I saw a patient recently who had major weight loss (around 100 pounds). She wanted filler, and was a good candidate for it, as she has a lot of volume loss. So we discussed the different types of filler, focusing on the HA (hyaluronic acid fillers like Restylane and Juvederm), and she decided to try those. She wanted one syringe.
We did the injection, and when she looked in the mirror, she was disappointed. “I don’t see any change.” I had taken photos, showed her the change as it was injected, and there was a change. But she wanted more volume. Due to money constraints (which I totally understand- this stuff isn’t cheap), she could not do more. And though even amounts were injected onto the right and left side, she thought “the two sides look different.” She then showed me photos of a friend who had filler who looked very plump. “Why do I not look like this?”
It inspired me to write this blog.
- 1. HOW MUCH FILLER YOU NEED VARIES. this could be a blog unto itself. I never know how much change you will get from injecting one syringe of filler. Some people get a big change, some a small one. Anyone over the age of 40 needs volume in their face. And usually the more volume, the better the results *within reason- I don’t overplump. General insights:
- The older you are generally the more volume loss you have, so you will need MORE.
- The thinner you are – for those Palo Alto moms with no body fat- the more volume you need, so you will need MORE.
- The poorer your skin tone, the less lift you will get with injection, so you will need MORE.
- If you have had major weight loss, your skin is likely a little lax. This means in general you will need MORE.
- 2. WE WILL GET AN IDEA OF WHAT YOU NEED AT YOUR FIRST INJECTION.
- Most of my patients need 1 or 2 syringes.
- I like a natural subtle look, not the overdone LA look. The goal should be “You look great!” not you look done.
- 3. IF YOU NEED A TON OF VOLUME, THEN FAT GRAFTING IS A GOOD IDEA
- Fat allows me to harvest a much bigger amount.
- If you are doing multiple syringes a year of HA filler, then it becomes more cost effective to just fix the issue with fat grafting.
- Fat has the extra bonus of stem cells, which make the skin quality look lovely.
- Fat also is more malleable. When I do microfat and nanofat, I am able to go all over the face and correct fine lines around the mouth, deeper “gills” lines in the cheek, add volume to the temple/lip/chin. I love love it.
- 4. YOU ARE ASYMMETRIC.
- Peoples faces are not symmetric. This has to do with muscle tone, sun damage, sleeping on your side, bone structure. I try to point these out to people ahead of time, as filler can help mask some of these things, but it isn’t magic. If your left side of your face is droopier or wider, it will still be that way after.
- 5. HAVE REALISTIC EXPECTATIONS.
- You cannot compare yourself to someone who is 15 years younger, has different skin tone, etc. Every person has variations- their response to the HA volume is different, how much they need is different, how long it lasts is different, if they tend to bruise is different.
- You cannot fix issues with the skin quality and looseness that needs a facelift by putting in filler. Filler should only fix the volume loss. If your skin is loose requiring a facelift, you need to fix that by tightening with a facelift. (And this goes for thermi, ulthera, lasers- if your skin is loose enough to need a facelift, these “tightening” procedures will not work either.)