In our last blog, I highlighted the pros of using permanent fillers. You can refer to that before reading this if you’d like, by clicking here.
This is going to sound unbearably snarky, but it’s just plain true. The vast majority of people who are administering fillers shouldn’t be doing it. I’ve seen a lot less of the good than I have of the bad and the ugly, and this is at least partly irrespective of the person’s credentials or “training”.
First of all, unless a physician has finished their residency/fellowship in the core specialties in the past ten years (and even if they have), it’s unlikely that they had any training in fillers at all other then a course where they got “certified” over a weekend or so. And although there are probably some exceptions to this, most people who are not surgeons in the core specialties have not had advanced education in facial embryology (how the face develops in the fetus) or facial anatomy. You have to know it cold. By the way, there are still textbooks being written on this with, believe it or not, new information. One of the major ones was just published in 2012 with a lot of information we didn’t know about before. On top of that, I’ve seen over and over again where the healthcare professional has wisely stayed away from the area around the eyes (because if you don’t have that anatomy down, you take more of a chance of causing visual loss), but then has thrown off the proportion of the face by placing the filler too low on the cheek, giving a heavy, unnatural look to the face. Actually, if done well, filler around the eye area is one of the most beautiful places to put it.
So why isn’t “training” the ticket? Because:
• This is literally sculpting soft tissue from the inside out, on a face, where unlike anything below the neck, every millimeter shows. Plus almost all of us are asymmetric to begin with, so there’s the extra challenge of not only seeing that on an individual, but then being able to correct that asymmetry as much as possible. This requires artistic vision, artistic skill and an eye and a passion for the tiniest detail. That vision is either there or it’s not – you can “train” a little of that into someone, but not a lot.
• In my world, fillers are not to be considered an “ancillary” procedure that is passed on to “ancillary” help. They are to be considered small surgical implants with all the respect and care that any surgeon should take with a surgical implant. This includes meticulous attention to aseptic technique (making sure we don’t drive bacteria or make-up particles under the skin). The consequences of that kind of sloppiness are bad in any situation, but with permanent fillers, the consequences are even more formidable than with temporary fillers.
Given the above, thank goodness most practitioners are not using permanent fillers on their patients. If they were, repairing the damage would be next to impossible and attempts to repair the damage would come with considerably more risk. In my revision patients where nonpermanent fillers have been used, there is a stepwise procedure that I follow, beginning with seeing the person periodically and treating as the old filler wears away -- and then I am always grateful for nonpermanent fillers.
I just returned from a national conference of the Foundation for Facial Aesthetic Surgery, a symposium attended by physicians in the three core specialties trained in this field. They are Oculofacial Plastic, ENT/Facial and General Plastic surgeons. This is a forum where generally the more enlightened surgeons, those who believe that instead of being competitors and guarding our “turf” (so last century) we and our patients benefit more by our getting together and sharing ideas from our various perspectives. Because this kind of mindset requires confidence, there were many nationally and internationally known surgeons in attendance, and the meeting was absolutely fascinating.
I had been asked to speak on integrating fillers and “neuromodulators” (BoTox, Dysport, etc.) for restoration of the face, but I asked to speak instead on permanent fillers, knowing that it would be a much more controversial and compelling topic. Besides, the issue of permanent fillers is one I feel more passionate about, both pro and con. Here are a few of the pros:
PROS• I’m happy to stand corrected on this, but I have conferred with a few surgeons regarding the statistic, and they agree that after the age of 30 we lose about 1cc of volume from the face each year. That’s 5cc per year (this would include both bone and soft tissue). Each syringe of filler that we use to correct volume loss contains between 0.8 and 1.5cc of product. Depending on the filler, these syringes run between about $450 and $1,000 a syringe for our patients. It doesn’t take much arithmetic to realize that this becomes prohibitively expensive for our patients unless they have unlimited resources, are content to chase their tails forever, or eventually just give up and/or age out of the process with little to show for it if nonpermanent fillers have been used.
• People generally don’t like having needles in their faces.
• Sadly, I do a considerable amount of “repair work” on poorly done surgery and fillers. Having suffered the results of that work usually involves some psychological trauma for the patient. Where fillers are concerned, the advantage of permanency is that once the repair work is done the patient can put the event behind them and move on rather than having to revisit the memory over and over as the “repair” wears away.
• We’re going to age anyway, and replacing lost volume in smaller increments rather than having to start essentially from square one each time, especially as the aging process becomes more profound, results in a better outcome.
• Most people want the attractive facial curves of youth, but they don’t necessarily want the world to know that they’re having something done to get them. With permanency, again we can do little bits at a time so that the upkeep attendant to the aging process is virtually undetectable.
We’ll look at the arguments against permanent fillers in our next blog. Check out our website to see client testimonials and to learn more about how permanent fillers could be right for you.
Oculofacial Plastic Surgeon, Sarasota, Florida
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