Preserving a natural look with fillers
The field of aesthetic medicine in general, and of anti-aging treatments in particular, have undergone an impressive revolution over the last two decades. Our waiting room has changed completely: from an audience made up entirely of women who don't want to age and come in to "rub off" their wrinkles, to women and men of all ages wanting simply to look better.
Naturally, our toolbox has grown and evolved accordingly: substances, injection methods, and energy-based technologies. Our methods have become safer and more effective.
We can now offer non-surgical solutions to a very broad variety of indications in the face and the body, and truly make people more beautiful and improve their experience when they look at themselves in the mirror.
What is the importance of a natural look, how do we make someone more attractive, why is there a need for a broad variety of volume/filling substances, and how do they help us in our work?
First the issue of natural appearance: our beauty doesn't lie in the absence of wrinkles; it is the sum of well-aligned shades (which is why women use blush in certain regions), proportions, symmetry, and the skin's appearance. You don't have to be an artist or an aesthetics specialist to notice a deformed face. An unnatural look has clear characteristics: excess volume, disproportion, lack of harmony between the face and the appearance of the neck and other body parts, and the absence of movement and expressions. Kids see this as a scary, distorted look, and sometimes I do too... Only a natural look can exude beauty.
How do we improve someone's look? Patients nowadays want to look better, and in aspiring to achieve this goal, filling wrinkles may be insufficient - and sometimes even irrelevant. We use fillers to correct disproportioned features, to tone down rough features, to bring back volume lost over the years, to lift dropped tissue, to accentuate facial lines such as the jawline and cheekbones, to fill in sunken areas such as under the eyes and in the temples, to improve symmetry, and of course, to promote a healthier-looking skin texture. We use fillers also to improve the look of the neck, cleavage, and hands, in order to create harmony, which is without a doubt one of the foundations of a natural look.
What are fillers? Most natural fillers are based on hyaluronic acid, a natural substance (a polysaccharide - a complex sugar), which our body produces in different tissues such as the skin, connective tissue, and joints. Hyaluronic acid absorbs water, giving the skin moisture and elasticity. Its production decreases over the years and stops completely around the age of 50. The first hyaluronic acid product intended for aesthetic purposes was manufactured and used in 1996 for the filling of wrinkles. Now there are over 350 brands of fillers, which differ greatly from one another in terms of their safety and efficacy.
Why is there such a broad range of fillers and how does it help us preserve a natural look? Products differ from one another in their viscosity, elasticity and plasticity. These characteristics have a direct effect on the outcome of treatment: the ability of the product to lift and stretch tissue, to accentuate facial traits rather than just add volume. The ability of the substance to diffuse and embed itself in a sensitive region when reconstructing volume, while not causing puffiness, such as when filling the sunken area under the eyes. However, if we disregard the texture of an aging skin we will never attain a natural look because there will be a difference between the volume of the face and the appearance of the skin, for this we also need products which would give the skin moisture and elasticity.
When we treat moving areas such as the lips and the area around them, we must use a substance whose elasticity is as similar as possible to the tissue receiving the injection, so that movement remains uniform and appears natural. When the goal is to add beauty, and where more than one area or one layer must be treated, we will always attain a higher-quality outcome by correctly combining different fillers.
A common question that is asked by many patients is: how long will it last? Here's the thing: it will last a very long time, the problem is that we keep aging. As someone who handles cases of complications and side effects, I often get to dissolve hyaluronic acid-based fillers a decade after they were first injected. The amount of time the substance lasts in our face is determined primarily by our age and the area of injection. The younger we are, the faster we break down the injected substance. The more dynamic and blood vessel rich the area is (as in the lips), the faster the substance disintegrates, and may last about a year. From my experience as my own patient, I can say that I give myself maintenance injections every two years or so.
What we don't have in our toolbox is a miracle drug to stop us from aging! We can't really stop time; all we can do is age gracefully.
A patient who cannot accept this fact, and a doctor who doesn't foster realistic expectations in their patients, are without a doubt one of the reasons for the inflated, stuffy faces we often see among Hollywood stars, as well as closer to home.