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What every woman needs to know about botox, fillers and threads, with Dr Naomi McCullum.

Dr Naomi McCullum is a renowned Australian Cosmetic Physician and a pioneer in the field of non-surgical cosmetic medicine. With a career spanning over two decades, she has distinguished herself as a leader in non-invasive treatments, with a strong focus on injectables. 

During this session of Mamamia's The Skin Summit, host of You Beauty and Executive Editor at Mamamia, Leigh Campbell, asked Dr Naomi McCullum all the questions you wanted to know about botox, fillers and threads. 

What is in an anti-wrinkle injection? And how does it work?

Dr Naomi McCullum: Because of TGA regulations, we can't say the substance that is in it... but basically, it's a purified protein that stops the message from getting to the nerve to the muscle, so it stops the muscle from working. 

How long do the results of antiwrinkle injections last? 

Dr Naomi McCullum: There's a curve. So we put it in, and then at four weeks after that is the maximal effect. At eight weeks, it starts to reduce, then at 12 weeks, it's about 50 per cent, back, and then at 16 weeks (or four months), it's about 80 per cent back so people can choose whether they want to have it redone it 50 per cent back or 80 per cent back or they can leave it longer. Or they can let it 100 per cent come back. 

Everybody chooses what they like. 

Where are the most common areas that people would get that done in their face? 

Dr Naomi McCullum: I would say the top two would be your frown line and your crow's feet. The horizontal forehead lines are really popular as well. 

Is this a bad thing for the muscle? Is the muscle going to die? 

Dr Naomi McCullum: The muscle over time can definitely atrophy because it's not getting worked. Is this a bad thing? In some ways, it's a good thing because you might need less of the anti-wrinkle injections over time so people see that as a positive. 

In some areas, we want the atrophy. For example, for people who want facial or jawline slimming - everybody wants atrophy. When we do trapezius injections, or calf injections, atrophy is part of it. So people want that.

There are areas where you might not want much atrophy. But the muscles are so tiny anyway, it's not that relevant clinically. 

So, what can injectables actually do for skin in general? 

Dr Naomi McCullum: There are injectables that we use to target the skin, these include skin boosters, and platelet-rich plasma or PRP. 

We also do something called Aqua Gold, which we use as a cocktail of those things to help the skin and also anti-wrinkle injections, we can put in the Aqua Gold. The skin booster is like a filler treatment, but really fine, and is very commonly used under the eyes. We use it over the whole face and that will really improve the crepe-like look and the fine lines. 

The PRP is really popular for under the eyes and the full face. The Aqua Gold is something we use for pore size, for redness and it also has a skin booster and the PRP in it as well. It will help the skin's quality and texture. 

Is there standard pricing? Or does it vary from clinic to clinic? 

Dr Naomi McCullum: The range is not that dissimilar, but most people price it by the amount used, so it is quite individual. 

Now let's talk filler because some people get the two mixed up. What is a filler and what does that do? 

Dr Naomi McCullum: So filler is completely different to anti-wrinkle injections, it can be used in some of the same spots but the filler is a gel that sits under the skin. It's made of something that our bodies are made of (which we're not allowed to talk about because of Australia's TGA guidelines).

But it can be used to give you volume where you've lost volume and it can be used to reshape, or it can be used to fill lines. It's able to be used in a lot of places.

I think you could put filler anywhere - there are just different risks for different positions. But definitely cheeks and lips and chins and jaw lines and tear troughs are probably the most popular areas. Nose or labile folds as well. The temples are important. Some people get the forehead and the nose. But all of the areas have different risks. 

People worry that filler might stretch their skin because you're adding volume... Is that a thing?

Dr Naomi McCullum: We're often using it for volume loss so it's not really stretching the skin, it's replacing it. Then when we're using it in lines, we're really putting it onto the surface where the line is and where we're also stimulating collagen wherever you put filler as well. 

It's not something I worry about clinically at all. 

There's a term called 'filler migration'. That sounds bad. But what is that? 

Dr Naomi McCullum: So that's something that can happen most commonly in the tear troughs and in the lip border. Those are two places where it's most clinically relevant.

We might put some filler in the depression of the tear trough, but it can move a little bit towards the nose and then what happens is that it is just not a good aesthetic result. 

That's the same with lip border migration. You want a nice, precise lip border and if you get migration - where the product moves outside that precise border - then it doesn't look as great. Although there can be some ways for it to look good and you can adjust it because it does stimulate the collagen.

So if someone has smokers lines and they get a little bit then actually, it's going to treat that. However, it's not a big deal to me clinically, because if it happens, we just treat it. 

It's like bruising, it's like swelling. If it happens, we address it. It's not catastrophic at all. There are catastrophic risks, but that's not one. It's not one of them. 

So how would it be treated? If there was a migration that someone wasn't happy with, then is it dissolved? 

Dr Naomi McCullum: You can dissolve the product.

First-time filler people might wonder if they can feel it under their skin. Does it feel like something is there when you touch your face? 

Dr Naomi McCullum: In the first few weeks, yes you can often feel it because it hasn't really integrated into your tissue. 

Lumpiness straight after injections is really common and not something we worry about because it usually over time integrates nicely into the tissue. You can't feel it. 

How long does filler typically last?

Dr Naomi McCullum: So with filler, it's less predictable as to how long it lasts. It lasts longer than anti-wrinkle injections in general. 

The other thing about filler is that it's not necessarily the type of treatment where one treatment will get you to the results that you want. The process we use with filler is we'll put the filler. Also, we tend to underdose because everybody wants natural results, we don't want to overdo it, we just want people to get it gradually. 

So we'll put some filler in, and we'll review them at four weeks after everything has settled. Then at that time, the patient will decide whether they want to have more filler and we can add some more filler.... Then we'll review them again. 

Basically, we need to finish the treatment phase, and then we've got the maintenance phase. 

The treatment phase is basically until the patient has achieved what they want. 

The maintenance phase depends on how many we've done in the treatment phase but typically, the maintenance phase means we might do another treatment at six months, and then eventually we just do treatments once a year. 

For example, I didn't have my filler more than once a year. 

Is there an option for a permanent filler? Does it last forever? 

Dr Naomi McCullum: So we have a saying: 'permanent filler permanent problems'. So I would avoid that. 

I don't know where it sits at the moment or whether there's an approved one currently. I haven't used one for many, many years. 

Again, on pricing: is it again down to an individual person's dosage?

Dr Naomi McCullum: Filler comes in a set amount. So basically, it comes by the ml and often people do price it by a mL. 

Let's talk thread lifts or skin threads. If anyone has seen pictures or videos, it can look terrifying. Can you explain what threading is? 

Dr Naomi McCullum: We find the threading treatment which has the highest satisfaction rate to be the short, collagen-stimulating threads. 

Basically, we just put a number of them in anywhere from 10 to hundreds, and it just stimulates the collagen. 

How long do these generally last? 

Dr Naomi McCullum: This is a difficult question because it depends on how many you put in as well. I would suggest doing them every six to 12 months.

Are there any complications people need to worry about? 

Dr Naomi McCullum: Yes, there are. With every procedure we do, there are risks and complications.

What can happen with the threads is you can get bruising, and you can get swelling. Sometimes you can get the threads coming out.

Everyone wants to know, does it hurt? 

Dr Naomi McCullum: It's really that is low pain. I would say the majority of people wouldn't even need happy gas for that. A lot of patients don't even want ice for that. Although the ice is good for the bruising. It's very, very quick, and it's not that painful. 

So filler then, is that more painful?

Dr Naomi McCullum: There's local anaesthetic in the product, which is nice. That was great when that was introduced years ago. But the lips are really painful. 

Why would the lips be painful? Is that a blood vessel thing? 

Dr Naomi McCullum: No, nerves. Also, the centre part of the face is really painful but the outer edges of the face aren't as painful. 

If someone's curious and has never done any sort of treatments to their face and don't know what they need -  where should they start? 

Dr Naomi McCullum: So I think I'm the most important thing to do first is to get a really good face design. They need to go and have a consultation where the practitioner will first ask them their concerns. 

After that, the practitioner needs to do a really systematic face design where they're assessing everything from the bone right up to the skin surface. 

The practitioner will make the recommendations, and then have a discussion about what's important to the person, what the risks are, what their downtime is and what their budget is. It's done together to just get the outcome that the patient wants. 

Should they maybe go away and think about it and not have the treatment immediately or...?

Dr Naomi McCullum: I think there are some procedures that are not that big of a deal to do. Crow's feet, a frown line, or anti-wrinkle injections on the day will most likely give a lot of satisfaction. The satisfaction rates are super high and the risks are very low. 

With filler, the thing is there's so much information online now. People can be very well informed already so we find that most people will have something done on the day. But if they're the type who wants to think about it? Yeah, great idea. Of course, there are serious risks. 

Did you miss The Skin Summit presented by Mamamia? Get on-demand access to the best skin experts in the world. Whether you love nerding out over a 12-step skincare routine or still use a bar of soap, the summit is the secret to the best skin of your life. Streaming directly to your couch. Catch up on-demand here.

You can follow Dr Naomi McCullum on Instagram.

Feature Image: Mamamia.

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