Tackling difficult areas with fillers
Why do fillers frequently look so false? Why you need to see an experienced doctor to minimise risks of going under the needle
A few years ago the Sunday Times did an article on downside of fillers called ‘The Joker Face’. “You’ve seen this face – it’s everywhere. There’s something muzzle-like about the nose and mouth. The lips are taut and bulbous, and a little wonky when they smile. In extreme cases, the cheeks sit like ping pong balls under spongy skin, eyes peering out of puffy sockets. The ‘pillow face’, our current answer to the 1990s wind-tunnel look, is down to dermal fillers. These semi-permanent gels are injected into the lips, cheeks and the lines between the nose and the mouth in a bid for youthful plumpness. Trouble is, the result is often not eternal youth, but a face like a water-retentive lion …"
Unfortunately things have got worse with this becoming almost the normal. Facial rejuvenation is an art and a science. It requires a thorough understanding of facial anatomy, facial ageing, skin, soft tissue and bone structure. This knowledge and skill requires years of study and practice. Artful injection treatments can produce some very nice and pleasing results. ‘The results should whisper and not scream’.
The temples, chin, jawline, tear trough and forehead are difficult to inject so you need an experienced doctor to do these and not someone who injects fillers ‘on the side’. Ask your practitioner how many filler injections they do and can they show some before and after photos. When injecting fillers it is important to stay away from the important structures such as nerves and blood vessels. So a deep understanding of anatomy is essential. When the jaw angle gets blurred, it makes a huge difference in how the person is perceived. We can inject fillers to contour the jawline, angle of the jaw and chin. Botulinum toxin injections remain popular for this area as in Nefertiti lift. As we age, we start to lose a little chin projection. This can be restored using fillers.
Another area where age-related changes can be very visible is the temple. There is not only loss of fat but also loss of other soft tissues and bone. Additionally, patients can develop sun damage, skin laxity and muscle
thinning. We are trying to replace a three-dimensional, multi-structural loss with one or two injection. We can usually get most of the temporal areas filled effectively with one or two injections. That minimizes the risk of danger and produces very nice and effective yet subtle rejuvenation.
We routinely inject fillers in frown lines and forehead lines but this is a tricky area to inject-even for very experienced practitioners. A more comprehensive approach to the forehead involves three-dimensional forehead reflation. This approach differs drastically from simply filling lines because it requires placing fairly substantial amounts of filler on underlying bone while avoiding the blood vessels. This is a challenging technique that can produce beautiful results.
There is more to dermal filler injections than simple line filling. Strategic placement of small volumes can produce very nice and natural results and avoid so called ‘pillow face’. Dr Sanjay Gheyi MBBS MS FRCS BCAAM is medical director and laser and cosmetic surgeon at the Coltishall Cosmetic Clinic. For more information log on to www.coltishallclinic.co.uk or call 01603 736487
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