It's no secret that there has been a global boom in aesthetics. Staring at ourselves on Zoom, coupled with hours spent mindlessly scrolling through perfectly curated, often photoshopped and filter-heavy images on social media, has come a demand for aesthetic procedures - especially dermal fillers.
As someone who has been in the cosmetic industry for many years now, the problem I am seeing more of, especially among my patients who first began with me several years ago, is the mistaken belief that fillers will fix all problems.
Watch: Check out You Beauty Collective member Alisha Bhojwani's experience with tear trough filler. Post continues below.
At least weekly, I see a patient who fully commits and spends the necessary time, energy and money to invest in what I call a full face rejuvenation - aka a 'facial renovation'.
The patient becomes used to compliments from others on how great she looks, how she passes for someone 20 years younger, etc - however, the fact is that the underlying bony changes of ageing is something that none of us, even surgery, can fully reverse or halt.
So, read on as I explore the limitations of what dermal fillers can do, and what they cannot.
Myth #1: Dermal fillers can erase wrinkles.
I recently had a patient in her late 30s come into my clinic, who was beginning to notice accordion lines (those smile lines on the sides of the mouth due to volume loss), and she asked if I do facelifts or if I know a surgeon who does.
She was half-joking, and yet she was not. Among other treatment options, we spoke of using small amounts of dermal filler in the area to help add some volume. When she smiles, the wrinkles are still there, but the muscles are not pulling on thin tissue as much as before, softening the lines and giving the illusion of "erasing or easing lines".
However, dermal fillers cannot actually 'get rid of wrinkles'.
Listen: To fill or not to fill? Tune in to this episode of You Beauty where Leigh and Kelly discuss injectables. No judgement, just the facts. Post continues below.
Looking at the accordion lines specifically, it is hard to smooth these lines completely. The best treatment options in this area would therefore be a combination of treatments.
For example, a series of laser toning sessions combined with small amounts of dermal filler, mono threads and similar collagen inducing therapies such as skin needling and RF micro-needling.
Myth #2: Dermal fillers lift sagging tissue.
This is among THE most common reason older patients ask for more filler.
But here's the thing: Filler does not lift sagging skin. And it certainly does not lift sagging tissue by as much as two to three centimetres - which is what people expect fillers (or thread lifts) can do. Dermal fillers simply cannot do this.
In a volume-depleted person, when we add filler, we are replacing lost volume and restoring sagging, deflated tissue back to where it belongs. As a result of this, a subtle lift is apparent - not because we have done any lifting, but because we are lifting skin folds back to their correct anatomical position.
With age, even if we had perfect sun protection habits and perfect diets and great genetics that allowed us to age beautifully, there is bony depletion that occurs, along with ligaments that begin to sag and collagen that is being rapidly depleted.
With this in mind, we simply cannot restore a 45 or a 50 or a 60-year-old face to one in its 20s or 30s with its cherubic qualities.
Yet for some reason, people continue to believe (and erroneously be told) that fillers can lift when they cannot.
The definitive treatment for truly sagging tissue and ligaments and really lax, poor quality skin is a face (and neck) lift.
Other cheaper options include treatments such as thread lifts, which temporarily lift sagging tissue and reposition them - but they last 12 plus months and are by no means a replacement for surgery.
Myth #3: Starting dermal fillers when you are younger can help you stay younger.
In large part due to social media influencers, many young women are literally waiting to begin their aesthetic journey as soon as they turn 18.
This group is often short on cash and so may opt to turn to chain clinics and Groupon deals, as opposed to a reputable clinician with many years of experience under their belt for their lip enhancement, non-surgical rhinoplasty or tear trough fillers.
The problem is, you cannot fix a problem you do not have.
Most young people are the epitome of youth and beauty, and do not have any medical need of "fixing" anything unless it is skin problems, such as acne or dermatitis from overuse of skin products.
Once we get into the habit of getting filler, whether it is to plump up lips or fill other perceived defects, it becomes a case of returning on a regular basis once we feel the filler is "gone" - when it usually hasn't. It's the swelling and side effects that are gone, leaving in their place compliments and comments from people that massage our egos.
Over time, these regular top-ups, when unnecessary, can lead to stretching skin. This contributes to an unrealistic and excessive focus on what needs "fixing" as opposed to recognising all the other beautiful attributes one has. Which leads to the next common myth.
Myth #4: Dermal fillers (or any injectables) will not treat unrealistic expectations or a desire to look forever young.
It is important in clinic to regularly remind patients of what they used to look like when they first began attending the clinic three, four, five or six years ago. We look at how much improvement we've made, compared to when they first began investing in themselves.
It is human nature to lose sight of the bigger picture and to forget what we used to look like. We become almost addicted to regular comments about how young, youthful and amazing we look.
We invest huge amounts of time, effort and money into ourselves - especially our faces - and start hyper-focusing on flaws. Some of these flaws may be real, but some might be imagined and things that no one else might notice - because no one looks at us as much as we look at ourselves!
I am regularly struck by how often people comment on how their fillers look "wrong" under certain lighting, but "perfect" in others. People have started noticing "this line here" or want "this side to match the other side". Patients come into the clinic and say, "I am unhappy and I want you to fix this".
Despite extensive conversations, it is becoming more common now than when I began, to remind patients that ultimately, we can only improve, but not perfect any aesthetic outcome, as we are working with living tissue and anatomy.
Also, the limitations we discussed the first time we met remain after five or six years of working together still exist. Namely, we are both some years older now, with associated ageing-related changes, not all of which are amenable to fixing.
Your unique anatomy limits what is possible, alongside your expectations and budget, because you may well be a candidate for surgery (face lift/ neck lift/ blepharoplasty) for anything that bothers you enough. Even then, surgery will only improve sagging skin and tissue - it will not replace lost volume due to age.
It is also possible that along the way; you become so used to loving the face you see in the mirror, that any sign of ageing that is not easily fixed is distressing - i.e. your expectations are veering into the unrealistic.
When this happens, and when your clinician has an extensive skill set that goes beyond just anti-wrinkle treatments and dermal fillers, coupled with the ethics of "first do no harm", we can say no to unrealistic requests.
If using more fillers would be detrimental or without much benefit and risk the 'pillow face' look, we can redirect you to other treatments that may be beneficial to address some of the (new) concerns, or refer you for surgery if that is your wish.
At Skin Essentials, this is why we harp on about the importance of building a long-term, therapeutic relationship with each and every one of our patients. This means we can be blunt, upfront and say no when we feel it is in your best interest, because we know the relationship can sustain it. Because experience and transparency matters.
This article originally appeared on Skin Essentials and has been republished here with full permission.
Feature image: Getty
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