Dermal Fillers

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Thank you for sharing your photo and description. I appreciate you sharing your concerns.
Filler placement in the nasal bridge may constitutes non-surgical rhinoplasty. This procedure requires immense skill, experience, precision and after-care. There is an extensive consent process involved including the potential risks and complications of the procedure. To give you an idea, even 0.1mL may make a considerable difference.
It is difficult to make an assessment without seeing you in person. Moreover, I cannot see any before injection photos to make an objective comparison. The "Klingon" appearance which you referred to may refer to the fullness of the facial area nasal to the medial canthus including the appearance of widening of the nasal bridge at the level of mid pupillary line. Not uncommonly, this appearance occurs following facial surgery especially with blepharoplasty procedures or rhinoplasty. However, it is usually self-limiting once swelling resolves after several months.
In your situation, this may be due to several reasons:-
-localised swelling due to filler placement. As a comparison to above, the filler remains after the procedure, where there may be a venous lymphatic plexus transient obstruction. -migration of filler. Depending on the type and quality of filler used, this may potentially influence the position of the filler. Other factors that influence this may involve the depth placement and technique used for filler placement. -granuloma formation. Any facial filler, has a potential risk of developing a granuloma. There is an encapsulation around the filler that results in a full appearance and firm feel during palpation. -cyst formation -infection is fairly unlikely.
Where to from here? It is imperative that you seek a second opinion from a qualified medical practitioner who is formally trained in aesthetic medicine and surgery. They would be able provide you with a detailed assessment and tailored plan for you.
Sometimes it is important to take a step back and assess the situation through cosmetic imaging. Some radiologists and radiographers are experienced in analysing facial filler related issues or complications through specific imaging tests and views such as with the use of radiographs, ultrasounds or magnetic resonance imaging. You may want to consider this depending on the advice of your physician. These findings, with the help of our radiology colleagues, may alter the management strategy.
Is this transient? This is always a possibility, without performing a clinical assessment on you it is impossible to say. Some patients may have other active health issues that require further assessment.
If this is due to filler migration, dissolving it through enzymatic medication such as with "hyalurodinase" may be useful. This in itself is complex as there are different ways of doing this. There are also different preparations of hyalurodinase. The expected results following this will be dependent on your assessment.
There are various ways of treating granuloma due to facial filler injections. Surgical excision is of course an easy statement but requires meticulous planning if this is considered.
Seek the best advice and opinion you can get from medical practitioner experts who are formally trained in aesthetic medicine and surgery. Take time to make your decision. 
Disclaimer: The content of this description is for educational purposes only. It is imperative to seek a second opinion from a medical professional who is qualified, experienced and skilled in aesthetic surgery and medicine.

I had dermal nose filler over a year ago. The nurse who filled the area insists she only filled the top of my nose, but I do recall her going a touch higher towards the bridge between my eyes. Over time I now have a lumpy section that almost has Klingon vibes. I have shown it to her and she insists it is natural, perhaps due to other areas hollowing, and not her work, but it feels hard and thick, slightly sore, and looks so unnatural numerous people have asked me about it. What do you think could be causing this and should I seek a second opinion either from a doctor or injector?

Lumpy between eyes over a year after filler. What could cause this and can it be fixed? (Photo)

Hi thank you for sharing your presentation and concerns. 
Each patient is unique with significant differences to another patient. Although the photos are of low resolution and hard to visualise, it may appear that there is excess skin in the lower abdomen.
There are limitations and clear indications for all aesthetic procedures including energy based liposuction. At times, the use of certain modalities may make the appearance of excess skin more prominent. This may not meet your satisfaction. It is best to get a quality consultation from a qualified medical practitioner trained in aesthetic medicine and surgery.
Whilst you may not be keen in tummy tuck surgery for valid reasons, it is important to look into all your options including the variations of tummy tuck surgery. Mini -Abdominoplasty may address lower abdominal excess skin. Again, please consult a specialist in cosmetic surgery and medicine. You may want to refer to some basic information about tummy tuck surgery at our webpage at the link below.
In conclusion, take time to look into all options including surgical options prior to making a quality decision for your presentation.
Disclaimer: These answers do not constitute medical advice. All cosmetic procedures have it's inherent risks and complications. Please seek a second opinion from a qualified medical professional trained in aesthetic surgery and medicine prior to committing to any procedure.

I am not wanting a tummy tuck but would like to have some of this lose skin tightened. Would Laser Lipo or Renuvion help acheive a less evident overhang?

I do not want a tummy tuck. Will Laser Lipo or Renuvion help to get rid of this overhang? (Photos)

Thank you for your question. It is a hard one. The tear trough region is known to be a difficult area to treat. An experienced aesthetic practitioner would not only understand the varied aesthetic treatments available but also the diversity of genetic composition of patients. Underlying medical conditions may predispose patients to develop a certain presentation of the tear trough. The tear trough region in itself is complex with its lacrimal system, venous drainage and thin skin to name a few. Orbital skeletal resorption makes it more complicated with varying angular anatomical changes of the tear trough in time.
Specific to your question, dermal filler and lower blepharoplasty cannot be equated. They are two different treatment modalities. Dermal fillers, or non-surgical treatment, may address structural visual changes to the tear troughs. Lower blepharoplasty or surgical cosmetic procedures may not necessarily address visual changes to the tear troughs. There are advantages and disadvantages for each respective treatment. 
I cannot see any imaging provided. Even so, it is imperative to gain a comprehensive consultation with a medical practitioner trained in aesthetic surgery and medicine to give you better insight into your enquiry. 
Pleas view some examples of blepharoplasty surgery with its changes to the tear trough presentation. 
I hope this give you some perspective into your question.
Disclaimer: The answer provided does not constitute medical advice. It is imperative to seek a consultation with a medial practitioner who has training specific in cosmetic medicine and surgery.

I have had consultations with a few doctors who have all said that they are no longer doing tear trough fillers due to the mixed results. One said that they look ok the first time they are done but more and more patients are experiencing issues with persistent treatments. Can I ask for opinions on this. Instead it was recommended that I have a lower bleph which I'm told would be more predictable in terms of results and would give me a good 10 years of improvement before possibly having to treat again.

Tear trough fillers issues - Are tear trough fillers unpredictable? Would a lower bleph be a better option?

Dear Jaspsadie,
Thank you for your question. This is relevant not just for yourself but also many others who seek an answer for this common presentation. First of all, well done for looking after yourself and losing some weight with a focus on healthy living.
Understandably, by this stage, we should have advanced with non-surgical techniques to alter the appearance of soft tissues after massive weight loss. Although a lot has improved in terms of techniques and research pertaining to radiofrequency, dermabrasion, lipofilling, platelet-rich plasma, and energy based devices, we still have a lot to learn and improve on. This is why cosmetic research is essential. 
Without performing a thorough clinical assessment, it is impossible to provide a dedicated and accurate plan for you. However, upon basic visual inspection, it appears that you may have moderate skin excess with associated irregularities of the surface of the skin. 
Of course, serial non-surgical procedures may assist temporarily in the mid-term especially with tightening the skin. Please realise that tightening the skin may not necessarily translate to the outcome you desire. This is a whole assessment on its own. The cumulative cost and unpredictable outcomes may be expected should you require further amendments following skin tightening.
Non-surgical options may have it's role for specific goals but this needs to be carefully assessed.
There is another option, which is surgery or brachiaplasty with or without simultaneous liposuction of the arms. Disclaimer: All surgical procedures have it's inherent potential risks and complications. It is imperative to seek a second opinion from a qualified medical professional prior to any surgical undertaking. Always consider your decision carefully after being fully informed about the procedure of your choice.
The benefits of surgical excision of the soft tissues of the arms may involve permanent removal of the redundant excess tissues that may present as "sagging" or "rippling" and the likely reduction of volume and diameter of around the arms. The downside of surgery of course are the potential risks of surgery such as scarring, numbness and contour irregularities especially around the scar line. 
It is essential to have a comprehensive consultation with regards to your presentation from a trusted and experienced doctor or surgeon specific to aesthetic surgery. 
To learn more about our quality consultation in Melbourne especially related to the component of liposuction you are welcome to click below. Learn about your options with confidence.

I am 54 yrs old and over several years have lost close to 50 lbs. A big downside of course, is that now the skin on my upper arms is sagging and rippling. Is there a Non-surgical procedure that will yield very positive results to tighten the skin? I dont want to spend thousands of dollars for only modest results. There has to be something available now that works well without having to cut the skin off. Right?

Close to 50 lb. weight loss - Non-surgical arm skin tightening? (Photos)

Dear Ace,
Thank you for your question. I am sure you want to have this fixed soon but please consider all your options carefully before deciding on what is the best option for you. First of all, well done on making the effort to look after yourself through health living! Let's understand what happens when a person has massive weight loss. The body goes through a lot of changes especially with regards to losing soft tissue elasticity. This translates into the tissues being unable to retract back favourably when there is moderate to large changes of volume. The soft tissues of the upper or lower abdomen in the body is sensitive to these drastic changes which result in excess skin. It is important to get examined by a doctor trained in aesthetic surgery to give you the best options available for any cosmetic procedure. If, on examination, you have moderate skin excess, there may be an option to consider surgical removal of excess skin. Of course, this leaves a permanent scar, but with the realisation of removing redundant skin. You need to also have the underlying structures beneath the skin assessed to ensure you do not have any herniation of the deeper soft tissues. There is certainly a lot more to the examination. Whilst it's tempting to think that energy based devices may assist the situation, sometimes there are advantages and disadvantages that need to be openly discussed to help you make an informed decision. Don't rush, get a second opinion from a qualified medical professional before proceeding. All cosmetic non-surgical or surgical procedures carry potential risks and complications. To learn more about skin excision procedures such as mini abdominoplasty coupled with liposuction feel free to click the link below. Thank you for your question and I hope it gives you some insight into important factors to consider for your presentation.

I am a 38 year old male, I weighed about 220lbs and have had liposuction in the past. My lifestyle at the time did not sustain further weight loss. I finally started dieting and going to the gym 6 days a week as of January 2024. I now weigh 165lbs and am 6’0 tall, my weight has been stable and does not fluctuate. I have a small amount of loose sagging skin on my lower abdomen above my belly button and on my lower back/love handles. I have heard of Bodytite and other less invasive options but would like something that will eliminate or make my loose skin much less noticeable and preferably something that isn’t a short lived/temporary solution.

What is the best procedure for tightening loose lower abdomen and lower back skin after weight loss? (Photos)

Thank you for your question. Whilst it's easy to assume that dermal filler would lessen the appearance of the recognised and known nasolabial or marionette lines, it is first important to obtain a comprehensive clinical assessment from a medical practitioner trained in aesthetic medicine. The nasolabial lines are commonly referred to the area lateral and above the corners of the lips. The marionette lines usually refer to the indentation of skin area just below the corners of the lips or mouth. There may be multiple reasons why this may have occurred. The face has varies anatomical layers including the underlying bony structure, retaining ligaments, SMAS, subcutaneous tissues, and skin. Any of these structures or combination thereof may have a role with regards to the appearance as described. The assessment of this may be rather comprehensive. Yes, dermal filler may help to reduce the appearance of smile lines preferably with a low cross linkage properties. However, this may not necessarily be the only way to manage this area or let alone the best way to address smile lines. Is there an element of not being adequately hydrated? There's a myriad of reasons. Take time to obtain a proper assessment. Some patients are happy to leave the smile lines as they are and may decide against dermal filler. A comprehensive and balanced assessment for your smile lines is invaluable for your overall result not just on the surface but also within.

I will try to attach a photo- I smile lines just lateral to my lips. I don’t know if I would call them nasolabial folds or marionette lines- they’re kind of in between. Would dermal fillers help in this area?

Dermal fillers for smile lines? (Photos)

Thank you for your question. Please note that clinical questions warrant a comprehensive clinical assessment for the best diagnosis and exploration of your issues. This will never be replaced by any form of technology. I have seen several patients who have puffiness of lower eyelid region following "filler treatment" after more than 12 months as described by patients. There are a constellation of potential reasons for this. Some patients do have residual "filler" that can be further investigated with radiological investigations such as with specific magnetic resonance imaging tests conducted by specialist radiologists who are familiar with these issues. If this is the case, dissolving the residual "filler" may help although it has its inherent potential side effects, complications as well as limitations. Other causes need to be excluded such as underlying conditions or infection. The ageing process may potentially contribute to this. It is important to take time to make a plan of treatment before deciding on any treatment. Seek advice from your general practitioner and get a full medical check up. It would be good to speak with the initial treating doctor , who performed the facial treatment, to get their advice. If you could please upload better imaging that might be helpful. Hope this helps.

I have received under eye filler over 12+ months ago and from time to time I get this random puffiness. I have not been able to determine a common factor why this occurs? Should I be concerned? Do you know what could be causing this to happen?

Under eye filler puffiness 12+ months after. Should I be concerned? (photos)

Thank you for your post. It is imperative to have an assessment performed by a clinician trained and skilled specific to cosmetic medicine and surgery. It is good to have a second opinion performed by a health care professional. A general practitioner assessment is important. The reference of mid section may differ to our understanding of the "mid-face". That is why it is important to have a consultation and examination performed by a doctor that you trust. Fat graft to the face has its merits and risks. Some merits include increasing the volume in some fat compartments of the face that may have reduced at the time of your weight loss as well as benefits to the skin. Risks involve asymmetry, bruising, lumpiness or even accumulation of fatty cysts. The fat resorption varies from individual to individual and so do the risks of of any procedure performed by your surgeon. Remember, you have time to think of what treatment is right for you. Looking at your photos, you may consider regaining the lost weight to see if it makes a comfortable difference without any intervention.

Hi, I'm 26yo- I've noticed when my face is In a neutral position that the sides look flat and hollow. I'm 26 and have lost a small amount of weight recently so I think that may contribute. When I smile my cheeks look large which makes my face look better. Should I get fat grafting to cheek area or filler to make my face while in neutral position look better? Also open to any other suggestions on face in general. Thank you

Lack of volume in mid section while in neutral position? (Photo)

Good question. Many of my patients ask questions pertaining to your description. This is a valid and respected question since you not only care about your safety but especially your child. Any elective procedure that penetrates the skin will have some potential risk of infection. This may be systemically transmitted into the breast milk. It may be prudent to delay these cosmetic interventions later on so as to avoid these risks. All clinicians have different perspectives on this. However, in our practice we always maximise your health and minimise the risks as best possible. Getting informed about a treatment plan during this time at a consultation would be wise idea.

I understand it isn't recommended during pregnancy but how about after birth whilst breastfeeding? Should I wait a certain timeframe before I get any treatments?

Is it OK to get treatments like Botox, lifting, RF microneedling and lasers whilst breastfeeding?

Kishen Nara, MBBS, FACCSM(Surg)

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Physicians are medical professionals who study, diagnose, and treat diseases, injuries, and other physical and mental impairments.

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I found Dr Kishen Nara to be; very personable and friendly when consulting with him on phone or in person. 
The doctor would also follow up on my health after a treatment was given within a 2-3 day period post treatment. 
The doctor is also highly knowledgeable and communicative on all aspects of the treatment I was and still have periodically. 
The doctor can also recommend other options of treatment appropriate to the situation I have experienced. 
I highly recommend Dr Kishen Nara, I believe he is a very caring, empathetic and professional cosmetic surgeon. 
I have no doubts of safety or competence in the doctor’s treatment of my cosmetic situation or his ability to confidently carry out the treatment. 
As a communicator, I value strongly feedback and answers to questions posed. Dr Kishen Nara has and continues to provide “Good bedside manner” too.

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9 Answers from Physician Kishen Nara, MBBS, FACCSM(Surg) See Education, Board Certification, and Treatments Offered.

Meet Kishen Nara, MBBS, FACCSM(Surg), a trusted Physician. See 9 expert answers, 5 before-and-after photos, credentials, treatments, and 1 real patient reviews. Book a consultation today!

MBBS (Monash University)

FACCSM(Surg) Surgical Fellow Australasian College of Cosmetic Surgery and Medicine

I found Dr Kishen Nara to be; very personable and friendly when consulting with him on phone or in person.
The doctor would also follow up on my health after a treatment was given within a 2-3 day period post treatment.
The doctor is also highly knowledgeable and communicative on all aspects of the treatment I was and still have periodically.
The doctor can also recommend other options of...

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Australia

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Meet Kishen Nara, MBBS, FACCSM(Surg), a trusted Physician. See 9 expert answers, before-and-after photos, credentials, treatments, and 1 real patient reviews. Book a consultation today!

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