This depends on two main factors; your volume loss & your natural biological volume deficits.

We lose 1% of collagen, starting in the early 20s. Hence in your 40s-50s, you will have lost 25 to 30% of collagen. As a guide (everyone is different), the amount of collagen replacement required is;

• 30s-40s: 1-3 mls
• 40s-50s: 2-5 mls
• 50s-60s +: 3-7 mls

*Natural biological volume refers to the amount of soft tissue that you may be lacking due to genetics. For example, my biological volume deficit is 6 ml- the volume required for jawline contouring. Defects range from 0 mls, to 10+ mls.

There are two ways to approach this. Firstly the classic method, as used by our nurses. This entails sticking to a predetermined area. Examples include-

• The cheek: most popular area 
• The jawline: especially in males
• The lips: for genetically small lips
• The chin: for better aesthetics
• The temple: for mature patients
• The treat trough: to correct some cases of dark circles. 

The second method is ‘freestyle’. You pay for the number of syringes required (usually 1-3), then trust our expert aesthetic eyes to do the rest. You will get better results with this technique.

The number of filling sessions varies depending on; 

• Your volume deficit. More deficit, more sessions.
• Your budget. We will guide you through what’s bang for your buck.
• Your confidence in letting us inject. Trust- it goes both ways.

The interval between sessions can be as short as one week, or as long as 6 months. It is up to you.

There are two types of collagen stimulating injectables. 

1. The newest injectable is a hybrid biostimulatory hyaluronic acid. It does NOT add volume, but stimulates your cells to produce collagen- hence its role in skin tightening. Most patients require 2 injectable sessions, spaced 4 weeks apart.
2. The second class of injectables add volume & stimulate collagen production. These injections are suitable for more mature skin who will benefit from volume displacement & skin tightening. They include PLLA (poly-L-lactic acid) & CAH (calcium hydroxyapatite). These fillers can have a marginal benefit on skin quality .

Every face is different. Some patients in their early 20s will benefit from fillers, conversely some patients in the 50s are not suitable candidates. 

Full faces may be candidates, as chin augmentation can reduce fullness. In summary, it depends on individual aesthetics. 

Top ups are performed, based upon clinical features & not the on-label lifespan of fillers. For example, if a filler has a lifespan of 18 months, we don’t refill at 18 months but base our decision on what you look like. In some cases, we may not ‘top up’ the area for 3 years, in other cases we may top up at one year. 

Ideally, volume is the last stage of skin rejuvenation as we address skin quality/texture & skin turgor or tone first. Why? Because collagen regeneration can improve dermal integrity & thickness, meaning more accurate placement of soft tissue fillers. Tightening before filling gives more precise results. 

This rule is not absolute, as in many cases we can combine a light resurfacing procedure at the same time as dermal fillers. For skin tightening procedures, we suggest a wait time of 2-12 weeks before fillers. 

Our team of dermatologists & nurses are very good. We train the industry. Companies invest their efforts based on our eye for aesthetics, so rest assured you will receive a natural result. 

Injectables are really just products, much like paint. It’s the artist that matters. You notice the bad jobs. The great results & natural outcomes…you don’t know & you can’t tell. That’s the work of my team.

The most predictable factor with fat transfer is the unpredictability of how much is retained. I utilize fat transfer for larger volume deficits, namely larger than 10-12 mls. In the context of ASC or adipose stem cells, we get much better results with simple low downtime procedures such as non-ablative lasers.

With over a dozen dermal fillers, the price varies. As a guide-

• One syringe of hyaluronic acid filler: $590 to $1290. Fillers by our nurses are about half the cost compared to dermatologists. 
• Collagen biostimulator injectables: $750 to $850 per 2ml. 
• PLLA or Ca Oh collagen stimulating fillers: $890 to $1690 per vial/syringe 

Following these instructions will save you a lot of grief & money. The concept is simple. If you lose too much weight off your face, your skin’s tensile strength can not match the reduction in volume. The result? An increase in skin laxity. We see this all the time. Here are some hints to help your skin cope with this process.

• Sensible weight loss. If you have had bypass-stomach surgery or Ozempic injections your weight loss can be epic. It’s literally like stepping on a brake. Modulate weight loss, ½ per week max. This translates to 2 kg per month, & 10 kg over six months. If your weight free falls, consider protein supplementation.
• Skin tightening procedures. Two great non-invasive skin tightening procedures are RF slow heat (NuEra or Tempsure) & collagen biostimulatory injectables. RF causes contraction of dermal collagen, in turn reducing laxity, whilst injectables increase the amount of collagen.
• Volume replacement. Simple soft tissue fillers can correct volume deficits. We employ over a dozen different HA & collagen stimulating fillers, depending on the clinical indication. 

Once your weight loss stabilizes, you can explore more powerful skin tightening procedures such as PDO monos threads (vector), dermal fillers, RF microneedling, deep laser resurfacing as well as surgical options. 

Every injector should know how to identify, treat & mitigate side effects. Side effects range from common, about 1-2%, to uncommon, between 0.0001 to 0.1%.

• Common side effects include over correction, early onset nodules, late onset nodules. 
• Uncommon side effects include infection, arterial compromise, & blindness.

Your injector will discuss side effects in great detail, prior to filling.

It’s a bell curve. Everything biological lies on a bell curve- height, weight, intelligence & even longevity of injectables like Botox & dermal fillers. For some patients, HA fillers only last half the expected lifespan, however in others they may last 2-5 times longer than advertised. 

The reasons of reduced longevity include-

• Fast metabolism. Consider yourself lucky. Metabolic degradation can be genetic, compounded by exercise. 
• Age related reduction of endogenous collagen & fat. This accounts for most cases of ‘fillers not lasting’. Concept is easy to understand. Filler is still there, but you are aging. Aging goes in cycles of 3-5 years. This means you’re steady for 3-5 years, but land on the 6-12 month cycle of accelerated aging, & BOOM, you’ve lost collagen, fat & bone. Don’t blame it on the filler or your injector. You’ve just landed on the accelerated time frame of aging. It’s called biology & it is not hard to understand.

For permanent solutions to facial aging, your choices are; 

1. Implants for the cheeks or chin.
2. Maxillofacial surgery to address maxilla-mandible. 
3. Cryogenic freezing in the United States to stop aging after you die.

Nil. PRP is a good adjunct for hair loss. In the context of volume replacement, it does nothing. You are better off investing in a pair of shoes. You will be happier. 

PRP can marginally speed up recovery. “Stem cells’’ in a bottle do the same thing. If you want the novelty of PRP, just ask our clinical staff for a quote. 

There is no cream that can replace volume. Topicals are designed to maintain skin texture or quality, or improve pigmentation. No matter what is advertised, skin care will not generate enough collagen to volumize deficits. If you are into stem cells, knock yourself out with Calecim.

Given the banal nature of collagen supplementation & the fact that it has been scientifically proven to improve joint health, especially for those who suffer from arthritis PLUS how cheap they are, you can give it a go. 

There is no (good) scientific evidence that drinking collagen will improve your skin. On the other hand, placebo can give you the ‘feel good factor’, which can not be measured with before & after photos.