Things to Know Before You Get Dermal Filler
Photo by Oleg Magni
Beauty treatments like dermal facial fillers have never been more in our face than they are now. (Pun intended.) Like many trends, celebrities tend to lead the way, and beauty treatments are no exception. The more very subtle (or sometimes major) tweaks that someone in the limelight makes to their face, the more curious the general public becomes about how they did it. Added interest means added accessibility…there are med spas popping up left and right. Filler is one treatment that got really popular, and that’s because it’s immediately quite effective. It does of course, also carry risks. Here are some things to know before you get dermal filler.
There are Quite a Few Different Kinds of Filler
There are a few different lines of filler, each with a number of different products within each line. You’ve probably heard of Juvederm and Restylane, which are line names of products in the hyaluronic acid family. The Juvederm family includes different fillers like Juvederm XC, Juvederm Voluma, Vollure, and Volbella. (Juvederm comes from the pharmaceutical giant Allergan, which also makes Botox, Latisse, Kybella, and a whole bunch of other things outside of beauty and skincare.) Restylane makes Restylane Silk, Restylane Lyft, Restylane Refyne, and Restylane Defyne. (Fun spelling thing they’ve got going on.) There are also other brands and products besides those two families.
All of the fillers mentioned above are made with hyaluronic acids, which is a substance that is naturally found in the body. The production of hyaluronic acid diminishes as we age, hence the need (or desire) to replace the lost volume with a similar substance. Once inside the body, the hyaluronic acid bonds with water and adds to the plumping effect. The reason why there are so many different versions of fillers within each line, is that they are made to have different particle sizes and structures. This allows the fillers to have different consistencies. A very thin, watery filler like Vollure can be used to fill small lines and depressions in the skin. A thicker, sturdier, filler like Voluma is going to provide a bit of a lifting effect, making it a popular choice for adding both volume and lift to the cheek area.
In addition to temporary dermal fillers made from hyaluronic acids, there are also semi-permanent and permanent fillers made from other things. The thing with permanent fillers, is that they don’t leave any wiggle room for natural changes that the face might continue to go through. (Our bone structure can keep changing, and whatnot.) There are also other types of fillers that work by encouraging the body to produce collagen rather than filling with hyaluronic acids. There are pros and cons to all of them. In this case, we’re mostly talking about treatment using hyaluronic acids.
Filler and Botox Do Different Things
Filler and Botox might be pals in the beauty world, and sometimes treat the same areas, but they work in very different ways. Botox is a neurotoxin that is injected into the muscle and keeps the muscle from contracting. This can reduce wrinkles caused by movement like furrowing the brows. as well as be used to move things around a bit. Botox can be used to raise or drop the eyebrows, or even slim the jawline. Fillers can be used for similar things, but how they get the effect is a different process. Rather than stopping muscle movement, they add volume.
Fillers can also be used to slim the appearance of the jaw in certain cases, but this is accomplished through the changing of proportions. (Sometimes a few millimeters different in different areas of the face can create a very different look.) As another example, Botox can be used to “flip” the upper lip so that more of it is visible, thereby making it look a bit bigger. But actually adding volume to the lips, of course, requires filler.
Every Injector is Going to Be Different
There are a number of constants when it comes to dermal filler, such as the filler itself. But there are a ton of different types of fillers, a couple different needle options, and a myriad of different placement techniques. Adding to that…every single injector is going to have a different opinion about which fillers to use and where to put them. Think about going to the hairstylist and saying “give me a trim and make me blonde.” That can go a lot of different ways. Warm versus cool tones. A trim versus a TRIM.
With your face, there is a general bone structure that any good injector should be able to see, but beyond that things are sort of up for interpretation. Some people think the top half of the face should be filler first. Other people might suggest that a weak jawline is throwing everything off. Some people will tell you that you shouldn’t inject your lips at all, and other people will plump them to the moon. Same injectors have a favorite under eye filler for example, but if filler placement is too shallow with certain fillers it can create what’s called a Tyndall effect, ie, a bluish tint. (Probably not the look you’re going for.) To get around the Tyndall effect, some people will go deeper, while other people will choose a different filler entirely.
The point is, that there a lot of different options and sometimes it takes a minute to get things right. You might have to meet with a few people for consultations to find someone who’s speaking your language, but they’re out there, and it’s definitely worth it to find a good match. The more research you can do in advance about what your different options are, the better off you’ll be. It goes without saying that you should only get fillers by people who are licensed and board certified to be doing such treatments.
Filler Costs Vary Dramatically, Even for the Same Product
The cost of filler can vary pretty dramatically, even for the same products. You can assume that there’s a base cost that a med spa or plastic surgeon pays to obtain the filler, and then a markup for their profit. The cost of the markup can depend on everything from what town you live in, to how long the injector has been doing their thing. It’s not always a good idea to go for the deal, since obviously an established spot or a full-on plastic surgeon has reason to charge more than a brand new nurse practitioner working under a plastic surgeon. However, that does not mean that going the most expensive route always makes the most sense either. If we’re taking Los Angeles, for example, a spot in Beverly Hills is going to charge more for filler than somewhere in North Hollywood. The office rent is higher and the clientele is fancier. That doesn’t always mean you’ll like the doctors better. Do lots of research either way.
Complications Are Possible
Complications are certainly not the norm, but they always exist. There’s no guaranteed risk-free way to inject things into the face. The most common issues are things like overfilling, unevenness, or the developing of bumps and nodules, all of which can be addressed. Less common but still possible are things like blocking a blood vessel which can have a variety of consequences. If you suspect that anything is weird post-treatment, always call and ask. Some doctors will actually use a cannula instead of a needle for some treatment, which can help avoid the puncturing of blood vessels. A cannula is like a needle with a rounded tip, which can be interested after a small prick is made in the skin with a needle. The cannula can roam more freely than a needle can while causing less trauma. Every doctor has different opinions about when each option is applicable.
It is Possible to Dissolve Some Fillers…But You Probably Want to Avoid That
The good thing about fillers made with hyaluronic acid, is that it is possible to dissolve them with a substance called hyaluronidase. Hyaluronidase is also an injection, so it’s not pain free. The enzyme causes hyaluronic acid fillers to break down at a rapid speed, which then allows the body to metabolize it much, much faster. Like days fast. In fact many people see an immediate change when hyaluronidase is injected.
The upside to this is that if you hate a treatment or experience some complications, it’s possible to get the filler out. The downside, is that the dissolving process is not a perfect science at all. Some fillers dissolve faster than others due to their structure, and there’s also no way to completely control how much of the filler gets dissolved. If, for example, you’re hoping to just reduce the size of your lips and keep some of the filler, it’s hard to say if that will work. The results might be perfect, or they might be uneven and over deflated. Dissolving filler can be a dream if you get a nodule or something weird going on, but it’s not to be thought of as a magic eraser.
Another thing, is that some practitioners claim that hyaluronidase can dissolve some of your natural hyaluronic acid as well. It sure would be a real bummer to dissolve some filler and then end up even more deflated than when you started. Other practitioners say that’s not possible at all. Either way, it’s assumed that in time the body would rebuild some of its own volume. But no one can guarantee that. Like we said, dissolving dermal filler not a perfect science.
It Might Hurt. It Might Not.
Fillers are a substance being injected by way of a needle, so yeah, it can hurt. Especially when you’re talking about an area like the lips that are created to be sensitive. But most doctors will offer you an option to numb up with the help of some numbing cream. On top of that, a lot of fillers contain lidocaine, which is also a numbing agent. That means that while you might feel a poke when the needle goes in, as soon as the filler and the lidocaine make their way in the numbing process will continue.
Post-treatment soreness is also possible, depending on the area. Again, sensitive areas like the lips and the nose are more likely to feel the pain. Sometimes it’s totally pain-free, while other times it can even feel a little itchy or irritating as it heals.
It Takes a Bit to Set
Hyaluronic acid fillers do have an immediate and visible effect, but they can reach their full effect after a couple of weeks. The fillers take a bit to settle into place, and it can also take some time for them to start bonding with water and plumping up. Also, even when swelling is mild, it can still take about two weeks to resolve. Being patient is a necessity to get the full and final scope of how your fillers look.
Your Swelling Might Be Different Every Time
If you get into the habit of touching up your filler, (or getting more in other places), you might assume that your swelling or lack thereof will be similar to the last round. It’s possible…but it’s safer not to bet on that if you have an event coming up. Every face is going to react a bit differently to a filler treatment, but different areas of your face can react differently as well. Getting filler in the temples, for example, is likely to not swell at all. The under eyes (or tear troughs), on the other hand, can get super puffy. If that area bruises, it looks like black eye central for a few days. Plus, everything else going on in your body can affect your filler treatment as well. Drinking a lot of alcohol before can thin the blood and increase the likelihood of bruising during treatment. Drinking a lot of alcohol after a treatment can sustain the swelling.
You Might See Fluctuations if You Tend to Retain a Lot of Water
Some people have those faces that look the same no matter how much they weigh or what else they’re doing. Others quickly gain and lose weight in the face, which sometimes has to do with water retention. If you’re the latter party, you might notice more of a fluctuation in the features that you’ve had treated with fillers. Remember that hyaluronic acid binds with water, so if you get puffy, you might get extra puffy with certain fillers. Different fillers tend to act differently when it comes to bonding with water, so that’s something to keep in mind when you’re considering your options.
There are Things that You Can Do to Make Your Filler Last Longer
Different dermal fillers last for different amounts of time, different metabolisms metabolize filler at different speeds, and different areas of the face hold filler longer. The filled effect of the cheek area might last for up to two years while the lips might only last three months. (They move around a lot.) How long filler lasts can also depend on how much filler you get in an area. The more you get in a single spot, the longer it lasts. In fact, certain fillers might actually stimulate your own production of collagen, which means that you’ll retain a bit of the plump even after the injected portion of the filler dissolves. Over time there might be less upkeep to an area that you’ve revisited repeatedly.
Despite the fact that most dermal fillers are temporary, there are definitely things that you can do to make your filler last longer. (And not do.)
Be mindful of the sun. We love sunshine, we know this is a bummer. But sun damage is known to speed up the aging of skin and it can also lead to filler breaking down more quickly.
Use hyaluronic acid externally. Putting hyaluronic acid on top of the skin is never going to be the same as injecting into the skin, but it might help sustain those results. Brands like Fillerina offer a topical product made with different sizes of hyaluronic acid molecules, which can actually sink into the skin lower than other skin creams. (And therefore create a more lasting effect.) The plumping effect is more mild than filler injections, but it is legit. We’re not partners or benefitting in anyway from recommending Fillerina. It’s just a good product.
Avoid stress. Lol, we know that’s easier said than done. But really, stress causes big problems for the skin. When you’ve got lots of cortisol racing through your body, it can slow down the production of elastin and collagen, both of which we need to stay tight and plump. Going without sleep is a known trouble-maker too. Try to relax and go to bed at a reasonable hour.
Stay hydrated and eat healthy. These tips also apply for healthy skin care whether or not you have dermal filler, but if you’re going to invest in your face you might as well commit to some healthier habits as well. Avoiding alcohol while drinking lots of water and eating healthy is going to help keep your face looking its best no matter what.
Find skin supplements that work for you. There are a ton of supplements out there that can help keep your skin (and hair) as healthy as possible. Anything you can do to retain your natural skin health will help your filler last longer too.
Watch the lasers. Be careful in what order you do your skin treatments. It is a very controversial concept that lasers can break down dermal fillers, but lots of people report that it seems to, so it’s suggested that you be aware of the possibility. Naysayers point to the fact that these treatments go after different layers of the dermis, meaning that there shouldn’t be an issue. Others say it happens anyway. We don’t know. The best way to avoid finding out is to do a laser treatment a couple weeks before a filler treatment, and not the other way around.
What to Do Before and Immediately After Treatment
You can start prepping for a filler treatment about two weeks before. That’s how long it’s suggested to avoid blood thinners, like Ibuprofen and fish oil supplements.
Stop taking those blood thinners…and then continue not taking them. While it can be tempting to treat swelling with Ibuprofen, some think that taking blood thinners after the treatment can actually make the swelling worse.
Avoid alcohol for a couple of days. Alcohol is also a blood thinner and can simply cause inflammation. It’s better to skip it for a couple of days before treatments.
Skip the gym. Some practitioners suggest avoiding the gym 24 hours before a treatment, and most suggestion to skip it for at least 24 hours after. Blood circulation is good, but too much excitement can increase swelling.
Ice. Icing is a great idea post-treatment. This can help constrict the blood vessels, preventing bruising and swelling.
Use Arnica. Lots of practitioners suggest using the homeopathic treatment Arnica on treated areas of the face. (Or body.) In fact, a lot of them will slather some on you before you even leave the office. You can also pick it up at your local Whole Foods or the like.
Try not to manipulate the filler. For the first couple of days the filler is still malleable, so you don’t want to mash it all up with a massage or a mega makeout session. Let it set before you get into all that.
Follow the after-care instructions you’re given. While fillers are easy to come by and can feel like a minor treatment, they’re still a procedure and have a post-op stage. It’s important to follow the individual instructions that you’re given each time. Sometimes someone might ask you to massage an area after a couple of days go by, while others will ask you not to. Ask any questions you might have while you’re in the office, but also feel free to follow up. It’s your face, after all.
We’re not doctors here at Divvy, so while we have tips and info to pass along, always check with your doctor before doing anything like Botox or fillers.
If you’re in the L.A. area and need some suggestions for places to go, feel free to get in touch and we’ll share our non-doctor opinions with you. (We’ll keep your request confidential, of course.)