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.
One of the facts of life that surprises a lot of my patients (although they invariably say something like, “Oh yeah, that’s right!” when I bring it to their attention) is just another of Mother Nature’s little ironies:
As women age, they tend to become more masculine looking in the face. Features harden and sharpen, and the soft curves of the face of their youth morph into angles.
As men age, they tend to become more feminine looking in the face. The chiseled jaw softens, sometimes into oblivion, and the strong virile features that defined their masculinity in youth seem to melt and sadden.
That is one of the reasons why facelifts, lid surgeries and even BoTox and fillers can go so awry. It’s why women can look “harder” after they’ve had work done and why men can look sort of “weird”. Those of us who treat faces need to understand that you don’t just follow your Doctor Book and approach people like a technician. It is our responsibility to understand the subtle differences that give femininity or masculinity to the face and to be able to translate that into the work we do with our patients.
The aim is to restore softness, sweetness, perhaps even a bit of an angelic look to the woman’s face. On the other hand, the aim with a man is to restore a look of strength and virility to his face. This requires an almost 180 degree turn in our approach to the two genders. And this is one of the ways we make our “work” look natural.
The term “liquid facelift” refers to plumping up the face where it has lost volume by the injection of fillers. While fillers can have beautiful results when given expertly and artistically, “liquid facelift” is a term that can be misleading by suggesting surgical results without surgery.
While fillers may be used in the neck area occasionally, in the vast majority of cases the aging of the neck is due more to inelastic skin, gravity, excess fat or skin in the neck and/or the edges of neck muscles forming the “bands” that run vertically down the front of the neck.
In the case of inelastic skin, collagen and elastin in the skin have broken down. This requires rejuvenation of the skin, and neither surgery nor fillers will fix it. For the other aging changes of the neck surgical repair is almost always necessary for an optimal result.
Excess fat can be removed by several techniques and the neck can be surgically tightened so that instead of hanging down, the muscle actually serves as a suspension to hold the neck in a youthful contour. Most often, especially once a person has reached a certain point in the facial aging process, surgical repair of the neck becomes part of an overall facelift. These procedures are done in tandem to achieve harmony and the ideal proportions between the face and neck.
Lastly, with expert surgical technique and a truly artistic eye, a facelift and neck lift will look entirely natural without sacrificing any of the rejuvenation.
If you are interested in this process and want to find out more, please contact us at 941-951-2220.
Join Dr. Holly Barbour and her cosmetically trained staff for an educational and fun evening to learn about a lasting solution for volume loss.
Light bites, mini cosmetic consultations and information about ArteFill- for volume that can last years instead of months.
Thursday, March 27 | 5:30 - 7:00 p.m.
1250 South Tamiami TrailSuite 302Sarasota, FL 34239
RSVP 941-951-2220 Amazing giveaways and discounts for attendees!Bring a friend!
In Part I, we covered your best topical products for intercepting the aging of your skin, “AA (anti-aging) creams” notwithstanding. However, there are now “BB (originally blemish balm, then later beauty balm) creams” and “CC (color correcting) creams” that multitask so you don’t have to layer on multiple products.
The term “Beauty Balm” covers a lot of territory, doesn’t it? Technically, we could affix this moniker to just about anything out there, otherwise why would we even bother using it? (Quite frankly, when my face breaks out, the most efficient “beauty balm” I could use would be a thick paste of benzoyl peroxide and a paper bag over my head.) Nevertheless, the conventional wisdom is that a “BB cream” is a product that combines sun protection with some foundation-like coverage.
The difference between a BB cream and a tinted moisturizer with SPF is that the BB cream generally offers more coverage and more sun protection. You want to look for an SPF of at least 20 for a normal business day with minimal sun exposure. Also, since SPF refers only to the UVB rays (the ones that can burn the skin), you also want to have a product that includes UVA ray protection (those are the insidious rays that come through windows, for instance, and don’t burn or tan you, but just quietly destroy your skin). These will either specify “UVA protection” or be labeled “broad spectrum” sun protection. We carry Jane Iredale products because they are anti-inflammatory, eco-friendly, cruelty-free, pure and really effective at making people look wonderful. Her new BB cream, “Glow Time” is just as fabulous as we would have expected with an SPF of 25, UVA protection and coverage that goes from light to concealer-quality, depending on how it’s applied. And as for the original “B”, this mineral-based cream won’t break you out or make you greasy either.
CC creams generally have a slightly lighter texture than BB creams. They contain various ingredients that benefit the skin and will usually have some sun protection. They distinguish themselves by being “color correcting” in that they will have a tint to offset unwanted skin tones. For instance, peach tones generally even the skin and brighten it up if it’s looking dull (too little sleep, anyone?), green or yellow will tone down ruddy skin and lilac will brighten sallow skin. Some CC creams will have a bronzing effect to warm us up a bit. Jane Iredale has a great one, except it’s been around for about eight years, doing what CC creams do without the catchy title. It’s called Dream Tint and comes in Peach, Lilac and Warm Bronze.
There are even DD and EE creams out there. Personally, I can’t wait till the marketing gurus get up to QQ. That could be a literary challenge. And by the time they get to XX, we may not even be able to talk about it!
by Holly Barbour
By now, with those little taxicab yellow smiley faces having become iconic, we’ve all had a chance to see how changing the position of the eyebrows on an otherwise bland round face with dots and dashes for features can have a powerful effect on the emotion that face conveys. (If you use an Emoticon app on your cell phone or tablet, you know how you communicate more effectively with these faces attached to the text.)
The eyebrows are important. They’re important for you and the look and mood you present to our vision-oriented world. Standards of beauty change over the decades and right now a lower brow is considered more of the moment, but part of that may be a reaction to the over-arched, over-lifted, “surprised” brows that we’ve come to associate with a “surgical” look. Also, while low brows on a tired appearing face can make one look more tired, low brows on a fresh appearing face just tend to look sultry -- and we have so many ways to keep a face looking fresh nowadays! Injectables like BoTox, Dysport and Xeomin -- and fillers too -- can tailor the position of the brows a bit – and “a bit” can make a big difference in your appearance. All that aside, a healthy, natural looking brow that sits in a position that is most harmonious with your individual facial shape will be the ideal for you.
This is where I’ve seen the problem come in. Many of us get so used to looking at ourselves, and the changes that take place over time can be so insidious, that we may lose sight of those changes and how much they affect the mood we project.
Let me share with you a few easily correctable problems that I see again and again in my practice.
I hope this was helpful. As always, if you would like some assistance, give us a call and make an appointment with our wonderful aesthetician, Jill or with me.
I have to tell you the feedback I am getting is a kick. Are you wearing different eye make-up? You look great, you must have had a great winter. What are you doing, your skin looks amazing. Your new hairstyle makes you look 10 years younger and on and on. Thank you, Thank you!! I don’t know how I’m going to go 6 months without you.
I cannot tell you what you have done for my well being. I was really starting to feel very old. Such a not so serious procedure and some really fun needles and my face and I feel like I matter. The exterior beauty you gave back to me has done wonders for my inner beauty. I like me again. My husband keeps telling me how great I look. I’m not sure he could love me any more than he did but I’ll let him try. Thank you!
I have received many compliments on how smooth my skin is. Of course, that's our secret.
Thanks & Hugs,V.
Oculofacial Plastic Surgeon, Sarasota, Florida
Subscribe to our newsletter