June 30, 2026 • 52 mins
Facial fillers have transformed aesthetic medicine—but they've also become one of its most controversial treatments. From "pillow face" to overfilled lips and viral celebrity reversals, it's no surprise that many patients are questioning whether fillers are still the right choice.
In this episode of Plastic Surgery Uncensored, board-certified plastic surgeon Dr. Rady Rahban is joined by Charlene, RN, for a comprehensive discussion on facial fillers. Together, they explain the different types of fillers available, why hyaluronic acid fillers remain the gold standard, and how the right product, technique, and injector can make all the difference.
The conversation explores where fillers can produce beautiful, natural results—including the cheeks and temples—as well as areas that require greater caution, such as the under-eyes, lips, jawline, chin, nose, and nasolabial folds. Dr. Rahban also discusses why so many patients have developed an unnatural appearance over the past decade, when filler should be dissolved, and how to recognize when surgery, not more filler, is the better solution.
Whether you're considering filler for the first time or trying to understand the growing backlash against it, this episode offers an honest, evidence-based guide to using fillers safely, conservatively, and appropriately.
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
In this episode of Plastic Surgery Uncensored, board-certified plastic surgeon Dr. Rady Rahban is joined by Charlene, RN, for a comprehensive discussion on facial fillers. Together, they explain the different types of fillers available, why hyaluronic acid fillers remain the gold standard, and how the right product, technique, and injector can make all the difference.
The conversation explores where fillers can produce beautiful, natural results—including the cheeks and temples—as well as areas that require greater caution, such as the under-eyes, lips, jawline, chin, nose, and nasolabial folds. Dr. Rahban also discusses why so many patients have developed an unnatural appearance over the past decade, when filler should be dissolved, and how to recognize when surgery, not more filler, is the better solution.
Whether you're considering filler for the first time or trying to understand the growing backlash against it, this episode offers an honest, evidence-based guide to using fillers safely, conservatively, and appropriately.
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
- Instagram: @drradyrahban
- TikTok: @radyrahbanMD
- YouTube: @Rady Rahban
- Facebook: @Rady Rahban
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Episode Transcript
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Speaker 1 (00:06):
Welcome to another episode of Plastic Surgery and Censored. I'm
your host, doctor Roddy Rabon, and we are excited about
episode two of a multi episode series. This episode is
about volumeizers or fillers, and I think this is a
really important episode because I can't tell you how poorly
(00:28):
and mistakenly and wrong fillers are being done, so much
so that it's caught the eye of social media, you know,
balloon face, pillow fase, celebrities are reversing it. I mean,
it's a huge discussion because I think it's one of
those things that when it first came on, it was like,
oh my god, this is too good to be true.
(00:49):
And then people started using it, using it, using it,
and then over using it, over using it, over using it.
Oh my god, I hate it. So we've really made
a full spectrum and a big pendulum. And I think
the key to the filler is knowing when, where, and
how and how much to use it. So let's begin
by just describing the concept of filler. It's funny. Filler
(01:12):
before was like, oh my god, that's so great, and
now that everyone's doing facelifts, like it's just always makes
me laugh. Trends set up everything in the past. Several
years ago, filler was the hottest thing ever. Fill my lips,
feel my chaks, fill my job, fill my chin now
because of Oh I can get a facelift. Oh I'm
(01:33):
gonna look now, A filler's horrible. Fillers horrible. Filler is horrible.
And you know my philosophy, nothing is great, nothing is horrible.
Everything has an intention and a use, and when used correctly,
when you use a hammer correctly, it does the right job.
It's not a drill, it's a hammer. So filler, as
the name says, volumizes an area that needs enhancement or
(01:58):
volume or fullness. So let's talk about let's talk about
the products that are out there. So in the world
of filler, I can tell you there's one million products,
and these products are so damn confusing that even I,
(02:19):
as a person who does this and is in this space,
I'm always blown away. They're like, oh, have you heard
blah blah blah. I was like, no, what the hell
is that shit? It's shit. So we're going to break
it down to you in its basic elements. By far,
the most effective, by far, in my opinion, the best
product for facial revolumeization is haluronic acid based products. We
(02:46):
refer to them as HA. The reason why HA is
the number one product we recommend, and really the only
product we recommend, is because number one, it's one hundred
sen biocompatible means it's made up high uronic acid. It's
made up of what you're made up of. Yeah, in
(03:08):
the past, this may maybe before Charlene's time, we used
to inject collagen, and collagen was horse collagen, right, and
we'd have to test you or bovine or whatnot, and
we'd have to inject you with a little of it,
and then we'd have to see if you had an
allergic reaction. And there was you know, a decent number
of people that their body reacted to. We don't do
any testing with HA.
Speaker 2 (03:29):
Why because it's biocompatible.
Speaker 1 (03:32):
It's in you. You can't react to HA. You're made
up of H. So I love that aspect. The second
and by far the main reason why I love HA
is it's reversible. Do you understand what that means? That
means I injected you and you are you hate it?
You're crazy, You're having a complication, what have you? I
(03:52):
can run into my exam room, go into the refrigerator,
pull up an enzyme called hileonomy Irani day's vit trace,
what have you inject the area that I injected, and
within magic, literally within hours, it's all gone. That right
there is the only thing you need to know. I
would never and as a result, I don't ever recommend
(04:15):
injecting things. And we'll talk about it. Maybe Charlene's done it,
and she has a different perspective. Inject things into your
face that has permanency or irreversibility or takes forever to
go away. And so as a result, I'm a big
fan of HA. So in the world of HA, guess what,
there's like a thousand products. So I would say, by
(04:37):
and large, there's two main companies. Okay, it doesn't mean
that they're the right ones, but they're just a two
main companies. One company is the Juvaderm world, the family
of Juvderm, which was the original drug, I mean, the
original filler juvenim, and one world of the Restallan family.
(05:01):
And they're both they're like Ferrari and Lamborghini. Okay, you
can't go wrong. They're both great, they're both safe, they're
both wonderful, but they do have some distinctive differences within
those families. There was once upon a time when I
was just starting out, that was it. You got Jupiter, Jupiter,
(05:22):
plus you had wrestle in and you had Perlaine, which
they don't call it perlain anymore. Essentially, the idea is
this gel. All they're doing is making it thinner or thicker. Right,
it's crosslinking, so imagine working with honey versus working with
(05:44):
syrup versus working with wax. It's just different thicknesses of product.
So in general, in general myself and just by cheer chance, Charlene,
we are more partial to the world of the Restallan family.
And the reason why I have historically stayed away from
(06:07):
the jupiterim family is it has a tendency to do
more of the one. It has a tendency to do
more of one of the complications I dislike, which is
water retention or puffiness or swelling. Because these products, the
way they work is twofold. Right, we inject the gel,
(06:28):
that area puffs up. Oh wow, look at your lips,
Oh wow, look at your chin, Oh wow, look at
your cheeks. Right, and then you go home and then
they behave like a sponge and they sequester or suck
in fluid, and then they get bigger than they were
than when I left you. So if I inject you
(06:49):
with a CC one CC, it may in totally one
point six or one point seven. The Juveiterim family of
products tends to be more hydro philic, sucks in more fluid,
and I don't like that because it's unpredictable. I like,
when you leave my office, I know what you're likely
(07:11):
to look like. Whereas with the juvenile products, people were
getting more swollen. Now that doesn't mean to say that
you should never use a juvenim product, because that provider
will have adjusted for presumably that product people really like it,
for example in their lips because they wanted it that
more luscious. Howdy look myself and Charlene like the accuracy
(07:35):
of the wrestling based family. Now again under that family,
I won't get into the belabor it there's Ultra, there's Jubiterm,
jujuvern plus Juvederm, Ultra plus Voluma Verrabella. Then there is
restall in Restalin plus contour defined. I mean, I find
all of this nonsense funny enough. We use like two
(08:00):
because at the end of the day, we are skilled injectors,
and I and Charlene can get whatever effect you want
everywhere I want with just these two products. And what
I'd rather do is get so accurate using these products
than to have, you know, most medspas, and this is
(08:21):
a fault. I think you go in and they carry
like twenty five products and then you know, they just
sort of cater what you want. And my opinion, your
your providers don't get excellent at any one product.
Speaker 2 (08:34):
And sometimes I felt was a little overwhelming.
Speaker 3 (08:36):
You know, I've worked at places where we did offer
a whole bunch of different types of products, and I
would sit in front of, you know, our cabin and
be like, what fillers should I use? And you know,
sometimes you're like it's just a little overwhelming.
Speaker 1 (08:48):
Yeah, And the patients and the change matters. The patients
don't know, nor should they know. It's the provider's discretion.
You should come to me. I evaluate you, and I'm like, okay,
we got you, and then I SHO should be able
to say I think she needs blobby blah blah blah.
A lot of places because these companies are advertising, the
patient comes in and says, do you guys have valuma
(09:10):
and they're like, uh, sure, can I put Valuma on
my nose? Sure? What that's like malpractice as far as
I'm concerned. So we here are more about injecting and
injecting skill than we are products and various products. So
we have a thin and a moderately thick, and in
(09:31):
that way, we know we can put the thin in
all the areas that it belongs and moderately thick and
all the areas that it belongs. So that's really important
for you to understanding. There are other ones like RHA's
come out, and there's gonna be other companies. Again, I'm
not going to bad mouth or promote any of them.
I don't work for any of them. None of them
give me any kind of kickback. I don't care. The
(09:52):
next question is, oh, there's two other groups of products
that I'm One is the world of sculpture. We're gonna
just touch on that brief because we won't revisit it.
Is sculpture is a biostimulator. This is a new category,
its own drug. It was really a drug that was
predominantly its focus was in HIV patients. People who got
(10:13):
HIV became gune. They lost all their fat in their face.
And if you are you know, had the misfortune of
knowing someone that you love, or you've seen it on
TV or you google it and you look at it.
People in late stages of HIV literally look like you know,
Holocaust survivors. They're skinny in their face, lost fat. So
(10:34):
you would take a lot of filler and to get
it in there. And so this whole category of biostimulats
came out, and you would take this drug, you would
reconstitute it, and then you would inject it. And then
this would stimulate the body to generate its own collagen
(10:55):
or tissue so to speak. Wow, that sounds great. Why
don't you use that regularly? Because in my opinion, number one,
it's not reversible. What if you come in and I
do this stimulator thing for you, and I put it
in your cheek and in a week from now you're like,
oh my god, I hate this. Yeah, get it out. Sorry,
(11:18):
can't help you. What do you mean you can't help me? Well,
when is it going to go away? Four years? How
long does it take for sculpture to go away? Three
to five years? What are you saying, doctor Rabon? Three
to five years? And then the kicker. It's going to
get bigger. What do you mean it's going to get bigger,
It's going to grow. It stimulates, So you can just
(11:42):
imagine what I just describe to you. I'm injecting you
with something that's you can't undo for three to five years,
and it's going to expand over time because it's designed
to stimulate. Does that mean that no one should use it? No?
Knock yourselves out. If you've like this product and you
find a provider who likes this, you're a match made
(12:05):
in heaven. In my practice, this makes no sense because
it doesn't add anything to me. And what it does
as a provider is it attaches me to you. And
I want the ability that if you have a complication,
or you're crazy, or you're dissatisfied, I can undo it
and you can go on your merry way. So just
beware of that group. And then the last group is
(12:27):
a disaster, which is permanent fillers.
Speaker 2 (12:31):
Radius.
Speaker 1 (12:31):
Oh I left Radius out. You're right. So there's another
group called radius, which is calcium hydroxide, and I again
not a bad product. Some people love it. They use
it in hands, they do all kinds of things. Radius
is similar to sculpture, but not as bad in that
(12:52):
it's you inject it. Oh my god, doctor r Bond,
this this is too much. I don't it's too much
in my cheeks or I'm sorry. It's gonna take a while,
how long? One year? Maybe more? You may have to
live with this thing for a year. Yeah. How it's
different is it doesn't expand it's not a stimulator like
(13:14):
tell me.
Speaker 2 (13:15):
It's a little bit, but not as much as ars.
Speaker 1 (13:18):
I just again, same reason, same reason as a sculpture.
I just think it's it'll advise. You have these products, ha,
products that are gold standards, that were great. I would
do it. The area that you want to stay the
hell away from is anything that's permanent. So there was
a drug called PMMA. There was silicon for years. And
(13:39):
the problem with these medications, these injectables, is sometimes they're
not told to you. So I have over the years,
in twenty years, I cannot tell you the number of
lip reductions I've done where I go in and cut
out portions of the lip for people who had silicone
(14:01):
injected in their lips ten fifteen, twenty years ago and
were told at the time, Oh, it's just some It
wasn't and not told it was silicone. And what happens
is a it never goes away. And the difference with
permanent filler is that it because it's permanent material, the
body keeps reacting and it doesn't just stay there. You're like, well,
(14:25):
that sounds great. What if it gets the injector injects
it perfect. It's perfect, right, it's there, it's permanent, it's perfect. No,
it stimulates granulation tissue and you get this what's called
granulomitis reaction, and it actually grows and becomes abnormal. So
a perfect example is in the lips. People say, yeah,
(14:45):
I had this injected. I went to a place they
injected it. It didn't look that bad at the beginning,
but over the years it started to look crazy. And
when I have my menstrual cycle or this, it's gotten
lumpy bumpy and it flares up. Get it out. I can't.
It can never be taken out. It is embedded, embedded
(15:06):
in your tissue. So I have to cut it out
and I do this thing called the lip reduction, which
you know is a procedure to correct it. But it's terrible.
So don't let anyone inject you knowingly but more importantly,
do not be fooled. My recommendations is, aside from going
to a reputable place. Often asked to see the filler,
(15:32):
we open the filler in front of you. We just
go here you go. You know it's the product you're
asking for. You know that it's sealed, you know that
it's yours. You know it's not like, oh, you know
the whole Chuck E Cheese scandal. They were taking leftover
slices of pizza and making a pizza out of it.
You didn't hear about that. Yeah, that was a Chuck
E Cheese scandal. And they would they would go and
(15:53):
round up all the leftover slices and make Some people
were like, god, my pizza looks oblong. It's not round.
So you you you'd be shocked. People will go in,
get filler done, not use up all the filler. You
don't know. You don't know. If they use up the
whole syringe and then the leftover they'll give it to
someone else. They'll just change us, change the needle, and
(16:15):
off you go. So you need to be a savvy consumer.
Go to a reputable place like Restore by Rabont, MD,
and then also make sure you see the product. Okay,
So let's talk about now all the different places that
can get injected with filler, and there are so many,
and the ones that we recommend, the ones that we
(16:38):
don't recommend, and why so I always like to look
at the head from top of the head down to
the neck. So let's start and work our way down.
What about the forehead disaster. Do not inject your forehead, people, listen.
Why it's incredibly dangerous, so elaborate on it. But there
(17:02):
are two catastrophic catastrophic complications associated with filler. One blindness
that is correct blindness, permanent blindness. Two necrosis tissue diyes
turns black gone finished. The blindness one is associated with
(17:25):
injecting around not around the eye ball, but around the
area of the eye. Because the vessels, the blood vessels
that are around the eye, the forehead, the nose underneath
the eye all communicate and lead back to the same
primary source. And the forehead has large vessels. And if
(17:46):
you start messing there and your surgeon or your injector,
unbeknownst to them, pushes filler into an artery or a vein,
and it retrograde, goes back up the wrong pipe, and
then goes down the eye pipe. You're gonna go blind,
so not worth it. The next one is temples. Temples.
(18:10):
We like temples. Temples a good one. Why would we
inject temples because it's.
Speaker 2 (18:15):
One in the airs that hollows out very quickly.
Speaker 1 (18:18):
Correct because you get peanut head. Peanut head is a
if you guys ever looked at that peanut or that guy,
the peanut guy, the main peanut character, the the mascot.
What happens is that you're you have bone hollowness, cheekbones,
and you get a concavity in your temples. My sister
(18:38):
actually had horrifically deep temples, and it is interesting. It
really ages you. Yeah, absolutely superbly ages you.
Speaker 3 (18:45):
Except something that people don't even realize either until you
point it out.
Speaker 1 (18:48):
Yeah. Yeah. And so you know what you want is
unlike other things that you want enhanced, this you want neutral.
You don't want like big temples. Ooh those are sexy.
You have huge temples. You want your temples to be
smooth and in a plane with the rest of it.
So again, we love temples.
Speaker 3 (19:10):
Yeah, yeah, it's done correctly right.
Speaker 1 (19:13):
There is under eye. So this is a very controversial area.
So let's talk about under eyes. So for many years,
under eyes were being treated left, right, and center. And
a very very very common issue with under the eyes
is something called bread loafing, or getting sort of a
(19:37):
fullness underneath the eye and the eye the lower eyelid
and that area traps fluid more than anywhere else, and
so it was an area that people were over injecting
and injecting the wrong product. So if you put any
product under the eye except for basically restall it, I
(20:02):
guarantee you within maybe a month to two and forever,
it will get puffy because the lymphatics of around the
eye just pull it in and you get this puffy,
bread loafy thing. And that's like the number one common
thing that you see in celebrities, your people, and you know,
you're like, God, that person doesn't look right. You get
(20:22):
a cat look. Yeah. The reason you get a cat
look is your cheeks start to blend into your lower islid.
And one of the things that makes a cat look
like a cat is their cheekbone is right underneath their eyelid.
There's no depth, there is no transition between eelid and cheek.
It just cheek is the iselid, so that area needs
(20:47):
to a be injected incredibly judiciously. I'm talking microscopic and
then only with the product wrestling, and even then you
can still get puffiness. Now, when is it indicated? Is
indicated in the following instances. You have a tiny amount
(21:08):
of tear trough, that's the hollow ness. You have the
tiny amount of eyebag, and you want to camouflage it.
Injecting filler doesn't get rid of a bag. Injecting filler
camouflage is the bag. You do not inject your lower
eyelids for dark circles. People. I hear hundreds of people
(21:32):
come to me over the years. How can I help you?
I need filler? What for my lower eyelids? What? What's
wrong with it? It's dark, It's got a darkness to it.
My friend went and got her dark areas filled and
it looks great. Her dark areas was in pigment. Her
dark areas was an illusion of the trough that hollow.
The hollow looks dark, so when you filled it, it
(21:55):
looked less dark. But yours is literally pigment. So do
not inject for pigment. It's not a good place.
Speaker 3 (22:04):
Yeah, and I'm very I'm very cautious with who I
inject on your eyes too. I'm very picky with the
candidates that I choose. They actually have to have a
true hollow, but doing less and less under I feller.
Speaker 1 (22:15):
Now, yes, yes, And I think that's part of the
evolution of us learning as injectors. Oh wow, I used
to do this. Even though I did it conservatively, I
still didn't like the way it looked. It still looked puffy.
Then we move to what I think is probably the
gold standard, the area that I think filler does the best,
assuming it's done correctly, which is the mid face. What
(22:37):
is the midphase, It's cheek and slightly below cheek is
slightly below. Now, the cheek is designed to be a tripod.
It's not a ball, and it's not one dimensional. It's
a tripod. So there is the cheek as it communicates
to the nose. There's the cheek as it's at its peak,
and there's the cheek out laterally as sort of we
(22:59):
can call the cheekbone or arch, and then there's the
space underneath the cheek. So one, two, three, and four.
It creates a tripod. So everyone anatomically is designed differently.
Some people have really high arches flat face. That's more Asian.
Asians have super high cheeks arch, but relatively flat. So
(23:23):
when we volumize them, we fill in the front to
create a little roundness. Some people are really full in
the front near their nasalabia fold, but empty and kind
of flat on the side, so we create a little
bit of an arch or filling out. Some people, like men,
(23:44):
are very hollow underneath their cheekbone and they have a
gaunter look. Now, with men, your goal is neutral. You
just want it to be just doesn't look like I'm
you know, starving, but you definitely don't fell it the
way you feel a woman where you want a little volume.
So I think the number one area where filler is amazing.
(24:05):
And by the way, facelifts do not fix entirely is
mid face volume depletion. So the reason why I say
facelifts don't fix it entirely is because when I do
a facelift, often I do fat transfer. I do fat
transfer because I've lifted up the excess skin. Check, I've
(24:27):
lifted up the muscles and repositioned them. Check, and this
person is still lost some volume and I need to
replenish that volume. The mid face is amazing and I'm
a huge fan of it, so much so that we
used to use a lot more cheek implants and we
use less of them because a cheek implant is firm
(24:50):
and a cheek should be soft. So I like to
replace with Like, something is soft, we want to replace
it with soft. Is something is hard, we want replace
it with hard. So I'm a huge fan of cheeks.
Now we're gonna move to the next controversial area, nasal
labial folds. So I have not injected a nasal labial
(25:13):
fold myself, probably in ten years. Now. That doesn't mean
I never injected. When I say I don't inject it,
I may inject the tiniest amount. But I have completely
and totally eliminated that from my practice. And there's a
reason for that. One of the number one things z
(25:34):
that was the number one indicator when we got indication
for the filler, it was for nasalabil folds. They found
a hollow, an area that was hollow from your nose
to your mouth. It's called the nasalabil fold. Ooh there's
a hollow. Oh, now we have a filler. Okay, let's
fill it. And the idea because people didn't know. What
they were doing was to fill it and obliterate it.
(25:57):
It's bad, hollow, bad fill, get rid of. And what
is unique about the nasal labial fold that isn't safe
for the temple is it's dynamic. Your temple doesn't move.
It's filled. When you smile, your nasal labia fold pulls.
And anyone who has filler in their nasal aabia fold
looks weird. It's weird, it's flat. It doesn't create a
(26:21):
natural dynamic movement. So I personally, I know Charlene does
a little of it.
Speaker 2 (26:27):
A little bit.
Speaker 3 (26:27):
It's going to be one of the last areas.
Speaker 1 (26:29):
Well.
Speaker 3 (26:29):
I'll just do a tiny touch if everything else looks okay. Yeah,
I know they have good mid face volume. They just
have the tiniest, you know, little indentation that we just
want to pop out.
Speaker 1 (26:39):
Yeah, I stopped. I did it too at the beginning,
albeit conservatively because it was always my style. But I
moved away from it essentially altogether. Now. The reason is
that nine out of ten patients come to you and
this is what they say, My naso labial folds look
so deep, I need you to fill them. And when
you examine them. It's their midface right above it, right
(27:03):
above it, that's hollow. So when your midface is hollow,
the naso labial fold, avalanche is down. Now this is incorrect.
Filler doesn't lift. It's a lie. It's bullshit. Listen to me.
It doesn't lift. But but as you revolumize the mid
(27:24):
face and it fills back to normal, the nasal labial
fold doesn't look as dramatic because it's not got a
hollow on one side and a hollow on the other.
It's not a nasal labial fold. It's a nasal labial roll.
It's a roll. And when you fill the cheek appropriately,
you now look, oh wow, oh my god, my nasal
(27:48):
labiel foold looks so normal. Yeah. So if you were
to get into a beasting and your midface would expand
into a balloon, yes, yes, it lifted you. Yes, you're
right now, naso labia fold is obliterated. But that's a
shit ton of volume, Okay, So I would just be
(28:09):
careful when it comes to your nasa labia fold again,
make sure your mid face is filled, otherwise I kind
of never inject. Then we move to the nose, so
I'm going to tell you this once. No one should
inject your nose unless they are a rhino plastic expert.
I know nurses like to do it. They're very skilled,
(28:30):
they're very knowledgeable. They can do circles around other surgeons.
It's an area that you shouldn't do unless you can
deal with the complication associated with it. And the other
thing is it's a nose, it's fragile, there's architecture in
their thin skin. You can't I've seen guys. I've seen
posts on Instagram where they take a nose and they
(28:53):
inject so much filler trying to do a nose job,
and it's it's it makes me cringe. The only thing
you should do with filler in your nose is when
you have a hump like mine and you have a
deep radix, that's the beginning part, and you can fill
(29:14):
it in. And by the way, this is close to
the vessels near your eye, and you fill that rdex.
As you fill the rateix, it creates the illusion that
your hump is going away, similar to what happens under
the lower eyelid. You fill it hollow. It makes something
look like it went away. Maybe you put a touch
in the tip, but none of this nonsense that you're
(29:36):
trying to lift the tip in whatever if your nose
is otherwise. And sometimes when patience noses is crooked after
a rhinoplasty, I'll put a tiny amount on one side
to straighten it. But again, this is nuanced faced stuff.
This isn't something you go, oh, I want a rhinoplasty.
I'm gonna go to my spat and go get a
liquid rhino. I just think it's ill advised. There's so
(29:58):
many other ways to take care of yourself than that,
So we'll leave that at that. Then we get to lips,
very famous, very popular. When overboard, everyone knows lips as
a duck lip. Now we have to walk everybody off
the ledge. Every time anyone comes in here, I have
to go through this whole shebang. I want my lips done,
but I don't want it to look like a duck.
(30:19):
And because everyone's petrified, they're going to look like these weirdos.
That's because they went overboard. Lip injections only look terrible
after you've injected like four syringes, So a small amount
one syringe, evenly distributed here and there, will look elegant.
(30:41):
I do it in older women it looks beautiful, but
it's a tiny.
Speaker 2 (30:45):
Amount over time too.
Speaker 1 (30:47):
Over time, what happens is people go in inject a syringe,
then two then like it's still there, and they come
back a month or two later and they keep expanding.
Where do you think your lip's going to go forward?
Speaker 3 (31:00):
And then that's when you get a lot of migration too.
That's why all these women were getting a lot of
migration exactly.
Speaker 1 (31:04):
So what is migration.
Speaker 3 (31:06):
Migration is when you're putting too much filler that the
filler has to go somewhere so it'll migrate into other
parts of the tissue very good.
Speaker 1 (31:12):
So migration. The concept is your face is not a balloon.
It's finite, and if you keep shoving CC after CC
of filler in a space, if it cannot accommodate it,
it will go somewhere else and it'll go to the
next closest area. So one common thing was people were
(31:34):
getting this very full upper lip, meaning from the nose
to the lip. The top of your lip, which should
have nothing, if anything, should be concave. A beautiful, youthful
upper lip is concave. Was filled and it looked like ridiculous.
So now if you're lucky and you did ha, we
could reverse it. If you were unlucky and you put silicone,
(31:57):
you're fucked because I can't fix the upper lip. I
can only fix the lip proper, so be very careful
with lips. Then we move to marionettes. So marionettes are
also an area that so let's talk about why it
happens and then how it is. A marionette is the
(32:19):
equivalent of a nasal labia fold, except it's for the jaw.
So that means as you get older, your jawline, your
skin starts to relax and you develop a jowl. There's
a very rigid area called a sulkis where your skin
(32:43):
is attached, and then there's a nasal abia full. Rather,
excuse me, a marionette. So again, your skin, your forty six,
your fifty two, your fifty eight, Your skin relaxes in
your upper face, it creates a hollow in your mid
and a big roll at your nasal labia fold. In
your lower face, it creates a jowl and a marionette.
(33:08):
So the treatment is a facelift the end. Now, Now,
not everybody wants a facelift. Now, some people it's early
and they haven't quite yet they're not. They're they're they're
gonna wait to do it in a young person. A
little bit of filler in the marionette. Again, you're camouflaging it,
(33:31):
you're not fixing it. Is okay. What was happening was
women kept getting more and more and then they were
getting what I called the KOI look like you know, koyfish.
They're like they have this like poudy side and the
like this. Everything was so heavy or a bulldog look.
The mouth became so wide and so heavy and so
(33:55):
squared off that it looked incredibly masculine. Now, unlike the
angle of the jaw, which is nice as strict and sharp,
the front of your mouth, as a woman, should be
relatively tapered. You don't want a wide, bulldoggy look. And
so a lot of older women who should have been
(34:16):
released from their injector. Mary, I'm so sorry. I can't
help you anymore. Mary. You need a facelift. You don't
want to face it, no problem, Mary, but I'm not
gonna inject you anymore. Listen to what I just said.
You don't want to face if, no problem, but I'm
not gonna do assisted suicide. People are like, well, she
(34:37):
wanted it or she wanted it. You can't just do
things because people are don't want to do what's correct,
and they just keep feeling them and they get too wide.
And this is actually one of the most common things
that celebrities were getting was puffiness under their eyes and
widening of their mouth. This was prior to twenty twenty four.
(35:00):
Prior twenty twenty four was the ozempic facelift era. That explosion,
the explosion of ozembic facelift occurred in twenty twenty four.
People finally add the light bulb. They went on ozempic.
Everyone was getting skinny, Celebrities were getting face lifts at
forty five looking amazing, and they realized, oh shit, filler
(35:22):
isn't the solution. Surgery was the solution. So now we've
had a real backlash on filler. People are now going, oh,
I don't want filler, I want to facelift. I don't
want filler, I want to facelift.
Speaker 3 (35:34):
But then we've also been getting ozembic face where people
have gotten a lot.
Speaker 1 (35:38):
Of volumes face. Yes, for sure, But what I'm saying
is that we this is the interesting part. We went
from Wow, this is crazy, I look at this tool.
I go and I can fill everything too, overfilling them
to now I'm sick of it. And then all these
celebrities are like coming out as if they're you know,
coming out and you know, coming out of the closet
that they're gay or something. They're like, Oh, I've had filler,
(35:59):
and I hate it. You're kidding me, you're joking me.
You had a filler. I mean it's obvious you had
a filler.
Speaker 2 (36:04):
Yeah.
Speaker 1 (36:05):
The next area of filling I'm not a fan of.
I think you'll uh maybe disagree with me on that
is I hate chin filler. I posted this, I got
a couple of filler people who jumped on and said, oh,
the response to everything whenever there's somebody who's trolling on
my side is you don't know how to do it.
It's like, really, I don't know how to do it.
(36:27):
The reason I don't like chin filler, and I know
you don't mind it and you do it occasionally, whatever
is you're replacing hard with soft, Whereas I love cheek
filler chin as you volumeize you're trying to get a
chisel sharp look and it doesn't expand, it migrates, it
goes downward, it gets rubbery, and when you put a
(36:48):
small chin in plant in, it's a home run, chiseled
and sharp, and so maybe you can get away with
a CC. Maybe. But I have seen so many posts
Charlatan doctors are like, look at this surgical non surgical
chinog and they're like four syringes and they look crazy.
Speaker 3 (37:12):
Yeah, I agree, I mean people have gone overboard. But
again it's all about you know, selecting the right patient
and looking at the anatomy, you know, really doing a
nice assessment and seeing if they're a candidate for it.
And with everything, I'm super super conservative, and I think
that it could be done correctly if the patient was
a candidate. I have a tiny drop of filler in
(37:33):
my chin. I do like maybe point two ccs every
I know. I haven't done it in like three years,
and I think it made a huge difference from making
my face more.
Speaker 1 (37:41):
That's different than a chinnog done with filler. So this
is what I'm referring to. Up to a CC, up
to a syringe. You can dabble in. It gives you
a little pop or an enhancement. Fine, I get it.
Like I put a little bit in I'm not gonna
go get a chinnog, doctor rabond I put it tight. Okay,
I'm talking people with recess chins that are going and
getting syringing syringes of filler put in. I just what
(38:06):
can I tell you? Because I have access to the
entire portfolio of tools, I can fill you and operate
on you. I'm always going to defer to the thing
that gives the best result. When you're an injector, your
tool is injecting. So you're selfish because you won't release
the patient and you keep referring, recommending to them the
thing that you do, whereas you should say, you know what,
(38:26):
this has reached the limits of what I think looks ideal,
so not so good. Then we shift gears to the
angle of the jaw or the jaw line itself, again
similar to the chin a little bit. It's the same concept.
What are we replacing a weak bone week jaw? So
a little bit along the jaw and a little bit
(38:47):
in the angle can help. But if you're getting in
syringes and syringes, I think you should really reconsider and
aside from wasting the money because it's going to go away.
And then you have to do it again. You look
much better if you had something surgically done.
Speaker 3 (39:03):
In my opinion, oftentimes it can just widen your face.
Re membor fuller does add volume, So putting volume in
that area can't make you right.
Speaker 1 (39:10):
Yeah, exactly. You go there hoping it will be chiseled
and just stick to your jaw, and then it just
puffs up and now you just kind of look fatter
or not more chiseled. Another interesting place, and here's some
actiric areas. Number One, you can put it in ear lobes.
A tiny amount in an ear lob goes super far.
(39:31):
Why would you put it in an ear lobe? Who
wants a big ear lobe? You don't want a big
ear lobe. It's as you get older, you get deflated
ear lobes, and it kind of looks a little ugly
and a little volume goes very far. Another area that's
interesting is hands. You can put it. Why would you
put it in a hand. Who wants a fat hand?
You're not getting a fat hand. You're putting it in
(39:52):
between the knuckles where there's depressions. As you get older,
as your knuckles and hands get loss of volume, it
makes you look oil older. And a bit frail. You
can put it in labia majory. Yeah, what, you can
put it on your outer labia. When you age and
you go through menopausal changes, your labia atrophy and become
(40:16):
flat and have no cushion left to them, and the
outer labia can be very effective as well. So those
are just some random areas we're going to switch quickly
to technique. So there are two ways to do filler,
and there is a right way to do filler in
each area. So the traditional way to do filler is
(40:40):
using a needle a needle. You open up the box
and in it comes comes two needles. Why two needles
because after a while one needle becomes dull and you
want to switch. So the duller your needle, the more
it hurts and the more bruising.
Speaker 2 (40:55):
Yeah.
Speaker 1 (40:56):
The other way to do it, and the advanced way
to do it, and the more wreck way to do
it in most areas is using a canula. What is
a canula?
Speaker 3 (41:06):
A canula is a it looks like a needle, but
it's blunt at the end.
Speaker 1 (41:11):
It's a long liposuction like canula, thin and tiny thin.
The hole is on the side, not at the tip,
and the tip is round and blunt, So we have
a sharp needle with a hole at the end of it,
and we have a long, blunt instrument that has a
hole on the side that's flexible. The reason what's wrong
(41:35):
with needles in general, and why the canula is the
main go to if you're in If your injector doesn't
use canulas, you should go somewhere else. This is now,
We're way past this. Now. A needle has the following downsides.
Hurts like hell, bleeds like hell. Why would it bleed
Because it's a knife. Every time you poke it, it
(41:58):
goes through the skin and into the vessel. Then it's short.
So if I want to air fill an area, I
have to take it out, push it in, take it out,
push it in, take it out, push it in. So
I'm creating a street out of cobblestones. It's more likely
to be lumpy and require a lot of manipulation. Afterwards,
(42:19):
I gotta massage it and sweep it and whatever. And
it has a risk of blindness because you have a needle,
and that needle can go into the artery, into the vein,
and the hole is at the end of it. So
when I push filler out. It's coming straight out of
the end, whereas the canula is blunt, it can't. It's
(42:43):
very difficult to almost impossible to puncture something, and the
filler comes out of the side, so you're not pushing it.
In the other aspect, the other risk is necrosis, which
is the same risk as blindness, which is you're injecting
into a vessel. The pain is significantly less with a canula.
(43:03):
So now let's shift over to a canula. A canula
you can do a lot of filling from one area.
So we make one poke right an entry point, and
then we enter this blunt canula under the skin where
everything is numb and you don't feel anything. The pain
was the single hole, and then we can go back
(43:26):
and forth in different planes and drop filler little by little.
I refer to it as the making a street out
of asphalt, making a street out of cobblestone, and like
cream cheese, you can just lay it in layer by layer.
So the areas I'll put it this way. Every area
should be done with a canula, with the following exceptions.
(43:50):
So number one, liquid rhino, for the most part, is
done with a needle, because you're putting tiny little droplets,
and you want to be there very precise, and you
want to poke through the skin, drop it and come out.
My experience with lips, and you can tell me otherwise.
I always did it with needles. Then I did it
with canulas for a while. And while I liked the
(44:13):
canula because the bruising was a tenth of it, I
didn't get the shapening I wanted. So I went back
to needles. Yeah, so I think it's it's a toss
up if you're you know, either way, I think the
needles is probably the right way to do it.
Speaker 3 (44:27):
Yeah, you could be a little bit more precise, give
a little bit more like shape.
Speaker 1 (44:31):
And that's it. That's it. What do you mean that's it? Temples, canula, temples,
upper brow canulus, lower eyelid canulus, mid face canulus, marionette canulus,
these chin and jaw. If you do it the canulas.
Speaker 3 (44:47):
There's tiny areas where if I do need some projection,
I'll use a needle, but very small amounts and it's
in conjunction with Yeah, the only.
Speaker 1 (44:56):
Areas that you can use it is if you're trying
to eface or flat. Now, a tiny little bit of
a marionette or a tiny little bit of a nasal
aba fold. Maybe you add a little bit and it's
just like a touch of it. But why I'm telling
you that is that if you're in a SPA currently
getting injected and your provider is essentially just using a
needle throughout. While that's okay, you're not at the gold standard,
(45:18):
and I think you're getting way more bruised, way more pain,
way more irregularities, way more lumpiness than you need to.
So my suggestion is you should shift over. So let's
talk about recovery because some people have never done fillers.
So what you can expect from the recovery of a filler, I.
Speaker 3 (45:34):
Mean, just like anything else that you do, you'll have
a risk of swellings, whisk of bruising. You know, it's
going to be different per client, depending on the area
that you treat, but it should be very very low
for the most part.
Speaker 1 (45:48):
Yeah, unlike botox, which should have almost zero issue. You
come in, you do it, you go about your lunch.
You've been done. Eh, maybe one out of I don't know,
one hundred bruises. Filler has a little bit more recovery
to it. In other words, I wouldn't do it and
then like have a big event the next day. I
think you will regret it. It depends on if you
take blood thinners. We ask you to take no blood thinners.
(46:10):
With botox, you can get away with it. It's not ideal,
but it's no problem. Filler, if you're on aspirin, if
you're taking a bunch of motor and ADVI libry profen,
you're light fish oils, you're likely to bruise more. Secondly,
you're more You're definitely gonna bruise from needles, lips, every
you're likely to do it. Even if you're an amazing injector,
(46:30):
you'll get a bruise here and there. With canula as
a bruising is a tenth, a fraction, maybe almost nothing.
You have different areas, so midface cheeks should have almost
no bruising, Lips you'll get some bruising, noses a little
bruising under the eyes using a canula should have no bruising.
(46:51):
Temples should really have no bruising. So you'll be a
little swollen. And with filler you need to be patient.
You will often pass point a little bit, so our
goal is for you to be let's say, at a five,
we inject you. You're at a three, we hit five,
and you'll go to like six, six and a half,
and then you'll come back. Especially with lips. If you've
(47:12):
never done lips, we always tell you, do not call
us for seventy two hours. I don't want to hear
from you. You will swell up. Do not panic, especially
if you've never done it before. And then later they're like,
oh yeah, oh okay, yeah.
Speaker 3 (47:27):
They always saw every lip coolar patient. I'm like, you
will bruise, you will swell, like, just don't expect it
from not happening.
Speaker 2 (47:34):
If it doesn't happen, great, but just expect it.
Speaker 1 (47:36):
My number one recommendation is ice ice is better than
oh I did Arnica grade fine, whatever, Bromolin grade fine, whatever.
Ice ice ice, ice ice. When do I start icing immediately?
Like literally immediately. The bruising is occurring immediately as you
leave the office. You're bruising inside deep underneath. So use
ice as quickly and often as possible. So and then
(47:59):
the last part that I want to talk about is complications,
because I think this is where you're talking about elevated
levels of skill set. You know, so many of the
things we see today, especially in the non surgical space,
is occurring to the influx of providers. I have posted
a thousand times where I am personally very much opposed
(48:20):
to metspas that are not run by physicians. What do
I mean by that? Aren't they all run by physicians.
I'm not talking about a METSPA where there's a medical
director that periodically shows up, signs a few charts and
they're an obgyn and it's run by nurses on their own,
injecting freely whatever they want. When you have a met
SPA under the umbrella of a clinician like myself, not
(48:43):
a pediatrician, I'm talking about a plastic surgeon or a dermatologist,
I think that that's a different met SPA than anywhere else.
And I think that today they're just I'm going to
go out on a limb. There's no reason for you
to go anywhere that isn't well supervised, you know, because
the reality is that I'm intimately connected to you, so
(49:05):
if something goes wrong, I'm here. Secondly, I vetted you
and I'm physically here with you. And third if I
hired you, I expect you to have a better skill
set than someone who just graduated, let's say three years ago.
So the complication that can go wrong, we'll start with
the simplest one, The easiest and simplest one is, let's
not say necessarily a complication, but you can get a
(49:25):
hematoma or a big bruise. Yeah, you can get lumpiness,
you can get asymmetry like, oh, my right side cheeks
more than my left side. You can get We talked
about the two dreaded ones. We'll get to this. Is
there any other ones that you think.
Speaker 2 (49:45):
Of that's really it? They're very mild when it comes
down to it.
Speaker 1 (49:49):
For the other two, and we talked about them, and
I'll just hit them one more time. Is blindness catastrophic necrosis,
Tissue dies catastrophic, and those are her with needles. I
don't think there's ever been a reported case of blindness.
Speaker 2 (50:04):
A few with a.
Speaker 1 (50:05):
Can, but let's say the rate of it is very,
very insignificant. And I think the key and if your
way to avoid it is provider driven, provider driven, provider driven,
And if God forbid that ever happens and you notice
and you went and got injected, and you go home,
You're like, wait, this doesn't look right call immediately go
(50:26):
back and use the drug vitrace. You're highly on a
dace like you should ask when you go to get filler.
This is this is what I would recommend you walk in,
you're about to get filler, say, do you guys have
holier on a day also known as vitch trace here
on in house in your refrigerator right now?
Speaker 3 (50:44):
And as a provider, you should make sure, I mean
just for you in your safety, that you should always
have them, right. No, but I will never inject a
patient if I don't have any.
Speaker 1 (50:53):
Oh, well, we'll get it if needed, we'll call the pharmacy. No, no, no,
no no.
Speaker 3 (50:58):
I canceled days when I've gone, when I've worked and
had no highlaluronodyck.
Speaker 1 (51:03):
So literally it is your literally, and it's like having
a forest fire and having no water in the hydrant,
like you need it to put out the fire. So
you want to make sure don't rely on them. You
should ask, just like you should look at the filler
when they open it. You should ask, hey, great, oh
my god, that's great, Susie, Hey, do you guys have
a trace here in the refrigerator? Can you go check
(51:25):
for me? Because those yeah, yeah, yeah, we have it,
and God forbid, you needed that moment. It's not like
you just go get it from CVS. You got to
go get it from a pharmacy, so very very important. Anyways,
I think that was a I think that's a wrap.
I think we covered an a to z of injectables
and fillers together. I hope you guys enjoyed that. The goal,
(51:47):
as always, is to educate you so that wherever you are,
we love it. If you came to our spa. But
some of you are listening from I don't know, the
UK or Australia or where have you, or you're in
another state. Obviously you're not gonna fly out here just
to go and get some fuller from us, So just
be careful when you do things. And now I hope
you're just that much more educated. As always. That's I
have two requests. One, you love our show, Go write
(52:10):
a review, Go write something nice, say oh my god,
we love your show. You're the best. Makes everybody who
works on the show happy. And secondly, share our podcast
with the people you love. The last thing you want
to hear, God forbid, is someone you care about has
a complication and you're like God I wish they had
listened to that episode. You just never know who's going
to go where. So send it, download it, subscribe and share,
(52:32):
all right, Charlie, that's a wrap, guys. Tune in next
week we have yet another episode. We're going to be
talking about lasers. I think that one's going to be
even more interesting than this one. So that's a rap.
I'm your host, Doctor Rudderbaan. See you next week on
Plastic Surgery Uncensored
Welcome to another episode of Plastic Surgery and Censored. I'm
your host, doctor Roddy Rabon, and we are excited about
episode two of a multi episode series. This episode is
about volumeizers or fillers, and I think this is a
really important episode because I can't tell you how poorly
(00:28):
and mistakenly and wrong fillers are being done, so much
so that it's caught the eye of social media, you know,
balloon face, pillow fase, celebrities are reversing it. I mean,
it's a huge discussion because I think it's one of
those things that when it first came on, it was like,
oh my god, this is too good to be true.
(00:49):
And then people started using it, using it, using it,
and then over using it, over using it, over using it.
Oh my god, I hate it. So we've really made
a full spectrum and a big pendulum. And I think
the key to the filler is knowing when, where, and
how and how much to use it. So let's begin
by just describing the concept of filler. It's funny. Filler
(01:12):
before was like, oh my god, that's so great, and
now that everyone's doing facelifts, like it's just always makes
me laugh. Trends set up everything in the past. Several
years ago, filler was the hottest thing ever. Fill my lips,
feel my chaks, fill my job, fill my chin now
because of Oh I can get a facelift. Oh I'm
(01:33):
gonna look now, A filler's horrible. Fillers horrible. Filler is horrible.
And you know my philosophy, nothing is great, nothing is horrible.
Everything has an intention and a use, and when used correctly,
when you use a hammer correctly, it does the right job.
It's not a drill, it's a hammer. So filler, as
the name says, volumizes an area that needs enhancement or
(01:58):
volume or fullness. So let's talk about let's talk about
the products that are out there. So in the world
of filler, I can tell you there's one million products,
and these products are so damn confusing that even I,
(02:19):
as a person who does this and is in this space,
I'm always blown away. They're like, oh, have you heard
blah blah blah. I was like, no, what the hell
is that shit? It's shit. So we're going to break
it down to you in its basic elements. By far,
the most effective, by far, in my opinion, the best
product for facial revolumeization is haluronic acid based products. We
(02:46):
refer to them as HA. The reason why HA is
the number one product we recommend, and really the only
product we recommend, is because number one, it's one hundred
sen biocompatible means it's made up high uronic acid. It's
made up of what you're made up of. Yeah, in
(03:08):
the past, this may maybe before Charlene's time, we used
to inject collagen, and collagen was horse collagen, right, and
we'd have to test you or bovine or whatnot, and
we'd have to inject you with a little of it,
and then we'd have to see if you had an
allergic reaction. And there was you know, a decent number
of people that their body reacted to. We don't do
any testing with HA.
Speaker 2 (03:29):
Why because it's biocompatible.
Speaker 1 (03:32):
It's in you. You can't react to HA. You're made
up of H. So I love that aspect. The second
and by far the main reason why I love HA
is it's reversible. Do you understand what that means? That
means I injected you and you are you hate it?
You're crazy, You're having a complication, what have you? I
(03:52):
can run into my exam room, go into the refrigerator,
pull up an enzyme called hileonomy Irani day's vit trace,
what have you inject the area that I injected, and
within magic, literally within hours, it's all gone. That right
there is the only thing you need to know. I
would never and as a result, I don't ever recommend
(04:15):
injecting things. And we'll talk about it. Maybe Charlene's done it,
and she has a different perspective. Inject things into your
face that has permanency or irreversibility or takes forever to
go away. And so as a result, I'm a big
fan of HA. So in the world of HA, guess what,
there's like a thousand products. So I would say, by
(04:37):
and large, there's two main companies. Okay, it doesn't mean
that they're the right ones, but they're just a two
main companies. One company is the Juvaderm world, the family
of Juvderm, which was the original drug, I mean, the
original filler juvenim, and one world of the Restallan family.
(05:01):
And they're both they're like Ferrari and Lamborghini. Okay, you
can't go wrong. They're both great, they're both safe, they're
both wonderful, but they do have some distinctive differences within
those families. There was once upon a time when I
was just starting out, that was it. You got Jupiter, Jupiter,
(05:22):
plus you had wrestle in and you had Perlaine, which
they don't call it perlain anymore. Essentially, the idea is
this gel. All they're doing is making it thinner or thicker. Right,
it's crosslinking, so imagine working with honey versus working with
(05:44):
syrup versus working with wax. It's just different thicknesses of product.
So in general, in general myself and just by cheer chance, Charlene,
we are more partial to the world of the Restallan family.
And the reason why I have historically stayed away from
(06:07):
the jupiterim family is it has a tendency to do
more of the one. It has a tendency to do
more of one of the complications I dislike, which is
water retention or puffiness or swelling. Because these products, the
way they work is twofold. Right, we inject the gel,
(06:28):
that area puffs up. Oh wow, look at your lips,
Oh wow, look at your chin, Oh wow, look at
your cheeks. Right, and then you go home and then
they behave like a sponge and they sequester or suck
in fluid, and then they get bigger than they were
than when I left you. So if I inject you
(06:49):
with a CC one CC, it may in totally one
point six or one point seven. The Juveiterim family of
products tends to be more hydro philic, sucks in more fluid,
and I don't like that because it's unpredictable. I like,
when you leave my office, I know what you're likely
(07:11):
to look like. Whereas with the juvenile products, people were
getting more swollen. Now that doesn't mean to say that
you should never use a juvenim product, because that provider
will have adjusted for presumably that product people really like it,
for example in their lips because they wanted it that
more luscious. Howdy look myself and Charlene like the accuracy
(07:35):
of the wrestling based family. Now again under that family,
I won't get into the belabor it there's Ultra, there's Jubiterm,
jujuvern plus Juvederm, Ultra plus Voluma Verrabella. Then there is
restall in Restalin plus contour defined. I mean, I find
all of this nonsense funny enough. We use like two
(08:00):
because at the end of the day, we are skilled injectors,
and I and Charlene can get whatever effect you want
everywhere I want with just these two products. And what
I'd rather do is get so accurate using these products
than to have, you know, most medspas, and this is
(08:21):
a fault. I think you go in and they carry
like twenty five products and then you know, they just
sort of cater what you want. And my opinion, your
your providers don't get excellent at any one product.
Speaker 2 (08:34):
And sometimes I felt was a little overwhelming.
Speaker 3 (08:36):
You know, I've worked at places where we did offer
a whole bunch of different types of products, and I
would sit in front of, you know, our cabin and
be like, what fillers should I use? And you know,
sometimes you're like it's just a little overwhelming.
Speaker 1 (08:48):
Yeah, And the patients and the change matters. The patients
don't know, nor should they know. It's the provider's discretion.
You should come to me. I evaluate you, and I'm like, okay,
we got you, and then I SHO should be able
to say I think she needs blobby blah blah blah.
A lot of places because these companies are advertising, the
patient comes in and says, do you guys have valuma
(09:10):
and they're like, uh, sure, can I put Valuma on
my nose? Sure? What that's like malpractice as far as
I'm concerned. So we here are more about injecting and
injecting skill than we are products and various products. So
we have a thin and a moderately thick, and in
(09:31):
that way, we know we can put the thin in
all the areas that it belongs and moderately thick and
all the areas that it belongs. So that's really important
for you to understanding. There are other ones like RHA's
come out, and there's gonna be other companies. Again, I'm
not going to bad mouth or promote any of them.
I don't work for any of them. None of them
give me any kind of kickback. I don't care. The
(09:52):
next question is, oh, there's two other groups of products
that I'm One is the world of sculpture. We're gonna
just touch on that brief because we won't revisit it.
Is sculpture is a biostimulator. This is a new category,
its own drug. It was really a drug that was
predominantly its focus was in HIV patients. People who got
(10:13):
HIV became gune. They lost all their fat in their face.
And if you are you know, had the misfortune of
knowing someone that you love, or you've seen it on
TV or you google it and you look at it.
People in late stages of HIV literally look like you know,
Holocaust survivors. They're skinny in their face, lost fat. So
(10:34):
you would take a lot of filler and to get
it in there. And so this whole category of biostimulats
came out, and you would take this drug, you would
reconstitute it, and then you would inject it. And then
this would stimulate the body to generate its own collagen
(10:55):
or tissue so to speak. Wow, that sounds great. Why
don't you use that regularly? Because in my opinion, number one,
it's not reversible. What if you come in and I
do this stimulator thing for you, and I put it
in your cheek and in a week from now you're like,
oh my god, I hate this. Yeah, get it out. Sorry,
(11:18):
can't help you. What do you mean you can't help me? Well,
when is it going to go away? Four years? How
long does it take for sculpture to go away? Three
to five years? What are you saying, doctor Rabon? Three
to five years? And then the kicker. It's going to
get bigger. What do you mean it's going to get bigger,
It's going to grow. It stimulates, So you can just
(11:42):
imagine what I just describe to you. I'm injecting you
with something that's you can't undo for three to five years,
and it's going to expand over time because it's designed
to stimulate. Does that mean that no one should use it? No?
Knock yourselves out. If you've like this product and you
find a provider who likes this, you're a match made
(12:05):
in heaven. In my practice, this makes no sense because
it doesn't add anything to me. And what it does
as a provider is it attaches me to you. And
I want the ability that if you have a complication,
or you're crazy, or you're dissatisfied, I can undo it
and you can go on your merry way. So just
beware of that group. And then the last group is
(12:27):
a disaster, which is permanent fillers.
Speaker 2 (12:31):
Radius.
Speaker 1 (12:31):
Oh I left Radius out. You're right. So there's another
group called radius, which is calcium hydroxide, and I again
not a bad product. Some people love it. They use
it in hands, they do all kinds of things. Radius
is similar to sculpture, but not as bad in that
(12:52):
it's you inject it. Oh my god, doctor r Bond,
this this is too much. I don't it's too much
in my cheeks or I'm sorry. It's gonna take a while,
how long? One year? Maybe more? You may have to
live with this thing for a year. Yeah. How it's
different is it doesn't expand it's not a stimulator like
(13:14):
tell me.
Speaker 2 (13:15):
It's a little bit, but not as much as ars.
Speaker 1 (13:18):
I just again, same reason, same reason as a sculpture.
I just think it's it'll advise. You have these products, ha,
products that are gold standards, that were great. I would
do it. The area that you want to stay the
hell away from is anything that's permanent. So there was
a drug called PMMA. There was silicon for years. And
(13:39):
the problem with these medications, these injectables, is sometimes they're
not told to you. So I have over the years,
in twenty years, I cannot tell you the number of
lip reductions I've done where I go in and cut
out portions of the lip for people who had silicone
(14:01):
injected in their lips ten fifteen, twenty years ago and
were told at the time, Oh, it's just some It
wasn't and not told it was silicone. And what happens
is a it never goes away. And the difference with
permanent filler is that it because it's permanent material, the
body keeps reacting and it doesn't just stay there. You're like, well,
(14:25):
that sounds great. What if it gets the injector injects
it perfect. It's perfect, right, it's there, it's permanent, it's perfect. No,
it stimulates granulation tissue and you get this what's called
granulomitis reaction, and it actually grows and becomes abnormal. So
a perfect example is in the lips. People say, yeah,
(14:45):
I had this injected. I went to a place they
injected it. It didn't look that bad at the beginning,
but over the years it started to look crazy. And
when I have my menstrual cycle or this, it's gotten
lumpy bumpy and it flares up. Get it out. I can't.
It can never be taken out. It is embedded, embedded
(15:06):
in your tissue. So I have to cut it out
and I do this thing called the lip reduction, which
you know is a procedure to correct it. But it's terrible.
So don't let anyone inject you knowingly but more importantly,
do not be fooled. My recommendations is, aside from going
to a reputable place. Often asked to see the filler,
(15:32):
we open the filler in front of you. We just
go here you go. You know it's the product you're
asking for. You know that it's sealed, you know that
it's yours. You know it's not like, oh, you know
the whole Chuck E Cheese scandal. They were taking leftover
slices of pizza and making a pizza out of it.
You didn't hear about that. Yeah, that was a Chuck
E Cheese scandal. And they would they would go and
(15:53):
round up all the leftover slices and make Some people
were like, god, my pizza looks oblong. It's not round.
So you you you'd be shocked. People will go in,
get filler done, not use up all the filler. You
don't know. You don't know. If they use up the
whole syringe and then the leftover they'll give it to
someone else. They'll just change us, change the needle, and
(16:15):
off you go. So you need to be a savvy consumer.
Go to a reputable place like Restore by Rabont, MD,
and then also make sure you see the product. Okay,
So let's talk about now all the different places that
can get injected with filler, and there are so many,
and the ones that we recommend, the ones that we
(16:38):
don't recommend, and why so I always like to look
at the head from top of the head down to
the neck. So let's start and work our way down.
What about the forehead disaster. Do not inject your forehead, people, listen.
Why it's incredibly dangerous, so elaborate on it. But there
(17:02):
are two catastrophic catastrophic complications associated with filler. One blindness
that is correct blindness, permanent blindness. Two necrosis tissue diyes
turns black gone finished. The blindness one is associated with
(17:25):
injecting around not around the eye ball, but around the
area of the eye. Because the vessels, the blood vessels
that are around the eye, the forehead, the nose underneath
the eye all communicate and lead back to the same
primary source. And the forehead has large vessels. And if
(17:46):
you start messing there and your surgeon or your injector,
unbeknownst to them, pushes filler into an artery or a vein,
and it retrograde, goes back up the wrong pipe, and
then goes down the eye pipe. You're gonna go blind,
so not worth it. The next one is temples. Temples.
(18:10):
We like temples. Temples a good one. Why would we
inject temples because it's.
Speaker 2 (18:15):
One in the airs that hollows out very quickly.
Speaker 1 (18:18):
Correct because you get peanut head. Peanut head is a
if you guys ever looked at that peanut or that guy,
the peanut guy, the main peanut character, the the mascot.
What happens is that you're you have bone hollowness, cheekbones,
and you get a concavity in your temples. My sister
(18:38):
actually had horrifically deep temples, and it is interesting. It
really ages you. Yeah, absolutely superbly ages you.
Speaker 3 (18:45):
Except something that people don't even realize either until you
point it out.
Speaker 1 (18:48):
Yeah. Yeah. And so you know what you want is
unlike other things that you want enhanced, this you want neutral.
You don't want like big temples. Ooh those are sexy.
You have huge temples. You want your temples to be
smooth and in a plane with the rest of it.
So again, we love temples.
Speaker 3 (19:10):
Yeah, yeah, it's done correctly right.
Speaker 1 (19:13):
There is under eye. So this is a very controversial area.
So let's talk about under eyes. So for many years,
under eyes were being treated left, right, and center. And
a very very very common issue with under the eyes
is something called bread loafing, or getting sort of a
(19:37):
fullness underneath the eye and the eye the lower eyelid
and that area traps fluid more than anywhere else, and
so it was an area that people were over injecting
and injecting the wrong product. So if you put any
product under the eye except for basically restall it, I
(20:02):
guarantee you within maybe a month to two and forever,
it will get puffy because the lymphatics of around the
eye just pull it in and you get this puffy,
bread loafy thing. And that's like the number one common
thing that you see in celebrities, your people, and you know,
you're like, God, that person doesn't look right. You get
(20:22):
a cat look. Yeah. The reason you get a cat
look is your cheeks start to blend into your lower islid.
And one of the things that makes a cat look
like a cat is their cheekbone is right underneath their eyelid.
There's no depth, there is no transition between eelid and cheek.
It just cheek is the iselid, so that area needs
(20:47):
to a be injected incredibly judiciously. I'm talking microscopic and
then only with the product wrestling, and even then you
can still get puffiness. Now, when is it indicated? Is
indicated in the following instances. You have a tiny amount
(21:08):
of tear trough, that's the hollow ness. You have the
tiny amount of eyebag, and you want to camouflage it.
Injecting filler doesn't get rid of a bag. Injecting filler
camouflage is the bag. You do not inject your lower
eyelids for dark circles. People. I hear hundreds of people
(21:32):
come to me over the years. How can I help you?
I need filler? What for my lower eyelids? What? What's
wrong with it? It's dark, It's got a darkness to it.
My friend went and got her dark areas filled and
it looks great. Her dark areas was in pigment. Her
dark areas was an illusion of the trough that hollow.
The hollow looks dark, so when you filled it, it
(21:55):
looked less dark. But yours is literally pigment. So do
not inject for pigment. It's not a good place.
Speaker 3 (22:04):
Yeah, and I'm very I'm very cautious with who I
inject on your eyes too. I'm very picky with the
candidates that I choose. They actually have to have a
true hollow, but doing less and less under I feller.
Speaker 1 (22:15):
Now, yes, yes, And I think that's part of the
evolution of us learning as injectors. Oh wow, I used
to do this. Even though I did it conservatively, I
still didn't like the way it looked. It still looked puffy.
Then we move to what I think is probably the
gold standard, the area that I think filler does the best,
assuming it's done correctly, which is the mid face. What
(22:37):
is the midphase, It's cheek and slightly below cheek is
slightly below. Now, the cheek is designed to be a tripod.
It's not a ball, and it's not one dimensional. It's
a tripod. So there is the cheek as it communicates
to the nose. There's the cheek as it's at its peak,
and there's the cheek out laterally as sort of we
(22:59):
can call the cheekbone or arch, and then there's the
space underneath the cheek. So one, two, three, and four.
It creates a tripod. So everyone anatomically is designed differently.
Some people have really high arches flat face. That's more Asian.
Asians have super high cheeks arch, but relatively flat. So
(23:23):
when we volumize them, we fill in the front to
create a little roundness. Some people are really full in
the front near their nasalabia fold, but empty and kind
of flat on the side, so we create a little
bit of an arch or filling out. Some people, like men,
(23:44):
are very hollow underneath their cheekbone and they have a
gaunter look. Now, with men, your goal is neutral. You
just want it to be just doesn't look like I'm
you know, starving, but you definitely don't fell it the
way you feel a woman where you want a little volume.
So I think the number one area where filler is amazing.
(24:05):
And by the way, facelifts do not fix entirely is
mid face volume depletion. So the reason why I say
facelifts don't fix it entirely is because when I do
a facelift, often I do fat transfer. I do fat
transfer because I've lifted up the excess skin. Check, I've
(24:27):
lifted up the muscles and repositioned them. Check, and this
person is still lost some volume and I need to
replenish that volume. The mid face is amazing and I'm
a huge fan of it, so much so that we
used to use a lot more cheek implants and we
use less of them because a cheek implant is firm
(24:50):
and a cheek should be soft. So I like to
replace with Like, something is soft, we want to replace
it with soft. Is something is hard, we want replace
it with hard. So I'm a huge fan of cheeks.
Now we're gonna move to the next controversial area, nasal
labial folds. So I have not injected a nasal labial
(25:13):
fold myself, probably in ten years. Now. That doesn't mean
I never injected. When I say I don't inject it,
I may inject the tiniest amount. But I have completely
and totally eliminated that from my practice. And there's a
reason for that. One of the number one things z
(25:34):
that was the number one indicator when we got indication
for the filler, it was for nasalabil folds. They found
a hollow, an area that was hollow from your nose
to your mouth. It's called the nasalabil fold. Ooh there's
a hollow. Oh, now we have a filler. Okay, let's
fill it. And the idea because people didn't know. What
they were doing was to fill it and obliterate it.
(25:57):
It's bad, hollow, bad fill, get rid of. And what
is unique about the nasal labial fold that isn't safe
for the temple is it's dynamic. Your temple doesn't move.
It's filled. When you smile, your nasal labia fold pulls.
And anyone who has filler in their nasal aabia fold
looks weird. It's weird, it's flat. It doesn't create a
(26:21):
natural dynamic movement. So I personally, I know Charlene does
a little of it.
Speaker 2 (26:27):
A little bit.
Speaker 3 (26:27):
It's going to be one of the last areas.
Speaker 1 (26:29):
Well.
Speaker 3 (26:29):
I'll just do a tiny touch if everything else looks okay. Yeah,
I know they have good mid face volume. They just
have the tiniest, you know, little indentation that we just
want to pop out.
Speaker 1 (26:39):
Yeah, I stopped. I did it too at the beginning,
albeit conservatively because it was always my style. But I
moved away from it essentially altogether. Now. The reason is
that nine out of ten patients come to you and
this is what they say, My naso labial folds look
so deep, I need you to fill them. And when
you examine them. It's their midface right above it, right
(27:03):
above it, that's hollow. So when your midface is hollow,
the naso labial fold, avalanche is down. Now this is incorrect.
Filler doesn't lift. It's a lie. It's bullshit. Listen to me.
It doesn't lift. But but as you revolumize the mid
(27:24):
face and it fills back to normal, the nasal labial
fold doesn't look as dramatic because it's not got a
hollow on one side and a hollow on the other.
It's not a nasal labial fold. It's a nasal labial roll.
It's a roll. And when you fill the cheek appropriately,
you now look, oh wow, oh my god, my nasal
(27:48):
labiel foold looks so normal. Yeah. So if you were
to get into a beasting and your midface would expand
into a balloon, yes, yes, it lifted you. Yes, you're
right now, naso labia fold is obliterated. But that's a
shit ton of volume, Okay, So I would just be
(28:09):
careful when it comes to your nasa labia fold again,
make sure your mid face is filled, otherwise I kind
of never inject. Then we move to the nose, so
I'm going to tell you this once. No one should
inject your nose unless they are a rhino plastic expert.
I know nurses like to do it. They're very skilled,
(28:30):
they're very knowledgeable. They can do circles around other surgeons.
It's an area that you shouldn't do unless you can
deal with the complication associated with it. And the other
thing is it's a nose, it's fragile, there's architecture in
their thin skin. You can't I've seen guys. I've seen
posts on Instagram where they take a nose and they
(28:53):
inject so much filler trying to do a nose job,
and it's it's it makes me cringe. The only thing
you should do with filler in your nose is when
you have a hump like mine and you have a
deep radix, that's the beginning part, and you can fill
(29:14):
it in. And by the way, this is close to
the vessels near your eye, and you fill that rdex.
As you fill the rateix, it creates the illusion that
your hump is going away, similar to what happens under
the lower eyelid. You fill it hollow. It makes something
look like it went away. Maybe you put a touch
in the tip, but none of this nonsense that you're
(29:36):
trying to lift the tip in whatever if your nose
is otherwise. And sometimes when patience noses is crooked after
a rhinoplasty, I'll put a tiny amount on one side
to straighten it. But again, this is nuanced faced stuff.
This isn't something you go, oh, I want a rhinoplasty.
I'm gonna go to my spat and go get a
liquid rhino. I just think it's ill advised. There's so
(29:58):
many other ways to take care of yourself than that,
So we'll leave that at that. Then we get to lips,
very famous, very popular. When overboard, everyone knows lips as
a duck lip. Now we have to walk everybody off
the ledge. Every time anyone comes in here, I have
to go through this whole shebang. I want my lips done,
but I don't want it to look like a duck.
(30:19):
And because everyone's petrified, they're going to look like these weirdos.
That's because they went overboard. Lip injections only look terrible
after you've injected like four syringes, So a small amount
one syringe, evenly distributed here and there, will look elegant.
(30:41):
I do it in older women it looks beautiful, but
it's a tiny.
Speaker 2 (30:45):
Amount over time too.
Speaker 1 (30:47):
Over time, what happens is people go in inject a syringe,
then two then like it's still there, and they come
back a month or two later and they keep expanding.
Where do you think your lip's going to go forward?
Speaker 3 (31:00):
And then that's when you get a lot of migration too.
That's why all these women were getting a lot of
migration exactly.
Speaker 1 (31:04):
So what is migration.
Speaker 3 (31:06):
Migration is when you're putting too much filler that the
filler has to go somewhere so it'll migrate into other
parts of the tissue very good.
Speaker 1 (31:12):
So migration. The concept is your face is not a balloon.
It's finite, and if you keep shoving CC after CC
of filler in a space, if it cannot accommodate it,
it will go somewhere else and it'll go to the
next closest area. So one common thing was people were
(31:34):
getting this very full upper lip, meaning from the nose
to the lip. The top of your lip, which should
have nothing, if anything, should be concave. A beautiful, youthful
upper lip is concave. Was filled and it looked like ridiculous.
So now if you're lucky and you did ha, we
could reverse it. If you were unlucky and you put silicone,
(31:57):
you're fucked because I can't fix the upper lip. I
can only fix the lip proper, so be very careful
with lips. Then we move to marionettes. So marionettes are
also an area that so let's talk about why it
happens and then how it is. A marionette is the
(32:19):
equivalent of a nasal labia fold, except it's for the jaw.
So that means as you get older, your jawline, your
skin starts to relax and you develop a jowl. There's
a very rigid area called a sulkis where your skin
(32:43):
is attached, and then there's a nasal abia full. Rather,
excuse me, a marionette. So again, your skin, your forty six,
your fifty two, your fifty eight, Your skin relaxes in
your upper face, it creates a hollow in your mid
and a big roll at your nasal labia fold. In
your lower face, it creates a jowl and a marionette.
(33:08):
So the treatment is a facelift the end. Now, Now,
not everybody wants a facelift. Now, some people it's early
and they haven't quite yet they're not. They're they're they're
gonna wait to do it in a young person. A
little bit of filler in the marionette. Again, you're camouflaging it,
(33:31):
you're not fixing it. Is okay. What was happening was
women kept getting more and more and then they were
getting what I called the KOI look like you know, koyfish.
They're like they have this like poudy side and the
like this. Everything was so heavy or a bulldog look.
The mouth became so wide and so heavy and so
(33:55):
squared off that it looked incredibly masculine. Now, unlike the
angle of the jaw, which is nice as strict and sharp,
the front of your mouth, as a woman, should be
relatively tapered. You don't want a wide, bulldoggy look. And
so a lot of older women who should have been
(34:16):
released from their injector. Mary, I'm so sorry. I can't
help you anymore. Mary. You need a facelift. You don't
want to face it, no problem, Mary, but I'm not
gonna inject you anymore. Listen to what I just said.
You don't want to face if, no problem, but I'm
not gonna do assisted suicide. People are like, well, she
(34:37):
wanted it or she wanted it. You can't just do
things because people are don't want to do what's correct,
and they just keep feeling them and they get too wide.
And this is actually one of the most common things
that celebrities were getting was puffiness under their eyes and
widening of their mouth. This was prior to twenty twenty four.
(35:00):
Prior twenty twenty four was the ozempic facelift era. That explosion,
the explosion of ozembic facelift occurred in twenty twenty four.
People finally add the light bulb. They went on ozempic.
Everyone was getting skinny, Celebrities were getting face lifts at
forty five looking amazing, and they realized, oh shit, filler
(35:22):
isn't the solution. Surgery was the solution. So now we've
had a real backlash on filler. People are now going, oh,
I don't want filler, I want to facelift. I don't
want filler, I want to facelift.
Speaker 3 (35:34):
But then we've also been getting ozembic face where people
have gotten a lot.
Speaker 1 (35:38):
Of volumes face. Yes, for sure, But what I'm saying
is that we this is the interesting part. We went
from Wow, this is crazy, I look at this tool.
I go and I can fill everything too, overfilling them
to now I'm sick of it. And then all these
celebrities are like coming out as if they're you know,
coming out and you know, coming out of the closet
that they're gay or something. They're like, Oh, I've had filler,
(35:59):
and I hate it. You're kidding me, you're joking me.
You had a filler. I mean it's obvious you had
a filler.
Speaker 2 (36:04):
Yeah.
Speaker 1 (36:05):
The next area of filling I'm not a fan of.
I think you'll uh maybe disagree with me on that
is I hate chin filler. I posted this, I got
a couple of filler people who jumped on and said, oh,
the response to everything whenever there's somebody who's trolling on
my side is you don't know how to do it.
It's like, really, I don't know how to do it.
(36:27):
The reason I don't like chin filler, and I know
you don't mind it and you do it occasionally, whatever
is you're replacing hard with soft, Whereas I love cheek
filler chin as you volumeize you're trying to get a
chisel sharp look and it doesn't expand, it migrates, it
goes downward, it gets rubbery, and when you put a
(36:48):
small chin in plant in, it's a home run, chiseled
and sharp, and so maybe you can get away with
a CC. Maybe. But I have seen so many posts
Charlatan doctors are like, look at this surgical non surgical
chinog and they're like four syringes and they look crazy.
Speaker 3 (37:12):
Yeah, I agree, I mean people have gone overboard. But
again it's all about you know, selecting the right patient
and looking at the anatomy, you know, really doing a
nice assessment and seeing if they're a candidate for it.
And with everything, I'm super super conservative, and I think
that it could be done correctly if the patient was
a candidate. I have a tiny drop of filler in
(37:33):
my chin. I do like maybe point two ccs every
I know. I haven't done it in like three years,
and I think it made a huge difference from making
my face more.
Speaker 1 (37:41):
That's different than a chinnog done with filler. So this
is what I'm referring to. Up to a CC, up
to a syringe. You can dabble in. It gives you
a little pop or an enhancement. Fine, I get it.
Like I put a little bit in I'm not gonna
go get a chinnog, doctor rabond I put it tight. Okay,
I'm talking people with recess chins that are going and
getting syringing syringes of filler put in. I just what
(38:06):
can I tell you? Because I have access to the
entire portfolio of tools, I can fill you and operate
on you. I'm always going to defer to the thing
that gives the best result. When you're an injector, your
tool is injecting. So you're selfish because you won't release
the patient and you keep referring, recommending to them the
thing that you do, whereas you should say, you know what,
(38:26):
this has reached the limits of what I think looks ideal,
so not so good. Then we shift gears to the
angle of the jaw or the jaw line itself, again
similar to the chin a little bit. It's the same concept.
What are we replacing a weak bone week jaw? So
a little bit along the jaw and a little bit
(38:47):
in the angle can help. But if you're getting in
syringes and syringes, I think you should really reconsider and
aside from wasting the money because it's going to go away.
And then you have to do it again. You look
much better if you had something surgically done.
Speaker 3 (39:03):
In my opinion, oftentimes it can just widen your face.
Re membor fuller does add volume, So putting volume in
that area can't make you right.
Speaker 1 (39:10):
Yeah, exactly. You go there hoping it will be chiseled
and just stick to your jaw, and then it just
puffs up and now you just kind of look fatter
or not more chiseled. Another interesting place, and here's some
actiric areas. Number One, you can put it in ear lobes.
A tiny amount in an ear lob goes super far.
(39:31):
Why would you put it in an ear lobe? Who
wants a big ear lobe? You don't want a big
ear lobe. It's as you get older, you get deflated
ear lobes, and it kind of looks a little ugly
and a little volume goes very far. Another area that's
interesting is hands. You can put it. Why would you
put it in a hand. Who wants a fat hand?
You're not getting a fat hand. You're putting it in
(39:52):
between the knuckles where there's depressions. As you get older,
as your knuckles and hands get loss of volume, it
makes you look oil older. And a bit frail. You
can put it in labia majory. Yeah, what, you can
put it on your outer labia. When you age and
you go through menopausal changes, your labia atrophy and become
(40:16):
flat and have no cushion left to them, and the
outer labia can be very effective as well. So those
are just some random areas we're going to switch quickly
to technique. So there are two ways to do filler,
and there is a right way to do filler in
each area. So the traditional way to do filler is
(40:40):
using a needle a needle. You open up the box
and in it comes comes two needles. Why two needles
because after a while one needle becomes dull and you
want to switch. So the duller your needle, the more
it hurts and the more bruising.
Speaker 2 (40:55):
Yeah.
Speaker 1 (40:56):
The other way to do it, and the advanced way
to do it, and the more wreck way to do
it in most areas is using a canula. What is
a canula?
Speaker 3 (41:06):
A canula is a it looks like a needle, but
it's blunt at the end.
Speaker 1 (41:11):
It's a long liposuction like canula, thin and tiny thin.
The hole is on the side, not at the tip,
and the tip is round and blunt, So we have
a sharp needle with a hole at the end of it,
and we have a long, blunt instrument that has a
hole on the side that's flexible. The reason what's wrong
(41:35):
with needles in general, and why the canula is the
main go to if you're in If your injector doesn't
use canulas, you should go somewhere else. This is now,
We're way past this. Now. A needle has the following downsides.
Hurts like hell, bleeds like hell. Why would it bleed
Because it's a knife. Every time you poke it, it
(41:58):
goes through the skin and into the vessel. Then it's short.
So if I want to air fill an area, I
have to take it out, push it in, take it out,
push it in, take it out, push it in. So
I'm creating a street out of cobblestones. It's more likely
to be lumpy and require a lot of manipulation. Afterwards,
(42:19):
I gotta massage it and sweep it and whatever. And
it has a risk of blindness because you have a needle,
and that needle can go into the artery, into the vein,
and the hole is at the end of it. So
when I push filler out. It's coming straight out of
the end, whereas the canula is blunt, it can't. It's
(42:43):
very difficult to almost impossible to puncture something, and the
filler comes out of the side, so you're not pushing it.
In the other aspect, the other risk is necrosis, which
is the same risk as blindness, which is you're injecting
into a vessel. The pain is significantly less with a canula.
(43:03):
So now let's shift over to a canula. A canula
you can do a lot of filling from one area.
So we make one poke right an entry point, and
then we enter this blunt canula under the skin where
everything is numb and you don't feel anything. The pain
was the single hole, and then we can go back
(43:26):
and forth in different planes and drop filler little by little.
I refer to it as the making a street out
of asphalt, making a street out of cobblestone, and like
cream cheese, you can just lay it in layer by layer.
So the areas I'll put it this way. Every area
should be done with a canula, with the following exceptions.
(43:50):
So number one, liquid rhino, for the most part, is
done with a needle, because you're putting tiny little droplets,
and you want to be there very precise, and you
want to poke through the skin, drop it and come out.
My experience with lips, and you can tell me otherwise.
I always did it with needles. Then I did it
with canulas for a while. And while I liked the
(44:13):
canula because the bruising was a tenth of it, I
didn't get the shapening I wanted. So I went back
to needles. Yeah, so I think it's it's a toss
up if you're you know, either way, I think the
needles is probably the right way to do it.
Speaker 3 (44:27):
Yeah, you could be a little bit more precise, give
a little bit more like shape.
Speaker 1 (44:31):
And that's it. That's it. What do you mean that's it? Temples, canula, temples,
upper brow canulus, lower eyelid canulus, mid face canulus, marionette canulus,
these chin and jaw. If you do it the canulas.
Speaker 3 (44:47):
There's tiny areas where if I do need some projection,
I'll use a needle, but very small amounts and it's
in conjunction with Yeah, the only.
Speaker 1 (44:56):
Areas that you can use it is if you're trying
to eface or flat. Now, a tiny little bit of
a marionette or a tiny little bit of a nasal
aba fold. Maybe you add a little bit and it's
just like a touch of it. But why I'm telling
you that is that if you're in a SPA currently
getting injected and your provider is essentially just using a
needle throughout. While that's okay, you're not at the gold standard,
(45:18):
and I think you're getting way more bruised, way more pain,
way more irregularities, way more lumpiness than you need to.
So my suggestion is you should shift over. So let's
talk about recovery because some people have never done fillers.
So what you can expect from the recovery of a filler, I.
Speaker 3 (45:34):
Mean, just like anything else that you do, you'll have
a risk of swellings, whisk of bruising. You know, it's
going to be different per client, depending on the area
that you treat, but it should be very very low
for the most part.
Speaker 1 (45:48):
Yeah, unlike botox, which should have almost zero issue. You
come in, you do it, you go about your lunch.
You've been done. Eh, maybe one out of I don't know,
one hundred bruises. Filler has a little bit more recovery
to it. In other words, I wouldn't do it and
then like have a big event the next day. I
think you will regret it. It depends on if you
take blood thinners. We ask you to take no blood thinners.
(46:10):
With botox, you can get away with it. It's not ideal,
but it's no problem. Filler, if you're on aspirin, if
you're taking a bunch of motor and ADVI libry profen,
you're light fish oils, you're likely to bruise more. Secondly,
you're more You're definitely gonna bruise from needles, lips, every
you're likely to do it. Even if you're an amazing injector,
(46:30):
you'll get a bruise here and there. With canula as
a bruising is a tenth, a fraction, maybe almost nothing.
You have different areas, so midface cheeks should have almost
no bruising, Lips you'll get some bruising, noses a little
bruising under the eyes using a canula should have no bruising.
(46:51):
Temples should really have no bruising. So you'll be a
little swollen. And with filler you need to be patient.
You will often pass point a little bit, so our
goal is for you to be let's say, at a five,
we inject you. You're at a three, we hit five,
and you'll go to like six, six and a half,
and then you'll come back. Especially with lips. If you've
(47:12):
never done lips, we always tell you, do not call
us for seventy two hours. I don't want to hear
from you. You will swell up. Do not panic, especially
if you've never done it before. And then later they're like,
oh yeah, oh okay, yeah.
Speaker 3 (47:27):
They always saw every lip coolar patient. I'm like, you
will bruise, you will swell, like, just don't expect it
from not happening.
Speaker 2 (47:34):
If it doesn't happen, great, but just expect it.
Speaker 1 (47:36):
My number one recommendation is ice ice is better than
oh I did Arnica grade fine, whatever, Bromolin grade fine, whatever.
Ice ice ice, ice ice. When do I start icing immediately?
Like literally immediately. The bruising is occurring immediately as you
leave the office. You're bruising inside deep underneath. So use
ice as quickly and often as possible. So and then
(47:59):
the last part that I want to talk about is complications,
because I think this is where you're talking about elevated
levels of skill set. You know, so many of the
things we see today, especially in the non surgical space,
is occurring to the influx of providers. I have posted
a thousand times where I am personally very much opposed
(48:20):
to metspas that are not run by physicians. What do
I mean by that? Aren't they all run by physicians.
I'm not talking about a METSPA where there's a medical
director that periodically shows up, signs a few charts and
they're an obgyn and it's run by nurses on their own,
injecting freely whatever they want. When you have a met
SPA under the umbrella of a clinician like myself, not
(48:43):
a pediatrician, I'm talking about a plastic surgeon or a dermatologist,
I think that that's a different met SPA than anywhere else.
And I think that today they're just I'm going to
go out on a limb. There's no reason for you
to go anywhere that isn't well supervised, you know, because
the reality is that I'm intimately connected to you, so
(49:05):
if something goes wrong, I'm here. Secondly, I vetted you
and I'm physically here with you. And third if I
hired you, I expect you to have a better skill
set than someone who just graduated, let's say three years ago.
So the complication that can go wrong, we'll start with
the simplest one, The easiest and simplest one is, let's
not say necessarily a complication, but you can get a
(49:25):
hematoma or a big bruise. Yeah, you can get lumpiness,
you can get asymmetry like, oh, my right side cheeks
more than my left side. You can get We talked
about the two dreaded ones. We'll get to this. Is
there any other ones that you think.
Speaker 2 (49:45):
Of that's really it? They're very mild when it comes
down to it.
Speaker 1 (49:49):
For the other two, and we talked about them, and
I'll just hit them one more time. Is blindness catastrophic necrosis,
Tissue dies catastrophic, and those are her with needles. I
don't think there's ever been a reported case of blindness.
Speaker 2 (50:04):
A few with a.
Speaker 1 (50:05):
Can, but let's say the rate of it is very,
very insignificant. And I think the key and if your
way to avoid it is provider driven, provider driven, provider driven,
And if God forbid that ever happens and you notice
and you went and got injected, and you go home,
You're like, wait, this doesn't look right call immediately go
(50:26):
back and use the drug vitrace. You're highly on a
dace like you should ask when you go to get filler.
This is this is what I would recommend you walk in,
you're about to get filler, say, do you guys have
holier on a day also known as vitch trace here
on in house in your refrigerator right now?
Speaker 3 (50:44):
And as a provider, you should make sure, I mean
just for you in your safety, that you should always
have them, right. No, but I will never inject a
patient if I don't have any.
Speaker 1 (50:53):
Oh, well, we'll get it if needed, we'll call the pharmacy. No, no, no,
no no.
Speaker 3 (50:58):
I canceled days when I've gone, when I've worked and
had no highlaluronodyck.
Speaker 1 (51:03):
So literally it is your literally, and it's like having
a forest fire and having no water in the hydrant,
like you need it to put out the fire. So
you want to make sure don't rely on them. You
should ask, just like you should look at the filler
when they open it. You should ask, hey, great, oh
my god, that's great, Susie, Hey, do you guys have
a trace here in the refrigerator? Can you go check
(51:25):
for me? Because those yeah, yeah, yeah, we have it,
and God forbid, you needed that moment. It's not like
you just go get it from CVS. You got to
go get it from a pharmacy, so very very important. Anyways,
I think that was a I think that's a wrap.
I think we covered an a to z of injectables
and fillers together. I hope you guys enjoyed that. The goal,
(51:47):
as always, is to educate you so that wherever you are,
we love it. If you came to our spa. But
some of you are listening from I don't know, the
UK or Australia or where have you, or you're in
another state. Obviously you're not gonna fly out here just
to go and get some fuller from us, So just
be careful when you do things. And now I hope
you're just that much more educated. As always. That's I
have two requests. One, you love our show, Go write
(52:10):
a review, Go write something nice, say oh my god,
we love your show. You're the best. Makes everybody who
works on the show happy. And secondly, share our podcast
with the people you love. The last thing you want
to hear, God forbid, is someone you care about has
a complication and you're like God I wish they had
listened to that episode. You just never know who's going
to go where. So send it, download it, subscribe and share,
(52:32):
all right, Charlie, that's a wrap, guys. Tune in next
week we have yet another episode. We're going to be
talking about lasers. I think that one's going to be
even more interesting than this one. So that's a rap.
I'm your host, Doctor Rudderbaan. See you next week on
Plastic Surgery Uncensored
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