Kerry: I’m Kerry, and I’m a dermatology registered nurse. I’ve been working in the industry of dermatology for 7 years. I’ve also been doing my cosmetic injectables for 7 years. I have a background in postgraduate studies in intensive care. I’ve worked in general nursing for over 25 years. I’ve also studied privately doing an aesthetic course through … A diploma in health science, actually. I majored in cosmetic injectables. I was one of the first people who was doing that, before they set up all these private courses that are now available. I was fortunately enough to be picked up by two of the pharmaceutical companies. They took me on-board and trained me up. I was actually sponsored for couple of years prior to being an independent practitioner. I’ve always worked directly under Dr. Gudmundsen, who’s a dermatologist. I love my job. I’m very passionate about the skin as a whole, not just injectables.

I’m really keen to have people know the benefits of looking after your skin and protecting your skin from the sun. Good skin care [ratio 00:01:33], which can also help to enhance your results of your injectable treatments and help to make them last a little bit longer. I think that’s about all I can tell you at the moment. I’ve got a couple of medispas running, which are quite successful. I’m injecting probably about 20 to 25 clients a day, 5 to 6 days a week. I’m open to any questions. Throw it at me. I’ve heard it all before. Maybe somebody can throw something at me that I don’t know, which kinds I would always refer it back to my prescribing doctor, who is Dr. Gudmundsen. He’s here on site, so if I have a need to ask anything, I can do that with him.

The first question that’s come through is “There’s so many fillers on the market, I’m confused as to what’s what. Can you please give us a run-down of what’s available here in Australia and how long each one last? Also, which fillers that are preferred and why?” In Australia, we’ve got 3 products that have been approved through the TGA. Brand names are: Botox which is made by Allergan. Dysport which is made by Galderma, and Xeomin which is the latest one to the market, which is through a company called Merz. I’ve got a lot experience with both Botox and Dysport. Basically, the mode of action is the same. You would achieve the same result from both. I don’t have a preference for either. I like them all. I have preferences for which one I prefer to use in different areas. Certainly, the least amount of product that has to be injected to achieve a certain result is always a benefit for you, the patient.

It makes it a much more comfortable experience, but I also said depending on what area I’m treating, I have different preferences for which product. I don’t have a lot of experience with the latest one to the market, Xeomin. Just because it’s new to the market, I’ve tended to just stick with the ones that I do know. The ones that I have a lot of scientific evidence behind them, which is why I’m stuck with those 2, for now. Each product tends to last … I can talk specifically, more about your Dysport and your Botox. When we’re treating frown line, for example. You can expect that they last 3 to 4 months with your Botox, and up to 5 months with your Dysport. Again, this is dependent on your muscles and how much you require with the treatment. I tend to start off with the recommended minimal dose. Get you back in 2 weeks to review and at that time if I need to, I can add more if needed. Generally, we did a lot for a scar.

Next question is about fillers. There’s a lot of fillers on the market and the longevity of those products varies depending on which product that you use. We have fillers that are of a thinner consistency, which tend to last roughly 3 months. They’re used more to hydrate the skin. Other fillers a little bit thicker, again different products, we use in different areas. There’s a number on the market. Your Juvederm range, by Allergan. Also, your Galderma products, such as Restylane, which has been on for a long time in Australia. It’s probably one of the longest used product in Australia. They’ve just introduced a new range of products called Emervel. It’s slightly longer-lasting and more natural. Closer to your natural fat, so I’m getting really nice results with that.

All the ones that I’ve tried from both Allergan and Galderma, give really nice results. If the practitioner knows which product to use for a particular area, it ensures a bit of a result for you. How long do they last? Again, that depend on the product that we choose to use. It can range anywhere from 3 months for your skin-booster type of products, right through to … I’ve been to 2 years with your Allergan range product. Voluma, last at 8 months to 2 years. Your Emervel products haven’t be around long enough for me to be able to personally say how long you’ll get out of it but generally, between 12 to 18 months is a good time-frame.

Next question, “I’ve seen some amazing results where people have had their lower eye-bags filled. Is this true? Can it be done? How long does it last?” Yes. It can be done. The choice of products that you would use in this area is particularly important. Before injecting into the tear trough area, always learn to have a look at the area here. This is called a malar fat pad, and generally we treat that prior to treating a tear trough. The reason for this is by correcting your tear trough, you can sometimes get a really sufficient result and a bit of a lift up to here which makes the tear trough appear less noticeable. Certainly by having tear trough treatment, you’d want to be with an experienced practitioner. We tend to use different techniques depending on the level of experience of the practitioner and also what’s appropriate for that particular person. Certainly, you can treat the tear trough area.

I’m just looking at … I’ve got a few questions coming through now. “Is it true filler can leak through the face and cause things like blindness?” Okay, so it doesn’t necessarily leak through the face and cause blindness but what it can do is push on some special nerves and arteries that run up through your face. If injected incorrectly, or too much, or the wrong product, they can press up against a vessel. If that occurs, it causes necrosis which means dying of that blood vessel. Certainly, in the past have caused some … Sorry about that. Yes. It has been linked with blindness in the past, so it’s really important that your practitioner knows how to treat any complications and have all the emergency equipment that they need on hand if that was to occur. Personally, I haven’t seen it … done, touch wood. It can happen, so just be aware of that.

The next question is “Why is some Botox places cheaper than other?” Okay, that’s a good one. Depending on the product that you purchase. Some people advertise using different measurements of dose. The biggest example I have of that is if I’m treating a frown line, for example. The recommended dose for that is 20 units of Botox, so if somebody had a set price, say $10 a unit, that would cost you $200. In the case of a product like Dysport, you use two and a half more that product to equal one Botox unit. Some people advertise it at a lower rate, say $4 a unit or $3.95. You do have to bare in mind if you’re trying to equivalent that to a Botox dose. You need to times that by two and a half. If somebody’s advertising at $4 a unit, times it by two and a half, you’re actually paying the same price, which is $10 a unit. They say that you shouldn’t … The doses are equivalent, but that’s the best as far as I can explain to people, so they understand the advertising techniques that are used out there to try and coach people to come to them.

Basically, price shouldn’t be your main concern. Your main concern should be that you’re with an experience practitioner. If you’re happy with that practitioner and comfortable. If it’s going to cost you $5 cheaper down the road, would you risk it? I don’t know. I would tend to stick with the practitioner that can offer you the best service. It’s not just about having an injection at your aftercare. It’s having a doctor available on-call if needed. If there’s a problem and certainly, for any follow up cares. You need to know that your nurse or doctor is available and to have times, for example, to do your review or to correct any problems that may occur. Price is probably, not where you should be looking at as your first point of call.

“How can I be sure I’m going to a good practitioner?” Certainly, the area. The clinic in which they’re working certainly would give you a good idea, whether there’s a doctor in the clinic or whether they have emergency equipment available. How long have they been practicing? Whether that’d be a nurse or a doctor. Certainly ask for before and after photos. You want to see their work and what they have done before. I think word of mouth is probably the best advertising out there. If you’re hearing a lot about a particular person, you can probably bet that you’re in good hands. Go by the first gut feeling you have. If you’re not happy and content with the person you’re having a consultation with, go somewhere else.

This is the last question that’s come through and says, “Hi, and thanks so much for taking my question. What does filler actually contain? And how safe is it to be injected into our bodies? Is there any long-term research done to prove it’s safety in long-term use?” I like this, because I’ve just recently studied this as part of my … ongoing training. The filler contains Hyaluronic Acid. It’s [grown 00:14:39] in laboratory the same as another medication in Australia, and it’s approved through the TGA. All of the products that are used in our clinics, certainly. Anything that I use is TGA-approved. It’s a natural sugar compound. It’s broken down into body over a period of time and as I’ve said before, that depends on the longevity of the product.

Generally, it’s in your system for 6 to 12 months, again depending on the product that you’ve had. Long-term research, it has been done. Anything that I’ve come across in my own personal research is that there’s never been an actual allergic reaction to the HA, which is the Hyaluronic Acid that’s in the product. There has been one case that I’m aware of where there was an allergic reaction and when it was tracked back, it was found to be a processing problem, so something that occurred in the laboratory that cause this reaction to occur. There’s lots and lots of research out there. A lot of the drug companies, such as Allergan, Galderma, Merz, have lots of data of that. I’m happy to show that information to people who are particularly interested in research and the science behind the products we’re using.

Another question’s come through. “What if you get lumps in your lips?” Lumps can occur sometimes, again depending on your product. I’ve seen some that have occurred more with some products than other products. It’s a good idea to massage them. Certainly, you want to be quite firm with your massaging and try and break it down. They can occur as a result of being too superficial. Sometimes, they can just happen. I think it’s a good idea to return to your practitioner. Usually, part of their aftercare they would discuss all that with you. If it’s a persistent lump that doesn’t go away, there are some dissolving agents available that could be used to dissolve that product.

“So you’ve heard of the filler, Elevess. Can it be removed? If there’s been too much in there.” Okay, Elevess is not a product that I know. I’m not familiar with it. As I’ve said, I’ve stuck to the products from Allergan and Galderma. I’ll have look into that, and try and see if I can answer that question for you. The question is “If it can be removed”? If it’s a Hyaluronic acid filler, yes. It can be removed. I’m not sure the ingredients is, so I can’t really answer that question. Sorry, but I’ll come back to it after I’ve done a little bit of research.

Sammy’s posted a question now, “Is it possible to change the shape of your nose with injectables?” Certainly, you can get some awesome results. Particularly with the bridge of your nose, here. Some people who have this pointing of the nose. There’s certainly some treatment options available. This is an advanced technique and again, I’ll be really looking for a practitioner who has lots of experience in that area. There is really great results that you can get with that. Angela’s posted “I’m having lumps post-injections … ” Okay, so Angela’s asking about lumps in the lips post-injectables … I’m assuming you mean filler? As I’ve said, yes, you can massage it. Certainly, you would turn to your practitioner if it’s an ongoing problem. It can be dissolved. Okay, certainly … Oh, thank you. Yep. That’s great.

Female: Last question.

Kerry: Last question, “Does it help with skin elasticity? For example, excess skin under the chin.” Excess skin is a surgical intervention. It’s not something that’s going to be fixed with filler. I would certainly refer you to a plastic surgeon for that. It can help with the elasticity, and the overall tone and texture of your skin but excess skin, no. It’s not going to. I would refer you onto a surgeon. Okay, any more questions? Anybody? Great. Thank you for joining us, and I hope I’ve answered all the questions sufficiently. I will get back to the question regarding Elevess. Thank you, and good night.

Trish

Trish is a plastic surgery blogger. She is passionate about wellbeing, health and beauty, and doesn't mind a little bit of 'help' from the amazing cosmetic and beauty procedures that are available today. Trish spends her days talking to women and men who are looking for suggestions and advice on procedures that are available to them. Cutting through the sales pitch and hype, a down-to-earth response on general information is what you will get.

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