Filler Up?

I see dozens of women every week in my plastic surgery practice. Most of them come to me because they have looked in the mirror and saw someone older than they remember. That’s frightening to most people. Not because older people look scary, but because wrinkles are proof that we are aging. And aging brings us a step closer to the inevitable end. Besides this confrontation with our mortality, wrinkles diminish our beauty and create what the shrinks call “cognitive dissonance”—a difference between how old we look and how young we feel.Wouldn’t it be nice if we were all so secure that we didn’t care what we looked like? We want to wear clean clothes and bathe regularly so that we look and smell nice. That’s pretty basic, and if we don’t adhere to these social requirements, we certainly would be stared at. So, it’s really not such a vain thing that we don’t love our wrinkles.And that’s why God created plastic surgeons.That brings us to you … and your wrinkles. There are lots of ways plastic surgeons get rid of them. We paralyze them with Botox, we fill them with hyaluronic acid, we shrink them with peels and lasers, and we sand them down. Wrinkles on different parts of the face are treated differently. The ones around the eyes and on the forehead are best knocked off with Botox. But the ones around the mouth … well those can be tough. Over one and half million women chose to have wrinkle fillers injected into those lines around their mouths last year. And despite the popularity of the technique, you only have to watch the Oscars to realize how easy it must be to screw it up.Here’s how I use filler to rejuvenate the mouth area.First, I want to make sure that the experience is fun for you. Okay, maybe not fun, but at least not painful. I do that by numbing up the nerves of the face from inside the mouth … like my dentist dad taught me to do. With you numb, I can inject many hundreds of tiny droplets of filler into your wrinkles without hurting you. Wait a minute, you say—rerun that tape. Hundreds of droplets: Does that mean hundreds of injections? You bet it does. I inject hundreds and hundreds of teeny, tiny bits of filler into your skin. That’s how I make you look better without the distortion that late-night comedians make fun of.I choose different types of fillers, depending on just what and where I’m filling. I use dense material like Radiesse (calcium hydroxylapatite) to fill in the nasolabial folds between the nose and mouth and the marionette lines between the corners of the mouth and the chin. I use this same material to fill in sunken cheeks and the depression between the chin and the jowl. This stuff lasts almost two years, but if it is placed too close to the skin, it can create lumps. So, for more superficial filling, I use hyaluronic acid.Hyaluronic acid has been available in the U.S. for almost a decade, and there are now many different competing brands, like Belotero, Restylane and Juvederm. I fill in the wrinkles around the mouth with this stuff. Using tiny needles, I deposit a drop of filler the size of a head of a pin into the lines that radiate around the mouth like spokes of a wheel. Then, I fill in those little acne scars that are so common just beneath the corners of the mouth. But then it gets fun. I rebuild the mouth.As we age, the lips lose volume, the ridge between the red and white of the lip disappears, and the philtral columns, those unappreciated ridges that extend from the nose to the lip forming the “cupid’s bow,” flatten. I recreate these landmarks with tiny amounts of filler. And then I restore the lips. No, I don’t make them look like some sort of fish. I insert just a little bit of material to recreate age 35.So, how do I do it without creating distortion? Small amounts of material, even if you want more. The secret to good filler is patience. Be prepared to have more than one treatment session. I fill, let you sit for a month or so, and then I fill a little more. That’s the way you look better—not bizarre.It takes me just over an hour to do a typical filling session. You’ll look a little swollen for a day and bruised for a few days. With creative makeup, you can go about your business the next day.About a third of women get a “touch-up” of filler in about a month. And then you should be good for about a year. One of the reasons fillers are so popular is because they are so safe—virtually no allergic reactions, very rare infections, and, okay, a one in a million chance of stroke or blindness. But overall, this procedure is certainly less risky than driving.And the results? Well, that depends on your doctor, who should also be an artist. If he or she is good, you will look great. If your surgeon is not really a plastic surgeon or dermatologist but took a weekend course to boost his income and is, perhaps, a gynecologist, dentist or nurse, then well, I’m sure the reader can figure out the consequences.MORE: Plastic Surgery Horror Stories

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