Hyaluronic Acid Fillers - What you need to know
Hyaluronic Acid Dermal Filler is a temporary dermal filler used to reduce the appearance of unwanted fine lines and wrinkles, improve face shape and contour and enhance facial features. Common brands of this type of dermal filler include: Restylane, Juvederm and Belotero. It works differently to Botulinum Toxin wrinkle relaxing treatments, which are mainly used to reduce lines and wrinkles on animation.
Hyaluronic acid is naturally occurring in our skin and body tissue, it is constantly being broken down and replaced by the body. Hyaluronic acid dermal fillers are made of complex sugars which are compounded with a bonding agent, to help them resist being broken down too quickly by the body. There are various types of dermal fillers, all formulated with different properties which affect the way the filler behaves in the tissue. For example, a firm robust filler, with minimal elastic properties is most suitable to add definition to the cheekbone, while a soft smooth filler may be more appropriate to address fine lines around the mouth. During a consultation I will recommend which filler (if any) I feel would be the best fit for your specific needs. All hyaluronic acid filler is hydrophilic, in other words it works by binding to water molecules in your tissue, so staying well hydrated will help to maximise your results.
My philosophy on dermal fillers is to recognise and respect that every face is unique and beautiful (or handsome) in its own way. I love to use filler in a way which highlights your most attractive features and distracts from those you are less fond of… all while respecting facial proportions, animation and principals of beauty. My goal is to help enhance your unique beauty and discover your most confident self.
If any of the following apply to you, we will need to discuss your suitability for treatment further, please be sure to mention them on your medical record *
Chronic health conditions
Acute illness on the day of treatment
Currently pregnant or breastfeeding
Unstable mental health conditions
Unstable heart conditions
Poor dental health, recent or planned dental procedures
Overseas travel in the next 10 days
Previous reaction to dermal filler
History of permanent or non-HA fillers
Sunburn in treatment area
Active skin infection or disorder on the face
*This list is not comprehensive, other conditions may also apply that will be detailed on your medical form and discussed during consultation.
Like all medical procedures, there are possible side effects and adverse events associated with treatment. The risk of these is heightened significantly if;
the dermal filler is not a hyaluronic acid based filler
higher risk areas are being treated such as the nose or frown (this only applies to dermal filler, not wrinkle relaxing treatments),
the injector is not well educated on facial anatomy or fails to take steps to prevent, recognise or act on early signs of a possible complication.
So what can go wrong? Common side effects include swelling, bruising & tenderness. I tell all patients to expect one or all of these to some degree post treatment. Lips and tear troughs (under eye area) are particularly prone to swelling and bruising. The severity or absence of these will vary between treatments, injection sites and individuals. You might be fine, with no bruising or swelling at all, however it is best you are prepared (ice, concealer, antihistamines, arnica, hirudoid or topical Vitamin K, oral and/or topical vitamin C are all ways you may be able help to reduce the effects of these and/or speed up the healing process). Injections may trigger a cold sore reaction in some individuals who carry the virus – if you are prone to getting cold sores prophylactic treatment starting the day before your treatment is recommended.
Of course, I will take every precaution to try and minimise the incidence of these side effects, however unfortunately given the unique nature of ones anatomy, there may be vessels and anatomical structures I cannot detect under your skin surface and every individual responds differently to bruising/swelling.
Swelling tends to be at its worst 24-72 hours post treatment. So please do not be alarmed if you experience swelling during this period. If the swelling is excessive, please do not hesitate to contact me. As above, lips and undereye treatments are most prone to this.
There are things you can do also to help reduce the likelihood of these tissue responses.
For 2 weeks prior to your procedure, you may wish to consider eliminating or reducing the consumption of the following:
Gingko biloba, ginseng, ginger, glucosamine, turmeric, fish or krill oil, omega or primrose oil, cloves, St Johns wart, anti-inflammatory medications (such as ibuprofen & voltaren), anticoagulants. If your medication/supplement is prescribed or recommended by your doctor, please discuss with them prior to stopping or reducing your consumption.
For 2 days prior avoid excess alcohol
On the day of treatment limit coffee or caffeinated tea and avoid makeup if possible
On the day of treatment, and for 3 days following, avoid strenuous exercise, spa baths, saunas, steam-rooms & excessive sweating.
If you do experience bruising/swelling:
Apply ice to the area for 20 minutes (through a moist tea-towel – not directly onto the skin) and then off for 20 minutes. This may be repeated as often as necessary for 24 hours post treatment.
Taking an oral over the counter antihistamine, may be beneficial in some circumstances.
Sleeping with your head elevated (at least 45 degrees) may help reduce the likelihood of you waking with excessive swelling.
Taking oral arnica and/or Vitamin C or applying arnica/hirudoid /Vitamin K or Vitamin C topically to the area may help to reduce the duration of your bruising/swelling.
Red LED light may be beneficial to assist healing and reduce inflammation.
Consider what you might tell other people if they notice (some patients prefer not to discuss cosmetic treatments with friends and family). White eye eyeliner and a good coverage concealer and/or foundation (eg thin Lizzy) can be effective at covering even dark bruises.
Please do not hesitate to contact me if you are concerned or if your bruise doesn’t look normal (eg patchy, motley, blanched or if there are any unusual patterns, broken skin or pustules). Or if you have severe or persistent pain (not consistent with tenderness from a bruise).
Firmness of the product or small lumps in the first 2 weeks following treatment, may occur. This can be influenced by the type of filler used, your body’s response to the filler and the thickness of your skin. Please do not be alarmed, it can take up to 2 weeks for some fillers/individuals to have the dermal filler integrate into the tissue. In actual fact it may be up to 6 weeks to completely settle, but majority of the integration takes place in the first 2 weeks.
It is not uncommon to walk out of the clinic with mild swelling, wake up the next day with moderate swelling (which can feel huge for lips especially), then a few days later feel a bit lumpy and maybe a bit asymmetrical – please stay calm and trust the process. Give your body the opportunity to integrate the filler into your natural tissue and heal any inflammation that may be present post the injectable procedure. Equally, if you don’t experience swelling or lumpiness – don’t panic. In all circumstances stay well hydrated in the weeks following your treatment. Hyaluronic acid works by binding to water.
There are some reported cases of filler hardening or becoming infected weeks to months following treatment. Although this is extremely uncommon, managing it appropriately is important. If you suspect this may have happened to you, please book an appointment to have it reviewed. Unfortunately, not all GP’s are familiar with cosmetic treatment, so may not manage complications as per current industry guidelines so please get in contact.
Although very rare, it is possible to have an allergic reaction to the dermal filler or lidocaine (numbing solution built into the product) – please ensure you disclose all allergies prior to this procedure.
Vascular occlusion is even more rare, but potentially very serious. This is where dermal filler has inadvertently entered a blood vessel, which effects the blood supply to that tissue area. This would normally present at the time of injecting, however there have been incidences where it has presented up to 3 days following the procedure. Vascular occlusion usually presents as an abnormal looking bruise or blanched skin, this may progress to a red or blue or grey uneven spiderweb like pattern over the treatment area with or without pustules (that can be mistaken for pimples/infection or cold sores). Dermal filler injections (particularly fat injections and treatment of the nose and frown) have resulted in blindness and/or stroke. The incidence of this is suspected to be about 1 per 5 million treatments.
For both of these incidences there are acute protocols in place that will likely commence with the administration of hyaluronidase (an enzyme which dissolves hyaluronic acid). This enzyme is commonly used for other medical purposes and is always on hand in the clinic. Should your vision be affected, you will likely be referred immediately to an ophthalmic specialist. Although this scenario would be very serious & scary – I must reiterate the incidence of this with hyaluronic acid in the areas I treat would be much less than 1:5 million and we have protocols and medications in clinic to help manage this should it occur. Many medications and procedures hold much greater risks, however given that this is an elective, cosmetic procedure it is important that you are well informed.
How painful is the procedure? This depends on the patient and how sensitive their skin is on the day. This may be strongly influenced by sleep (or lack of), anxiety, stress, hormones or medication. Please advise me if you are concerned about pain and we can talk through some possible options to help to minimise this (these include prescription grade topical anaesthetic, local anaesthetic and other modalities). Some clients find brining headphones and music or meditation a helpful distraction.
Dermal filler can create a beautiful rejuvenated result. I will always use my clinical experience and knowledge to best advise you of what treatments and how much product I feel will address your concerns, or whether I feel dermal filler is the appropriate treatment in the first instance. Unfortunately, however, I cannot guarantee you will be satisfied with the result or that you will not experience any side effects. You may need additional product at your expense, and you will need to continue to have treatment at appropriate intervals if you wish to maintain your result. I can give you an estimate on how long the specific treatment may last, based on clinical studies and anecdotal clinical experience, however there will always be patients that fall on either side of these guidelines. Similarly, a GP cannot guarantee paracetamol will resolve a specific individual’s pain sufficiently to their expectation or guarantee how long it will last. How long the treatment will remain effective is influenced by the type of filler used, the area of treatment, injecting technique, individual metabolism of filler, lifestyle factors (exercise, medication, stress etc). As a general guideline dermal filler lasts 6-24 months for most individuals.
If you have a major event planned ensure you plan ahead. It can take time for your true result to take effect. It is best to allow 3-5 weeks before the event. If the event is your wedding or if you have significant volume loss, you may even wish to allow more time so that your treatment can be done in stages to produce the most natural looking & best result.
I offer complimentary consultations, so if you would like to know if you are a good candidate for dermal fillers or what I might recommend, book a consultation – I’d love to see you.
Eyebrow Microblading - What you need to know
Eyebrow Microblading is a customised procedure used to improve your eyebrow shape & colour. The procedure involves a handtool and tattoo pigment. To maintain optimal results, most clients will need a colour refresh at 12-18 monthly intervals.
Your initial brow tattooing will usually be done in 2 stages (the second 4-6 weeks following the initial treatment). It is important to allow 3-4 months prior to any special events (eg wedding) to allow adequate time for healing prior. In some circumstances more than 2 sessions will be required to achieve desired results.
Your brows will appear much darker and bolder for up to 2 weeks following treatment – this is normal and expected.
Some clients will experience mild flaking/dryness 7-14 days following treatment – be sure too keep up with postcare recommendations to help to minimise this.
PERMANENT MAKEUP IS NOT RECOMMENDED FOR CLIENTS WHO ARE OR HAVE:
Pregnant or breastfeeding
Viral infections and/or disease
A pacemaker or major heart problems
Have had an organ transplant
Tendency to keloid scar
Skin irritations or psoriasis near the treated area (rashes, sunburn, acne etc)
Sick (cold, flu, etc)
Had Botox in the last month
Have an upcoming special occasion in the next 3 months
Have used Roaccutane/Accutane in the past 12 months
Allergy to anaesthetic, (lidocaine)
Extremely sensitive or problematic skin.
No strenuous exercise, swimming, sauna, steam rooms, hot showers and/or hot baths on the day of treatment.
Avoid alcohol for 48 hours and limit caffeine on the day of treatment.
Avoid sun exposure for one week prior to treatment.
Do not take Aspirin, Niacin, Vitamin E, Voltaren or neurofen for 72 hours before treatment.
Avoid Fish oil, Ginko Biloba & St John Wart for 10-14 days prior to treatment.
Discontinue topical Vitamin A (Retinol) , Chemical peels and microdermabrasion for 4 weeks prior to procedure and do not apply to the brow area following the procedure.
Avoid Alpha Hydroxy Acid (AHA) products close to the brow for 2 weeks prior to procedure and avoid applying to the brow area following the procedure.
Botox and filler on the forehead, temple and eye area should be avoided 1 month prior to treatment for those who do not regularly receive injectables.
No brow waxing, tinting, brow serums (eg LiLash) for one week prior to procedure.
Note: You will be more sensitive during your menstrual cycle.
Keep your brows clean by cleansing them with a damp cotton pad or Q-tip 2-3x per day and pat dry with a lint free towel or cotton t-shirt. Apply a small amount of supplied post care serum after drying and again during the day if your brows feel itchy or dry.
Do not rub, pick or scratch the treated area. Let any scabbing or dry skin naturally drop off. Picking can cause scarring and pigment loss.
If your brows feel itchy consider taking a oral antihistamine.
Avoid any water or moisture (apart from damp cotton pads/Q-tips as above) for 7 days or until brows feel healed over. This includes any sweating.
Avoid sleeping on your face/brows for at least 7 days.
Keep hats and hair off your face for 7 days.
No make up or skin care products over treated area (except serum supplied) for 7 days or until healed over.
No facials, chemical treatments and microdermabrasions for 4 weeks.
No Botox for 4 weeks post final touch up.
After 7 days, or once brows have healed, apply sunscreen over brows throughout the day to prevent pigment loss.
Eyebrows should not be tinted for at least 2 weeks following procedure.
Completely avoid direct sun exposure and tanning beds for a minimum of 1 month following procedure. Direct sunlight can cause the pigment to change colour while it is healing and may also result in hyper/hypo pigmentation and scarring.
Avoid any active skin ingredients over tattoos – these will fade your brows.
Avoid pool, sauna, steam rooms, hot showers and/or hot baths for 3 weeks following procedure.
Note: Eyebrows will appear darker and bolder due to natural healing in the first 2 weeks. Please do not be alarmed and do not try to remove or fade the pigment. This may result in scared or patchy results.
Kate is a Registered Nurse (RN) with a diverse and comprehensive background in Appearance Medicine.
She gains immense satisfaction from her work and thrives on working with clients to bring out the most confident and positive version of themselves. Her goal is to make clients feel comfortable in their own skin. Patient safety is at the forefront of her practice.
Kates passion for her career was ignited when she worked for the Franchisor of one of New Zealand’s largest appearance medicine businesses. During her time in this business, she was soon promoted to the role of National Trainer and then Clinical Director. Kate was a member of their clinical advisory board and helped govern, develop & deliver training and support the clinical practice of over 100 nurses throughout the country.
Kate has also trained nurses and doctors privately and on behalf of Industry Suppliers. She currently contracts to Galderma as a Clinical Trainer, where she shares her knowledge and passion with other Health Professionals.
Kate treats patients in Auckland (CBD, Westmere, Rosedale & Torbay).
To Peacock or not to Peacock?
Be a peacock in a world of pigeons...
Pride in personal appearance. This is not a new concept, nor one to obsess over, however in the polarised world we live in, society seems to have put great or no value into this concept.
Pride in personal appearance is nothing new, nor unique to humanity. It is a key attribute in personal confidence, and of course an instinctive factor in sexual attraction. However, today more than ever we seem to have gone crazy with this notion.
As a born people watcher, I see obesity, anorexia, poor presentation, immaculate presentation, neglected skin & obsessive beauty regimes…. Balance appears to be the exception.
With that said, I’m all for the odd Pyjama day and am guilty of being a combination of lazy, rushed and negligent more often than I would like. However, putting a little effort into personal presentation can make a world of difference to your self-esteem and confidence.
When I started my career in Appearance Medicine, one of my first patients was a timid, recently single Mum of 3. It was clear her confidence was at rock bottom, and she confessed her financial situation wasn’t much better. I felt ethically torn treating her with dermal filler and wrinkle relaxants at this difficult stage of her life. I was disappointed in myself when I agreed to treat her – were cosmetic treatments really what she needed right now?!.
A few weeks later she was booked for a routine review. I was prepared to console her, expecting that the cosmetic treatments would not have addressed her underlying issues so she would be disappointed. To my surprise, a new woman entered the clinic. She appeared 6 inches taller and was radiant and beaming. She was applying for work and had signed up to trampolining classes. In her mind, the treatments were exactly what she needed. She was a loyal and grateful patient for years following, and I enjoyed watching her blossom and thrive.
Now I’m not advocating that everyone lines up to have their faces to be used as pin cushions. What I am saying is that maybe we all need to remind ourselves of our realistic presentation and personal goals more often. We can’t sit back and blame social media and advertising for our predicament. What do you need to do or stop doing, to be the best, most sustainable version of yourself? What is holding you back? Invest in yourself. This could be as simple as wearing sunscreen, watching a youtube makeup tutorial, or scheduling an appointment with a hairdresser or as complex as following a diet and lifestyle overhaul. If it is your frown line that bothers you, consider a wrinkle relaxing treatment (Botulinum toxin is one of the most extensively tested drugs, it has been used for over 30 years with millions of treatments performed year on year).
Do what you feel comfortable doing, to be your most confident self – but please don’t stay awake at night worrying about the signs of inevitable ageing. Don’t regret growing older, it is a privilege denied to many.
Ever wondered what actually happens during a cosmetic consultation?
To Peacock or not to Peacock?
Firstly, it’s not scary and there is no obligation to proceed with treatment.
Before I see you, you will be asked to complete a medical consultation form. This is to ensure that you don’t have any medical conditions or are on any medication that would exclude you from the treatment options that we offer.
I’ll then go through your consultation form and ask further questions. It’s really important that I know whether you are on any medication, if you’re pregnant or breastfeeding, what your medical/dental history is, what your impending travel plans are etc. Some questions may seem silly but there is a reason each one is there, so take your time to complete all relevant information.
We would then move on to discuss any specific concerns you may have. You will be given a hand mirror and I may take some photos at this point too.
I’ll then complete a holistic assessment of your face shape, facial features, proportions, symmetry & skin quality.
From there we will discuss your treatment goals and we’ll work together to develop a treatment plan.
I’ll go into details about the treatment options, expected outcomes, risks & possible side effects. There will be the opportunity to ask any questions and you’ll be given some information to take home and read in more detail.
The plan may be as simple as a one off wrinkle relaxing treatment or as complex as several wrinkle relaxing treatments throughout the year in addition to dermal fillers and skin boosters.
How your customised plan looks is determined by your concerns, my assessment, your budget and your overall goals.
The consultation takes about 30 minutes.
In some cases there is the opportunity to have a wrinkle relaxing treatment during this consultation time.
The changing face of Appearance Medicine...
The days are numbered for the niche market of 60 year olds trying to wind back 40 years and 20 year olds with bee stung lips. Now the accepted objective of most cosmetic procedures is to look and feel well, at every age. For example, many of our clients now recognize that lost fat and other changes in the face can make them look tired and unwell, so they come to us for dermal fillers and a natural, healthy looking result. Shaving a few years off is just a bonus.
I love that I get to help people be the most confident version of themselves. Elegantly enhancing facial features and contours allows for a holistic, natural looking result.
The cats eye, Mr Spock, frozen face, pillow cheeks and trout pout are out. A natural, healthy and beautiful aesthetic is in. And with this brings a whole new, and ever growing population of rejuvenated beauties and gentlemen.
Important: Kate contracts to various clinics, which operate independently of each other. Prices and services may vary between clinics.
Keris Aesthetic Clinic
Ph +64 9 948 6012 (English)
Ph +64 9 3689073 (Chinese)