingstone if you are new to injectables. 

Skin Boosters will not alter your shape/volume but can give you an indication of the power of hyaluronic acid. Superficially placed treatments don’t have the longevity of deep treatments. 

No. Our dermatologists have written a paper on this. It’s because energy devices do not reach over 70 degrees. treatments are stable to over 110 degrees for several minutes as part of the sterilization process.

1. Yes. We fill first, then anti-wrinkle later. The order is important as this reduces migration of anti-wrinkle, which can lead to unwanted side effects such as reduced muscle contractions elsewhere. 

In most cases, yes. It’s because we place treatments in a much deeper plane than superficial laser resurfacing. You do need to clear this up with your injector & your laser technician. They will run this by our dermatologists for clearance. treatment & deep fully ablative lasers are not advisable. 

Hyaluronidase is a special enzyme occurring naturally in the human body. This breaks down hyaluronic acid. A synthetic version is used to break down hyaluronic acid treatments. Our skilled injectors can precisely place hyaluronidase or Hyalase in key focal areas of treatments to dissolve them. 

You may find that you need multiple sessions to break down all the treatment. Different types of treatment respond in different ways to treatment. Also, if you have had many treatment treatments, the treatment builds up over time. It may be that the treatment has become integrated into the tissue. The most common areas we dissolve include:

• Under the eyes or tear trough treatments. Over time this area takes in water making treatments look lumpy & blue
• The lips, especially if there is treatment migration 
• The cheeks as treatments can accumulate over time

Hyaluronic acid treatments, which come in a variety of thickness, last 6-24 months. Collagen stimulating treatments last beyond two years. Longevity depends on the type of treatment, location & importantly your metabolic rate. 

anti-wrinkle can last around 3-6 months. Longevity is shortest in areas of repeated movement including the lips (lip flip) & marionette areas. 

Our team of dermatologists & cosmetic nurses have been using injectables for nearly 20 years. We not only have comprehensive training in facial aesthetics, but we train the industry. Our dermatologists are national & international trainers for Allergan. 

It is skin to using a flamethrower to cook your steak. No, we don’t. We do however see lots of side effects from this treatment, including persistent lumps, bumps & treatment injections.