Everything you’ve ever wanted to know about injectables

You don’t know what you’ve got until it’s gone — and plump, firm, wrinkle-free skin definitely falls into this category. Around about the time you realise the best days of your skin are behind you is when you start asking about Botox, fillers and what else could be done to help restore your skin to its former glory.

This is a topic that is often talked about in our forums, so we put it to our members and asked them what they really wanted to know about injectables. Dr Soo-Keat Lim from the Ashbrooke Cosmetic Surgery Clinic has given us the rundown on all things injectables.

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Botox, Dysport, Xeomin — what is the difference?

You’ve probably heard these terms before, but the first thing to note is that Botox, Dysport and Xeomin are all brand names of muscle relaxant drugs containing Botulinum Toxin A as the main ingredient. All three are approved for use by practitioners within Australia by the Therapeutic Goods Administration (TGA).

What is the difference between fillers and muscle relaxants?

Fillers and muscle relaxants are completely different products that target different concerns. Dr Lim says, “The filler is used to rebuild the volume in your face that has shrunk due to weight loss, sickness or to the ageing process; or when used in the lips to plump them up.” Whereas, muscle relaxants are injected into the muscle to relax the area and target cosmetic concerns such as lines.

Another good thing to know about fillers is that some of them are also reversible. “If the results aren’t to your liking you can have them dissolved and start again,” he adds. “There are many brands and within each brand there are many different grades. You will need to discuss with your practitioner which is most ideal for the area you wish to fill.”

What is the price comparison between fillers and muscle relaxants?

There are many factors that impact the cost involved in fillers and muscle relaxants. Dr Lim says, “Fillers are generally more expensive because they require more skill to inject and the procedure takes a longer time to do. Most fillers come in pre-packed syringes containing 1ml of the product. So you are charged for the 1ml whether you use it up or not.”

He also adds the price of fillers and muscle relaxants will vary from clinic to clinic and between brands. “Generally, fillers are sold by syringes of 1ml. Depending on the brand and the grade it can vary from $350 to $800 per syringe. Muscle relaxants are sold by the unit. Depending on the brand, it could be $5 to $15 per unit.”

Are fillers safe to use?

Dr Lim reassures us that the safety of fillers in Australia is checked by the TGA before approval is granted for use. Although he warns that it doesn’t come without risk. “Complications arise more commonly when the practitioner doing the injecting is not properly trained or not experienced in the use of the injectable products. It is important to remember that there is an element of risk that something can go wrong when you have a procedure done. So it is important to find the practitioner who has the skill to perform the procedure you are after and who has the knowledge and skill to reverse any unwanted side effects,” he says.

How long do the results of fillers and muscle relaxants last?

“Results vary from one brand of filler to the next and from one person to the next. The same applies to the muscle relaxants,” says Dr Lim. “Generally, the HA fillers last longer if you continue to be well hydrated.”

When it comes to muscle relaxants he says there are no special tips to making their effects last longer. “They usually last 3 to 4 months, sometimes 6 months. However, if you are regular with your return visits be it 4 or 6 months you will find that after a few years there is a tendency towards longer intervals between treatments.”

Will you look permanently different after long-term use of fillers and muscle relaxants?

Dr Lim says, “You are not going to look permanently different but you will look younger provided you are consistent with your follow up treatments.” He also advises that none of these injectables can delay the ageing process. “What they can do is to control the way your muscles in the face contract. When you stop your treatment and the muscles start contracting around your facial skin again the lines will reappear. The lines stay away if you continue to have your treatment regularly.”

What are the most common side effects of muscle relaxants and fillers?

Side effects most commonly occur as a result of bad injecting, which is why it’s important to do your research before you commit to a practitioner. For fillers these can include bloated, pouty lips; lumpiness, unevenness and a blue tinge under the skin. For muscle relaxants these can include droopy brows, raised brows, the fixed stiff and motionless look.

Dr Lim says most of the side effects associated with HA fillers are reversible, but to reverse non-HA fillers may require surgery that will leave a scar.

Are there any long-term side effects?

On a more serious note, he warns those receiving filler injections around their eyes, frown area and nose of a rare side effect that results in loss of vision. This can occur when a filler is injected accidentally into a blood vessel that carries the droplet of filler into the artery that supplies blood to that eye, effectively cutting off blood flow to the eye.

“Vision can be lost within an hour if emergency treatment fails to re-establish the circulation. You must contact your practitioner immediately if he or she has not detected it while you are still in the practice. You must let him or her know if you have a problem with your vision or pain in the eye while he or she is injecting. This is how fast the side effect can occur.”

If you are getting filler injections around the frown area or nose there is one other side effect you should be aware of, and that is necrosis of the skin.

“Necrosis refers to the inflammation and loss of skin in the affected area. This may take a few days to a week or more to be apparent. Contact your practitioner immediately you see blisters appearing in your skin or a dark discolouration or redness around the areas injected. They may be associated with pain and sometimes there is no pain. Scarring will develop after the skin has healed. Healing can take weeks to months,” says Dr Lim.

How do you find a medically trained doctor who is also ethically responsible when advising their clients?

“The best is word of mouth recommendation,” says Dr Lim. “Otherwise give the Australasian College of Cosmetic Surgery (ACCS) a call and they will assist. Give them an idea what procedures you would like. The college represents Cosmetic Surgeons as well as Cosmetic Physicians. The number to call is 1800 804 781.”

Dr Lim also says that you should never be afraid to ask your practitioner the following questions:

Whether he or she is a doctor or a nurse
What level of experience does he or she have in the procedure to be carried out on you
Where have they received their training
Has any of their patients suffered any complications
Can they tell you what complications are associated with the procedure
How long have they been doing it
Do they have the expertise and the tools to treat the complications (They should have Hylase in the premises at least)
If a nurse is doing the injection make sure she has a covering doctor. Is he or she nearby and is he or she available immediately if required
Whether your practitioner is a doctor or a nurse you must have a contact phone number that you can get him or her on at any time.

Dr Soo-Keat Lim MBBS (SYD) FFMACCS Dip of Lipoplasty (ACCS) graduated with an MBBS from the University of Sydney in 1966 and has vast experience in family medicine, both in Australia and overseas. Since embarking on a career in cosmetic medicine some 25 years ago, Dr Lim has acquired a commanding experience in a wide variety of cosmetic procedures. The Ashbrooke Cosmetic Surgery where he practises has two locations – one in Mosman and the other in Parramatta.

Have you had muscle relaxing injections or fillers?