Rx Fear Factor: Fear of Fillers

As a plastic surgeon, I commonly use a wide variety of fillers as part of my skin rejuvenation procedures. I understand that it’s not enough to just treat the surface of the skin if I want to smooth out wrinkles and restore facial volume. I mostly use hyaluronic acid based fillers: temporary fillers that are easily accepted by the body. These fillers come in different viscosities and properties. They serve as powerful workhorses to provide instant results. Despite the name, hyaluronic acid isn’t harsh or scary. It’s a very powerful moisture-binding sugar that occurs naturally in our own skin. A baby’s skin, for example, has lots of hyaluronic acid, which is why they have such moist, dewy, soft skin. As we age, the level of hyaluronic acid in our skin gets depleted. The result is that it looks dry, deflated and wrinkled.

Over the years, I’ve noticed that many first-time patients arrive in my waiting room, afraid of the whole concept of fillers. I understand this. Many women have expressed concern over the safety of these fillers, and many have questioned whether they would look weird or abnormal following treatment, while others are afraid of the cost. Most of their fears are based on a lack of knowledge. It’s my job as their plastic surgeon to educate and guide patients about their best aesthetic options.

Let me reassure you that when your treatment is put in the right hands, there is nothing to be afraid of!

Safety Fears:
Many of the fillers currently available in Canada are very safe. They are highly purified products that have been specifically designed to be injected into the skin. Who you choose to do your filling is where your concern should lie. Is the technician using a proper sterile technique and do they have an in-depth knowledge of facial anatomy? Many injectors are RNs or non-plastic surgeons (family doctors or general surgeons who call themselves “cosmetic specialists”). The fact is they likely have had no more than 1-2 days of training in anatomy and injectable techniques. In contrast, the average plastic surgeon has 13-15 years of post-graduate education and at least 5 years of that is in their specialty plastic surgery training. This extensive amount of training prepares them to be very skilled and technically safe.

Fillers injected into certain facial danger zones can lead to catastrophic events such as blindness or skin death leading to permanent facial scarring and distortion. Plastic surgeons are highly trained in facial anatomy, proportions and aesthetic principles. Their training prepares them to be safe injectors and to avert these risks. The price point might be nicer for you with a “cosmetic specialist” at the outset, but personally, I would be afraid to allow them to inject my face. Their skill set is limited and their ability to deal with complications is often negligible. It’s a cookie cutter approach to facial aesthetics … like following a recipe by rote. That means that whether you are 25 or 65 that the filler injection approach will not vary – there’s only one recipe after all – that is a set up for looking “wierd”. As well, one little oversight and when complications do occur, it’s the plastic surgeon who gets called to fix things. Why do you think that is?

Aesthetic Fears:
Using fillers well requires an in depth knowledge of anatomy and facial proportions plus a level of finesse and heightened aesthetic sensibility. The reason we see a lot of unnatural faces out there is because there is such a wide variability in the skill sets of the injectors. Even if we leave the weekend workshop “cosmetic specialists” out of the conversation, there are still some plastic surgeons whose aesthetic sensibilities will not be on par with yours. A plastic surgeon’s skill set will optimize your chances of safely getting a good result, but you still need to choose your surgeon wisely.

I hear a lot of woman say I want to look natural and I don’t want to look done, but what do I hear most? I don’t want to look weird or unrecognizable. New patients often cite an over-filled, over-taut, frozen-faced Hollywood star as an example. We’ve all seen them. Their implicit assumption is that the use of fillers will equate to this overdone look. Unfortunately the few poorly done faces that everyone talks about on social media, stands out over those who have had expert work done. Why? Because when “work” has been well done, it’s subliminal and very natural looking. Virtually all of the age 35+ stars that walk the red carpet walk hand in hand with a highly skilled plastic surgeon or dermatologist and if they don’t look done it’s because that surgeon’s “work” is impeccable. Yes, most celebrities have won the genetic lottery, but they still need to take amazing care of their image … it’s their job to look great! Those timeless beauties that seem to be aging so beautifully … well, they are, but trust me, they do so with help. They’ve just chosen their surgeons carefully and wisely. It’s called good decision-making! Contrast this to the unfortunate celebrities who have not. They look aberrant and distorted. You don’t need a trained eye to see that something is really off. It just goes to show, even in Hollywood you can get it wrong – you have to choose your plastic surgeon carefully!

Once you’ve found a plastic surgeon that you feel you can trust, I would recommend moving forward slowly; just do a little at a time, making small incremental changes until you have built up a sound therapeutic alliance. Once you have that relationship, consider yourself lucky and stick with your surgeon. Shopping around, bargain hunting and Groupons may seem like an easy way to save money, but you’re taking a big gamble with your precious face.

Cost Fears:
I think that fillers are actually a very cost-effective way of turning back the clock – the results often last for 1 to 2 years. If you were to divide a typical course of treatment into monthly payments, you might be surprised to find that it works out to cost a little more than what you’d pay for a really good haircut & colour every 6 weeks.

The price really depends on the type and quantity of the fillers used, plus the skill set and experience of the injector. It’s true that plastic surgeons, including myself, will often charge more for our services than a “cosmetic specialist”. But it’s important to remember what you are paying for – is it just the syringe of filler or is it the skill set of your plastic surgeon injecting that filler? It’s ultimately your choice. You do indeed get what you pay for. My hope is that having read this article, you’ll be in a better position to steer your way towards better aesthetic choices – and exquisite results without anything to fear.