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Markers of Ageing


One of the things people commonly say to me when asking about cosmetic injectables  is “I don’t need anything (yet).”

What they mean is, they feel they are too young for anti wrinkle treatments or especially, for filler treatments, usually because when we think of someone who needs some “work”, this is what we think of.

The ageing lower face
The ageing lower face

The problem with this statement is, by the time laypeople begin to notice enough changes that they feel dissatisfaction with their appearance – “I get told I look angry”; “I look sad when I am not!” “I love my body because of my cardio but not so much my face.” – it has been evolving for quite some time.





So why is that a problem?

Well. This is where my passion for primary prevention, ie General Practice, which is the speciality focused on preventing things from going south in the first place, shows.

Prevention is always better than cure, so I encourage people to be proactive about their skin just like their health.

So if it feels like one day, we literally wake up, and there is a mass of wrinkles where there used to be lovely smooth skin:







We begin to look grumpy while concentrating and have comments to that effect.

Frown lines





There are hollows where there used to be lovely soft dips- in our cheeks and under our eyes.

volume loss midface








There are sags where there used to be none…

Downturning Mouth




If that is you, then we’ve missed the opportunity to prevent and have moved to the “cure” stage. Which is more time consuming, worrisome and expensive.

Some will simply say, “Why bother!” and carry on. Others will say “I embrace my wrinkles!” to which I say, more power to you, and good for you.

But, for someone who is very much wash-and-wear, I am rather vain about my face, especially since I don’t wear makeup but do like to look good for my age.

Exercise, as great as it is for your heart and general health and mood, isn’t as good for the rate at which you lose fat, including from your face; it predisposes to fat loss from the face, resulting in the “runner’s face” – wrinkles, hollows, eyebags and jowls.









So small amounts of filler, used wisely, and in a way that fits your budget (keeping in mind filler is about $500-650/ml depending on thickness and where it is placed and how long it is expected to last), injected every 6-12 months in small increments is far more subtle and gradual than a sudden injection of 6-8ml of filler (assuming anyone has an extra $5000-10000 lying around!) in one hit:


Maree, from a well known filler company, after a total of 8 mls of filler plus anti-wrinkle treatment over some months. 

  1. done well, filler should not be noticeable to anyone but you. People, if they notice, should only notice that you look fresher, less tired.
  2. filler can give swelling and bruising depending on where it is injected, and can also cause the tissues to swell for a few days afterwards, so I believe firmly in less is more and in underfilling rather than overfilling.
  3. combined with anti-wrinkle treatments, they often remove the need for other treatments such as microdermabrasion, microneedling etc, though if you like them and want to add them to your repertoire, go for it!

Some examples of ladies I have done subtle work on:

early fat loss mid face and under eyes29yo with 0.5/0.5ml thick filler







29 year old busy mum of many, looking tired and drawn with early under-eye hollows and mid face volume loss. Top: before anything. Bottom: after 0.5ml filler to each cheek.









Lady in her late 40s with years of midface volume loss. Her deep eyebags worried her the most, but we had to restore the cheeks first before her eyes began to look better. Total volume used over 3 months- 5 mls.

So what can you do?

  1. Like all preventative care, begin before the damage has occurred if possible
    1. focus on a diet that is low in processed foods and high in fruits and vegetables
    2. get enough sleep – most adults need 7-9 hours/ day
    3. quit smoking!
    4. watch your alcohol intake
    5. use sunscreen, rain, hail or shine!
    6. care for your skin – it is the biggest organ of the body, and will be with you from birth to death, so it deserves that you care for it like you would the rest of your body!
  2. Get exercise and work on your heart and bone health with a good mix of cardio and weight bearing exercises.
    1. bear in mind that cardiovascular exercises, like running and aerobics, will stimulate more fat burning and cause a more gaunt appearance over time. BUT they are also great for mood, and the increased blood flow to the skin will help circulation so that’s a win!
    2. weight bearing exercises are important for bone health, and an important role in osteoporosis prevention as we age.
  3. Don’t shy away from spending on quality products to care for your skin
    1. try not to be penny wise but pound foolish – many of the OTC products you slather on your skin will do only so much, especially once past a certain age.
    2. fillers will not only plump up skin from within, they will also attract water to the site, evening out lines and wrinkles and they provide a lasting hydration that surface moisturisers don’t mimic as well.
    3. anti-wrinkle injections will relax muscles that predispose to wrinkles, smoothing them out over a year or more of sustained use.
  4. So, budget for quality care and care for your skin, look after it and it will repay you for years and years to come!thedrisin


Lastly, don’t forget, I am available each week at Moorebank as well as at Castle Hill for appointments to discuss your personalised treatment plan. Take advantage of my special packages in May while they are on offer!

Any questions? Email me

  • 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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