So, You Thought About A Filler?

Dermal fillers…another tool for beauty enhancement that could turn into anti-aesthetic nightmare. Yes, the same social magazines, TV and commercials are filled with monstrosities created in the name of anti-aging medicine…over-inflated lips, protruding cheeks, lumps and lines that blossom when you smile…when you talk…sometimes when you move.

Amazingly, I have watched a promotional video made by one of the manufacturer of dermal fillers. The models had some of the above features…a sad reminder that aesthetics are attributes of art rather than a mechanically simple ability to empty syringe into ones face. And yes, the word aesthetic means art.

Regardless of your experience, you are anxious about the pain, bleeding, bruising, bumps and unnatural look. And, regardless of your experience, you will be amazed how minimal the discomfort could be….not more than the injection of Botox. And this is a norm at VISAGE MedArt….and I would challenged anyone who will tell you otherwise…you can simply ask our patients.

The two most important questions are…which filler is best for me and where to place it.

And here is the first problem. The most frequently injected area, the naso-labial folds, folds that run from the nose down toward the corners of mouth, are injected mostly without a significant aesthetic effect. Yes, you can have your folds less deep…even completely flat but, the chances are, you still look tired and aged…you still have a signs of aging although the filler is already in….injected supposedly to reverse the signs of time. And you’ve paid for it?

There are very few but key areas of the face that will make a dramatic improvements instantly and there are places, injected too frequently, where the effect is mediocre. Frequently, in my opinion, placing a filler in There are certain areas where, in my opinion, injecting filler is a waste of money.

You may ask why it happens? The answer is quite simple. Injection, as a physical act, requires rather basic skills. The anatomy of the face is pretty consistent and learning it does not require extraordinary mental skills. Yet, what is required above all, is an artistic understanding of spatial relationships and art form, ability to invision the outcome before the needle enters your skin. And this, only this, makes filler injection a difficult task, achievable only by those who have artistic inclinations. Since a good plastic surgeon, in order to be good, must be artistically inclined, I would find much more comfort in their abilities than any other medical specialty.

There are very few non-permanent fillers approved and available in the US. What matters mostly for any patient is the duration of filler’s effect and its price.

  • First, the longevity of the product that is claimed by the manufacturer does not reflect any specific case. These are for orientation purposes only and duration varies significantly; this must be discussed with any patient interested in any filler in order to avoid disappointments. As always, take the manufacturer claims to be the best case scenario and not the norm.
  • Second, some fillers are better than others for a specific area; eg. you don’t want some products to be injected into your lips or near your eyes. And since only very few products are available, you can learn what’s best quite easily.
  • Third, the price of fillers.. The prices vary from region to region, from office to office. A medspa around the corner may have much lower prices; at this does not necessarily mean that the injector is less “qualified” or less skillful. What it means is that the abundance of aesthetic services have created an atmosphere of “flea market” mentality, far from the medical artistry required for the optimal results.

It would be to your advantage to learn which are the most cost efficient fillers available.

This can be easily determined by considering the average duration of the effect and the size of syringe.

There is a substantial volume difference between the products ranging from 0.75 cc to 1.5 cc per syringe. It just happens that the largest syringe by volume contains a filler that last the longest. And this filler requires much more conscious and precise placement that the others since misplaced product may violate the rules of aesthetics giving very undesirable effects that may last for a very long time.

How many syringes you may need? Shoot for less rather than more. You can always add more later.

I am not good in estimating the amount one may need if, in my assessment, one syringe is not enough. Few months back one of my patients asked me this question. I responded that he may get away with two. And just few days ago, over 3 months later, I injected the seventh syringe! Yes, the patient looks absolutely great and natural even during the most extreme facial expressions. But it proves again and again that a slow approach, a small volume at the time, pays off and prevents mishaps. There is no place for rush or cavalier approach. It’s your doctor’s choice. But it is your face.