Dermal fillers can nowadays do so much, but no one wants to look “done”. Still, we’ve all seen it, or maybe it’s even happened to us: the brow too high, too low, too frozen; the balloonish lips or Angelina-Jolie-cheekbones that give the game away.
What is mostly asked by my patients is the non-surgical facelift. And most of them believe that the only way to achieve it is to pump up the skin with plenty of fillers. Apparently because this is what they have seen or experienced till now. When we see overfilled or disconcertingly immobile faces, there can be several factors to blame. It nearly always involves either an unskilled injector or an unscrupulous one who will give patients anything and will let them pay for it, which they do not need.
As cosmetic surgeons have grown more sophisticated in their methods and the array of fillers and neurotoxins has become more diverse and specialized, patently obvious nonsurgical work is becoming the exception rather than the rule. A good aesthetic doctor now recognizes that the most natural-looking effects are achieved incrementally, with tiny, almost imperceptible adjustments.
When I talk to my patients, I’m actually analyzing their facial expressions, harmony and beauty. I draw out a master plan with each patient, using a face-analysis tool on a photo of the patient. We start with baby steps and give touch-ups until we’ve achieved a uniquely personalized map of what and where to inject.
A good facial surgeon does not need tons of material to achieve an impressive tightening of the skin, even at a 75-year-old patient. Why?
Because she or he knows exactly where to inject it. A good doctor injects between the right ligaments of the face, that will keep the fillers stable and not diffuse them. He or she respects the natural anatomy of the person and aims to enhance and not change the one’s features.
I’m a big believer in “Less but regularly”. Small touch-ups, but more often instead of coming back every two years. Softly adjusting gives the most beautiful results, and budget-wise it’s more reasonable as well.
This is the secret behind all the celebrities who the layperson thinks are just genetic phenoms. They are able to age beautifully because they’re not doing major overhauls. They’re not changing their faces, adding tons of volume, or erasing their expressions. They’re just focusing on tiny changes that really fly under the radar. These changes are not so perceptible that it’s like, ‘Oh, she went and got her eyes done’ or ‘She’s changed her lips.’
With injectables, small hits can have a big impact – and not necessarily in the places one might expect. I, for example, sometimes use a tiny bit of Botox at the base of the columella, which is that divider between the nostrils, to lift the tip of the nose. There are a lot of small physiological changes that people don’t really notice as signs of aging, which we can address.
Another trick: making the eyes look bigger by injecting a “baby dose” of Botulinum toxin just underneath the eye. If you just put one unit of Botox there, it drops the lower eyelid about one or two millimeters and opens up the aperture of the eye. So you look a little more awake, a little younger or prettier – but not noticeably different.
In more traditionally treated areas, dermal Fillers and Botox tend to stay with standard doses. When you use too little between the eyebrows, you’re not going to prevent those etched lines from getting deeper over time. And I find that I need to put in 1 to 2 ml – the more traditional doses of filler – along the cheekbone in order to get the lifting effect I’m after. But for the rest of the face, I have completely changed my injection technique.
To address crow’s feet, for example, I use microdoses of Botox – delivered with an ultrathin needle – around the eye, starting from the tail of the eyebrow and finishing under the lower eyelid. Instead of hitting that area with just three injections on each side, I actually do a series of about six or seven injection sites. That way, I get a very gentle, natural, widespread effect that opens up the eye and lightens up heavy lids. It also changes the texture of the skin in a way that traditional deeper injections don’t, because I’m actually affecting only the very superficial muscle fibers.
Similarly, I use minuscule doses of hyaluronic acid fillers in marionette lines, smile lines, and nasolabial folds, placing them shallowly into the dermis to gently hydrate the skin from beneath the surface. This imparts an immediate dewy glow but also galvanizes a longer-term benefit: It triggers your own body to produce more collagen. So even after the enzymes in our bodies break down that hyaluronic acid filler, the skin looks tighter and firmer.
In general, dermal Fillers and Botox are breaking away from a one-size-fits-all approach. My goal is to make you look like a better version of yourself, not like everyone else. I really believe injectables are an art. Every single face is different, and there are vast differences in how you approach someone. It’s about enhancing – not changing.
No one will know how you’ve managed to sail through time so remarkably unravaged. And isn’t it better to leave them guessing?