NASHA

This stands for non-animal stabilized hyaluronic acids and are safe, reliable class of dermal fillers that have a low potential to cause allergic reactions. They are commonly used to correct moderate to severe facial lines and restore volume loss that occur during natural ageing.

NASHA dermal fillers are non-permanent, safe and give reliable and consistent results in their volumizing capacity. They tend to confer a softer and more natural look.

Choosing the correct NASHA

The higher the concentration of HA the stiffer the product and the longer it lasts. The larger the particle and the greater the concentration of HA, the greater the lift in the skin will occur.

Another factor to consider is the amount of free HA that is not crosslinked. If the HA is free, fragmented or lightly crosslinked therefore the gel can flow out of the syringe with ease. It is the amount of crosslinking that determines the longevity of the product. This can vary between

Patient Evaluation

A careful medical history is done during the patient consultation. You will be asked about a history of herpes simples (cold sores), pregnancy and breastfeeding, keloids and the presence of any autoimmune disorders such as lupus. Any allergy to lidnocaine will exclude you from this treatment as most of the dermal fillers are premixed with this local anaesthetic agent.

Medications that can increase the risk of bruising include multivitamins, fish oil, vitamin E, blood thinners, aspirin, nonsteroidal anti-inflammatory drugs and Gingko biloba. If you are on any of these medications it is advisable that they are ceased at least 14 days before treatment. Alcohol should be avoided at least 48 hours before treatment as it can increase the risk of bruising.

If you have a past history of a dermal filler we will document this in your medical notes which will include when, where was the filler placed and if you were satisfied with the results.

Pre-treatment photographs

At least 3 photographs will be done: left side, right side and an oblique view. If you are having a specific area corrected, a close-up photograph will be done of that area.

Rejuvenation Management Plan

Any facial asymmetry at baseline will be discussed with you and noted in your notes. Your desires and expectations are carefully documented and discussed with you. A management plan is then formulated and a copy is given to you.

The type of filler and anti-wrinkle treatment will be outlined as well as the amount required will be documented. The cost of each treatment will be documented in your management plan. The possible side effects and the necessary aftercare will be in your management plan.

The treatment with a dermal filler may involve the use topical numbing cream of local anaesthetic injection prior to the injection of the dermal filler.

Treatment times can vary but generally takes from 30 to 60 minutes.

Treatment with dermal fillers sometimes requires more than one session. You will be asked to return for review a few weeks later.

Informed Consent

This will be obtained prior to any procedure. Financial cost will be given in writing in your Rejuvenation Management Plan.

Where are dermal fillers used?

Dermal fillers are used to fill or replace the lost of volume in certain areas of the face. Facial volume loss occurs in the ageing process.

Common areas for HA fillers are cheeks, followed by nasolabial folds, meilolabial folds, chin and lips. HA fillers can last from 3 to 18 months depending on location and amount of product previously injected. They last longer in areas of low mobility and shorter in areas of greater movement.

Post dermal filler care

NASHA or HA fillers are safe, effective and easy to use. Complications are rare and are generally limited to oedema (swelling) and bruising.

After the procedure you will be asked to apply an ice pack to the area for up to 10minutes every hour. In certain areas such as the lips you will be encouraged not to purse your lips or fold them on top of one another for up to 6 hours.

The following day you will be advised to expect additional swelling as hydration occurs. This may result in some soreness. Bruising may occur up to 72 hours after the procedure.

Certain areas are best avoided such as the glabella area. Although rare, injections into an artery can occur.

What are the potential complications of temporary dermal fillers?

Acute injection site reactions such as mild to moderate swelling or bruising are common. They usually last for less than 7 days.

Superficial or inappropriate placement of the temporary filler can cause lumpiness, nodularity or visibility of filler. When the HA product is placed too superficially, a nodule with the Tyndall effect can occur resulting in a visible bluish bump. Proper injection technique in experienced hands can minimize this risk. Post-procedure massage can mitigate the appearance of lumpiness.

Hypersensitivity reactions

The risk of hypersensitivity reactions is rare but is increased, in theory at least, when patients wear make-up as these substances can be implanted into the dermis during filler procedures. Therefore, patients must be make-up free at the time of injection.

Pro-inflammatory medications

Patients need to be aware certain medications taken after the dermal filler procedure can lead to an increased risk of hypersensitivity reactions if they take proinflammatory medications. Hypersensitivity reactions have known to occur up to 10 years after the dermal filler procedure. Therefore, it is important that a medical practitioner reviews your medical history during the discussion on dermal fillers.

Infection is a rare complication but may be due to reactivation of a common virus, herpes simplex (cold sores).

Contamination may occur in non-TGA approved imported products. Our practice only used TGA approved dermal fillers.

Necrosis

Injection of dermal filler into a vessel or infiltration of tissue with sufficient volume to compress blood flow poses a risk of necrosis. In experienced hands, such as dermatologists this is unlikely to occur. In the event it does occur topical prescription vasodilators or injection of solution that reverses the HA filler may reverse the impending necrosis. Injection of a prescription anticoagulant by the physician can promote clot resorption in recalcitrant cases.

Note: Prescription drugs can only be administered by medical practitioners.

Protocol for delegated cosmetic S4 injections

We are fortunate to have a suitably trained registered nurse who can administer S4 medications for cosmetic purposes after consultation with the dermatologist face-to-face with the patient and a formulated written management plan documented.

1. Time period no greater than 1 year
2. The areas to be treated
3. The medications to be used
4. The maximum number of procedures
5. The maximum dosages of the medications to be administered

Factors used in the selection of HA dermal fillers:

• Concentration of HA
• Degree of crosslinking and the quantity of crosslinked HA versus uncrosslinked HA
• Duration of correction
• G or elastic modulus
• Hydration level of the product in the syringe
• Presence of local anaesthetic agent
• Needle size
• Sizing technology
• Syringe – design of syringe and size
• Hyaluronidase
• Hyaluronidase is a soluble enzyme that hydrolyzes HA. It is used to dissolve HA filler overcorrection.
• Semipermanent Fillers

Calcium HydroxylapatiteCaH

CaH is a viscous gel composed of carboxymethylcellulose, glycerine, purified water within which 25-45um spherical particulars ofCaH are suspended. These fillers commonly have a duration lasting over 12 months. It is commonly used in cheeks and nasolabial folds volume enhancement.

Poly-L-lactic Acid PLLA

PLLA is a synthetic material used in resorbable sutures. PLLA comes in a powdered form with microspheres of 40-63um in diameter. It is reconstituted with sterile water prior to injection. It is classified as a bioactive filler as it has the ability to stimulate collagen production. Initially approved for HIV lipoatrophy since July 2009 it has been approved for aesthetic indications. It is used for diffuse global improvement rather than individual small areas such as rhytides. It requires multiple sessions for the desired cosmetic results. The effects require 3-6 months for maximum effect as fibroblasts are stimulated to produce new collagen and dermal remodelling occurs.

Temporary biodegradable fillers are the hyaluronic acid compounds and tend to last less than one year. Semi-permanent biodegradable fillers such as PLLA last one to two years. Unlike HA dermal fillers they cannot be removed. It may be advisable to have a temporary filler initially before considering a semi-permanent filler for this reason.

Medications, herbs and supplements can increase the risk of bleeding during cosmetic procedures.

TGA legislation does not allow us to name prescription medications. Therefore, you need to seek advice from your registered medical practitioner.

The following herbs and supplements are known to increase bleeding:

• Arnica – when used with anticoagulants
• Alcohol
• Ginger
• Ginseng
• Garlic
• Gingko biloba
• Kava kava
• Celery root
• Fish oils
• St John’s wort
• Vitamin E
• Feverfew
• Dong quai

We recommend that patients who are contemplating cosmetic procedurescease the use of the above herbs and supplements. Medications that increase the risk of bleeding need to be discussed with the medical practitioner before any changes are made.

Book your dermal fillers at SkinDoc in Liverpool

If you are interested in dermal fillers or any other cosmetic treatment, such as microneedling or chemical peels, get in touch with our clinic today. No matter if you’re in Narellan, Bankstown or Fairfield, we are conveniently located.