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Dermal Fillers in Practice


This week, a reflection.

I often get people coming in and asking for filler, afraid it’ll change the way they look, or be too obvious. Most of the time, they underestimate how much they need; occasionally, I get caught out too.

Most people don’t want to look like The Real Housewives of Sydney. They don’t want to look fake, fat or like they’ve had filler or botox. They simply want to look like the best possible version of themselves.

Cheek filler to correct NLF
Cheek filler to correct NLF

To these people, I always say, that filler, if done well, is almost unnoticeable. The change is gradual and subtle. Likewise anti wrinkle treatment. YOU know something has happened, but the results are subtle, and usually, due to the cost involved for most people, gradual.

Rather than going for what’s cheapest, possibly to regret it, I suggest budgeting for what’s better, if more expensive. There’s a reason why chain clinics are cheap.

So, let’s look at some examples of cheek fillers, and how they work to help with many “problem” areas on the face- eyebags; nasolabial folds and marionette lines; jowls.


Eye bags are often the result of loss of fat from the cheek just under the eye, next to the nose. This leads to drooping and sagging of a ligament, resulting in eyebags.

Correction of this has to begin with replacement of volume loss in the cheek to support the tissue under the eyes.

This lady was very hesitant to have “too much” filler into her cheeks for correction of her deep eye bags.


Here you can see that 2mls (1ml to each cheek) has made a difference, but in my opinion in order for her to lose the eye bags, she needs 1-2mls more in each cheeks and THEN 0.5ml to each eye bag area, or tear trough, to avoid a lumpy under-eye area due to a flat cheek.


2. Marionette lines (downturned sad mouth) and Nasolabial Folds (nose to mouth lines)

A common cause for marionette lines is sagging due to loss of volume in the cheeks. Correction again involves replacing the lost volume first as that may be enough to reduce the lines.

Here, this lady had 1ml to each of her cheeks and cheekbone area in total as well as in her tear trough area, with significant improvement in her downturned mouth as well as nasolabial folds/lines.

With age and further fat loss in the cheeks and around the jaw near the angle of the jaw, skin pools around the jaw, giving a jowled appearance. As may be apparent by now, many signs of ageing are related to loss of volume from the midface so correction necessarily begins with replacement of this volume with fillers in this area first.

Post 0.5/0.5ml thick filler

This lady needed only 0.5ml to each cheeks to help reduce the appearance of her tired eye bags and reduce the flattened appearance of her face closest to her nose.


Here, 29 year old young woman with very slim face and tired look due to deep eye bags. Here just after 1ml of cheek filler, with more planned soon.

Also, remember, the younger you are, the less volume you (usually) need to replace though there will always be some people who will be unusual, and others who, having always had a slim face, will lose fat faster. So if you are likely to begin the filler journey, start with smaller amounts younger (eg 2-4mls) eg around early to mid 30s, than a large amount when older (eg 6-8 mls or more).

And filler is never wasted- the 1-2mls you spend money on, even if results aren’t striking, goes to form the base for further filler that will effect a change, and last anywhere from 9-12 months or more, depending on thickness and where it is used. So it’s money well spent, and an investment.

Email me if you have questions! See you in a clinic soon!

  • Dr Imaan Joshi has been working as a doctor since graduation from the University of Sydney in 2001. She spent years between 2004-2011 as a surgical trainee before switching to a different speciality program for work-life balance. She is passionate about her work in Medicine and especially about procedural Medicine, and loves her work as a Cosmetic Physician. When she isn't working, she is busy focusing on an active life with her family, which includes 4 active children! Dr S Imaan Joshi BSc, MBBS, FRACGP


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