Fillers to enhance the face have always been popular with both surgeons and patients, even before there were fillers. The use of fillers has gotten a little over the top, quelle surprise. When humans find anything that works, they will take it to excess. This generally happens for two reasons. The first is an historic American Life Law: “if some is good, more is better”. The other reason is quite simply to see how far out it still works. You can’t have “moderation” unless you have been to “excess”.
But we are talking beauty here, whatever that may mean; and beauty, to many, means style. The hidden meaning of style is it’s not for everyone – I give you “hot pants”. But when faces age, they lose fat, elasticity, and confidence, among other things. Trying to replace the age loss, (atrophy), is like trying to replace genius. At its best, it will fall short.
THE LAW OF SUNDRY SOLUTIONS
So ok that’s sort of the “why”, but what about, when, how, and how much, and which ones. Here we have the Law of Sundry Solutions. When there is no one solution to a problem, humans will figure out alternative solutions. They all work and they all fail. Got appendicitis, take out the appendix. It works all the the time…well sort of. So we got fillers, and some are pretty good, but you have to know the players, not only what’s in the syringe but who’s on the plunger.
QUESTIONS TO ASK
Like political polling, you have to ask the right questions. Do you like Washington is not the same as would you vote for Washington. So before the needle hits the skin here are a few things you may want to know. Is it safe? Will it work? How long will it last?
The first two are usually never asked, but the last one is always asked. You may have to ask quickly, because in some places you get filled while you’re filling out forms. This is more common in big style cities like Los Angeles where I work.
A little background music. There are a few basic problems with filling. The first is, it is a blind procedure. All injections are blind. You don’t actually see where the needle tip is. The second problem is about the control ….over what’s happening. In some cases you may have some control before the deed, but during, you don’t. Control comes in different colors. There is control in the consultation; and control inherent in the procedure itself; the person doing the pushing has some control; and your body (skin) has a little bit also. And those are only the tip of the iceberg. With all those variables, it’s easy to see why control works best when accompanied by trust.
IS IT SAFE
Not the line from Marathon Man, but about the fillers for injection – one human to another. The only real safe filler is that which comes from your own body, and that would be “fat” for the most part. That’s been going on since the 40s, (1940s).
A few synthetic products are also pretty safe. The first was Collagen. Well that’s not true. Way back in the day, before there was a “back in the day”, cowboy surgeons were using wax and ivory and things like that. You don’t even want to know.
So Collagen is probably still good, but had a few allergic reactions, and in some cases didn’t last long enough justify its continue use. Then came the Hyaluronics: Restylane, Juvederm, and Belotero. These are made of an ubiquitous molecule (remember high school) that’s present in most living things, so it’s a little bit safer than Collagen. Safety aside, will it work, will it look good. Perhaps another piece sometime.
Patients almost always ask about something that’s permanent, ( silicone, methylmethacrylate, and such). Hey, like your body is “permanent”- right! In most cases you really don’t want permanent. You want something that will do good things then begin to fade – get reabsorbed by your body. Bodies change, styles change, mates change, opinions change; so you do actually want a second bite at the apple, like they did with the Affordable Care Act. You have your teeth cleaned twice a year, or…Shoot! Permanent is a tattoo, or your parents, or one of those license plates. If that’s not reason enough, here’s another: the permanent filler can also be the permanent error. So, I have to be backed into a corner with no other choice before I go there.
There’s kind of a cavalier attitude about fillers. It’s become almost a business, and that’s not a good thing. Injecting a filler is an esthetic surgical procedure; and just like any other. It takes the some thinking, and some planning, and some skill, and a good eye. It takes knowing how much, and where, and when is enough, and when is too much, and when to stop. Then there’s all that stuff about talent, and character. The latter always trumps the former….don’t even! I’m a cosmetic plastic surgeon, so the operation is over when I say it’s over. And people wonder why surgeons have egos.
Keep those cards and letters coming
Thanks for listening