April 9, 2025 • 53 mins
You’ve seen the faces — puffy, overfilled, unnatural. Social media calls it “pillow face,” and celebrities are now racing to reverse it. But what went wrong? And more importantly, how do you avoid becoming the next cautionary tale?
In this no-holds-barred episode of Plastic Surgery Uncensored, Dr. Rady Rahban teams up with his aesthetic nurse Charlene to pull back the curtain on fillers — what they are, how they should be used, and why the “less is more” philosophy might just save your face. From lips to jawlines to the controversial under-eye area, this is the deep dive you didn’t know you needed. Expect unfiltered opinions, hard truths, and expert insight into the products flooding the market — including why Dr. Rahban only trusts a select few, and which ones he thinks are downright dangerous. Whether you're filler-curious or already a frequent flyer at your local med spa, this episode will change the way you look at injectables — and maybe even your injector.
Think all fillers are created equal? Think again. Tune in and learn how to protect your face, your wallet, and your future.
In this no-holds-barred episode of Plastic Surgery Uncensored, Dr. Rady Rahban teams up with his aesthetic nurse Charlene to pull back the curtain on fillers — what they are, how they should be used, and why the “less is more” philosophy might just save your face. From lips to jawlines to the controversial under-eye area, this is the deep dive you didn’t know you needed. Expect unfiltered opinions, hard truths, and expert insight into the products flooding the market — including why Dr. Rahban only trusts a select few, and which ones he thinks are downright dangerous. Whether you're filler-curious or already a frequent flyer at your local med spa, this episode will change the way you look at injectables — and maybe even your injector.
Think all fillers are created equal? Think again. Tune in and learn how to protect your face, your wallet, and your future.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
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. Charlene and I.
Charlene are wonderful aesthetic nurse for our SPA restored by Raban, MD.
Charlene and I are tackling, one by one an expansion
(00:27):
of the menu of services that we provide. Even though
a lot of these things are things that people are
accustomed to. They read, they hear, their friends are doing it,
they're doing it. I kind of find that people don't
really have that much knowledge, or at least very good knowledge.
And so what we decided to do is highlight in
an episode. One in each episode a singular treatment that
(00:48):
we provide, hoping that we can really expand on it
for you, so when you're out there and you're in
you're a METSPA wherever you are, you get the knowledge.
So this episode is about volumeizers or fillers, and I
think this is a really important episode because I can't
tell you how poorly and mistakenly and wrong fillers are
(01:11):
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. And then people started
using it, using it, using it, and then over using it,
(01:33):
over using it, overusing 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 before was like, oh my god, that's so great,
(01:54):
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, fill my chicks, fill my job, fill my
chin now because of Oh I can get a facelift.
Oh I'm gonna look now, A filler's horrible. Fillers horrible.
(02:16):
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 volume or fullness. So let's
(02:42):
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, as a person who does this
and is in this space, I'm always blown away. They're like, oh,
(03:04):
have you heard a 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,
and obviously we'll tell you what we like because that's
what we've chosen to you. So by far, the most effective,
by far, in my opinion, the best product for facial
(03:25):
revolumeization is hal uronic acid based products. We 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 percent biocompatible, means
(03:47):
it's made up highly uronic acid. It's made up of
what you're made up of. In the past. This is
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
(04:08):
was you know, a decent number of people that their
body reacted to. We don't do any testing with HA.
Speaker 2 (04:14):
Why because it's biocompatible.
Speaker 1 (04:16):
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
(04:37):
can run into my exam room, go into the refrigerator,
pull up an enzyme called hyluronidase vitrace, 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
(04:57):
as a result, I don't ever recommen and 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
(05:17):
a thousand products. So I would say, by 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 Juveriterm,
which was the original drug, I mean, the original filler Juventerm,
(05:41):
and one world of the Restallan family. And they're both
they're like Ferrari and Lamborghini. 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,
(06:03):
that was it. You got Juveiter, Juveiter plus, you had
restall In, and you had Perlane, which they don't call
it Perlain anymore. And 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
(06:29):
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
(06:51):
stayed away from 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,
(07:12):
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
(07:33):
with a CC one CC, it may in total be
one point six or one point seven. The Juveterim family
of products tends to be more hydrophilic, 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
(07:55):
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 Jubidim product because that provider
will have adjusted for presumably that product. Ye, people really
like it, for example in their lips because they wanted
it that more luscious. Howdy look myself and Charlene like
(08:17):
the accuracy of the wrestling based family. Now again under
that family, I won't get into the belabor it there's Ultra,
there's jubiterm Jujuivern plus jewwderm Ultra plus Voluma Verrabella. Then
there is restall in Wrestlin plus Contour defined. I mean,
(08:39):
I find all of this nonsense funny enough. We use
like two products because at the end of the day,
we are skilled injectors, and I, in Charlene, can get
whatever effect you want everywhere I want with just these
two products. And what I'd rather do is get so
(09:00):
accurate using these products. Then to have, you know, most
med spas, and this is 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 (09:19):
And sometimes I felt was a little overwhelming.
Speaker 1 (09:21):
You know.
Speaker 2 (09:21):
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 (09:32):
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 should be able to
say I think she needs blobbery blah blah blah. A
lot of places because these companies are advertising, the patient
(09:52):
comes in and says, do you guys have valuma? 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
(10:13):
and a moderately thick and in that way, we know
we can put the thin in all the eras that
it belongs, and a moderately thick and all the areas
that it belongs. So that's really important for you to understand.
There are other ones like RHA has 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 next question is, oh,
(10:38):
there's two other groups of products that I'm One is
the world of sculpture. We're gonna just touch on that
briefly because we won't revisit it. Is sculpture is a biostimulator.
This it's a new category, its own drug. It was
really a drug that was predominantly its focus was in
HIV patients. People who got HIV became gone. They lost
(11:00):
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
and their face lost fat. So you would take a
lot of filler and to get it in there. And
(11:23):
so this whole category of biostimulus 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 or tissue so to speak. Wow,
that sounds great. Why don't you use that regularly? Because
(11:46):
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, can't help you. What do you
mean you can't help me? Well, when is this going
to go away? Four years? How long does it take
(12:10):
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 imagine what I just
describe to you. I'm injecting you with something that's you
(12:31):
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 like this product and you find
a provider who likes this, you're a match made in heaven.
In my practice, this makes no sense because it doesn't
(12:54):
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 be aware of
that group. And then the last group is a disaster,
which is permanent fillers.
Speaker 2 (13:15):
Radius.
Speaker 1 (13:16):
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
(13:36):
it's you inject it. Oh my god, doctor R Bond,
this is too much. I don't it's too much in
my cheeks or wherever. I'm sorry. It's going to 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.
Speaker 2 (13:59):
Like a little bit, but not as much as strangers.
Speaker 1 (14:02):
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 silicone for years.
(14:23):
And 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
(14:46):
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 the difference
with permanent filler is that it because it's permanent material,
the body keeps reacting and it doesn't just stay there.
(15:09):
You're like, well, 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, I had this injected. I
(15:31):
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 in your tissue. So I have
(15:53):
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 terear. 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
(16:13):
asked to see the filler, 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,
(16:35):
that was a Chuck E Cheese scandal. And they would
they would go and 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
(16:56):
give it to someone else. They'll just change us, change
the needle, off you go. So you need to be
a savvy consumer. Go to a reputable place like restore
by Ramon 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
(17:16):
are so many and the ones that we recommend, the
ones that we 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
(17:44):
we'll elaborate on it. But there are two catastrophic catastrophic
complications associated with filler. One blindness that is correct blindness,
permanent blindness. Two necrosis tissue diyes turns black gone finished.
(18:07):
The blindness one is associated with 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
(18:28):
has large vessels. And if 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.
(18:51):
The next one is temples. Temples. We like temples, temples
a good one. Why would we inject temples?
Speaker 2 (19:00):
It's one in the air. Is that hollows out very quickly?
Speaker 1 (19:02):
Correct? Because you get peanut head. Peanut head is a
if you guys ever looked through that peanut or that guy,
the peanut guy, the main peanut character, the mascot. What
happens is that you're you have bone hollowness, cheekbones, and
you get a concavity in your temples. My sister actually
(19:23):
had horrifically deep temples. And it is interesting. It really
ages you. Yeah, absolutely superbly ages you.
Speaker 2 (19:30):
Except something that people don't even realize either until you
point it out.
Speaker 1 (19:33):
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 2 (19:54):
Yeah, yeah, done correctly.
Speaker 1 (19:56):
Right. There is under eyes. 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
(20:20):
a 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 restul it,
(20:46):
I 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, that person doesn't look right. You get a
(21:07):
cat look. Yeah, the reason you get a cat look
is your cheeks start to blend into your lower eyelid.
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 eyelid and cheek.
It just cheek is the eelid. So that area needs
(21:32):
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
(21:52):
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, yeh,
camouflage is the bag. You do. Not inject your lower
eyelids for dark circles. People. I hear hundreds of people
(22:17):
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 the hollow.
The hollow looks dark, so when you filled it, it
(22:40):
looked less dark. But yours is literally pigment. So do
not inject for pigment. It's not a good place.
Speaker 2 (22:48):
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 I'm doing less and less under I filler.
Speaker 1 (22:59):
Now, Yeah, 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 is
(23:22):
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 call the
(23:45):
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 when we volumeize them,
(24:09):
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, are very hollow underneath
(24:31):
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 fill a woman
where you want a little volume. So I think the
number one area where filler is amazing. And by the way,
(24:52):
facelifts do not fix entirely is mid face volume depleae.
So the reason why I say facelifts don't think 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 lifted up the muscles
(25:13):
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 and a cheek should be soft.
(25:37):
So I like to replace like with Like something is soft,
we want to replace it with soft. Something is hard,
we want to replace it with hard. So I'm a
huge fan of cheeks. Now we're going to move to
the next controversial area, nasal labial fools. So I have
not injected a nasal labial fold myself, probably in ten
(26:01):
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 zo that was the number one indicator when
we got indication for the filler, it was for nasalabil folds.
(26:25):
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.
It's bad hollow, bad fill get rid of. And what
(26:45):
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 nasalabia fold looks weird.
It's weird, it's flat. It doesn't create a natural dynamic movement.
(27:09):
So I personally, I know Charlene does a little of it,
a little bit.
Speaker 2 (27:12):
It's going to be one of the last areas well.
I'll just do a tiny touch if everything else looks okay. Yeah,
I know they have good midface volume. They just have
the tiniest, you know, little indentation that we just want
to pop out.
Speaker 1 (27:24):
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 labia folds look
so deep, I need you to fill them. And when
you examine them, it's their midface right above it, right
(27:48):
above it that's hollow. So when your midface is hollow,
the naso labia 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 revolumeize the mid
(28:09):
face and it fills back to normal. The nasal alabial
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 my
(28:32):
nasal labil fold looks so normal. Yeah. So if you
were to get into a beasting and your mid face
would expand into a balloon, yes, yes, it lifted your face. Yes,
you're right. Now, naso labial fold is obliterated. But that's
a shit ton of volume. Okay, So I would just
(28:54):
be careful when it comes to your naser labia fold again,
make sure your mid face is filled, otherwise I kin
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, they're
(29:15):
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 inject
(29:38):
so much filler trying to do a nose job, and
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 it in.
(30:00):
And by the way, this is close to the vessels
near your eye, and you fill that radix. As you fill,
the rateis 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 trying to lift
(30:21):
the tip and whatever. If your nose is otherwise, And
sometimes when patients noses it's crooked after a rhinoplasty, I'll
put a tiny amount on one side to straden it.
But again, this is nuanced space 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 many other ways
(30:43):
to take care of yourself other 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 And because
(31:04):
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,
even they distributed here and there, will look elegant. I
(31:26):
do it in older women. It looks beautiful, but it's
a tiny amount amount over time too. 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 2 (31:44):
And then that's when you get a lot of migration too.
That's why all these women were getting.
Speaker 1 (31:47):
A lot of migration exactly. So what is migration.
Speaker 2 (31:50):
Migration is when you're putting too much filler that the
filler has to go somewhere so it'll migrate into other parts.
Speaker 1 (31:55):
Of the tissue very good. 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
(32:17):
common thing was people were 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
(32:39):
unlucky and you put silicone, 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
(33:00):
about why it happens and then how it is. A
marionette is the 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
(33:27):
where your skin is attached, and then there's a nasal
abia fold rather, excuse me, a marionette. So again, your
skin you're forty six, your fifty two, your fifty eight,
your skin relaxes in your upper face. It creates a
hollow in your mid face and a big roll at
your nasalabia fold. In your lower face. It creates a
(33:49):
jowl and a marionette. 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,
(34:14):
you're camouflaging it, 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
(34:38):
so heavy and so 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 old women who should have
(35:01):
been 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 no problem, Mary, but I'm not
going to inject you anymore. Listen to what I just said.
You don't want to face if no problem, but I'm
not going to do assisted suicide. People are like, well,
she wanted it, or she wanted it. You can't just
(35:26):
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 mouths. This was prior to twenty twenty four.
Why prior twenty twenty four was the ozempic facelift era.
(35:49):
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 celebrit We're getting facelifts
at forty five looking amazing, and they realize, oh shit,
filler isn't the solution. Surgery was the solution. So now
(36:11):
we've had a real backlash on filler. People are now going, oh,
I don't want filler, I want to face. If I
don't want filler, I want to facelift.
Speaker 2 (36:18):
But then we've also been getting a zembic face.
Speaker 1 (36:21):
People have gotten a lot of volume 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 too. 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,
(36:43):
I've had filler and I hate it. You're kidding me,
you're joking me. You had a filler. I mean it's
obvious you had filler.
Speaker 2 (36:48):
Yeah.
Speaker 1 (36:50):
The next area of filling I'm not a fan of.
I think you'll 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.
(37:11):
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 volumize, you're trying to get a chiseled,
sharp look, and it doesn't expand, it migrates, it goes downward,
it gets rubbery, and when you put a small chin
(37:33):
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 by Charlatan doctors
are like, look at this surgical non surgical chin og
and they're like fores yringes and they look crazy.
Speaker 2 (37:57):
Yeah, I agree. I mean people have gone overboard, and
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 my chin.
(38:18):
I do like maybe point two ccs. Every 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 (38:26):
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 recessed chins that are going and
getting syring syringe is a filler put in. I just
(38:50):
what 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 and recommending to
them the thing that you do, whereas you should say,
you know what, this has reached the limits of what
(39:12):
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 in the angle can help. But
(39:33):
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 2 (39:47):
In my opinion, oftentimes it can just widen your face.
Membor Fuller does add volume, So putting volume in that
area you can't make you right.
Speaker 1 (39:55):
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,
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. Why
(40:16):
would you put it in an ear lobe? Who wants
a big ear lobe? You don't want a big ear lobe.
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 between the knuckles,
(40:37):
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 majora. Yeah, what you can put it on
your outer labia. When you age and you go through
menopausal changes, your labia atrophy and become flat and have
(41:02):
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
(41:23):
the traditional way to do filler is 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. Yeah, the other way to do it,
and the advanced way to do it, and the more
(41:44):
correct way to do it in most areas is using
a canula. What is a canula?
Speaker 2 (41:51):
A canula is a it looks like a needle, but
it's blood at the end.
Speaker 1 (41:56):
It's a long liposuction like canula, thin in tiny. 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
(42:19):
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.
Speaker 2 (42:32):
Now.
Speaker 1 (42:33):
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 goes through the skin
and into the vessel. Then it's short. So if I
want to 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
(42:56):
out of cobblestones. It's more like to be lumpy and
require a lot of manipulation. Afterwards, I got to 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
(43:18):
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 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
(43:39):
the same risk as blindness. Which is you're injecting into
a vessel. The pain is significantly less with a canula.
So now let's shift over to canula. A canula you
can do a lot of filling from one area. So
we make one poke right an entry point, and then
(44:00):
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 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
(44:22):
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.
So number one, liquid rhino, for the most part, is
done with a needle, because you're putting tiny little droplets
(44:43):
and you want to be 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
canula because the bruising was a tenth of it. I
didn't get the shapening I wanted, so I went back
(45:05):
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 2 (45:12):
Yeah, you could be a little bit more precise, give
a little bit more like shape.
Speaker 1 (45:16):
And that's it. That's it. What do you mean that's it? Temples, canula, temples,
upper brow, canulus, lower iselid canulus, mid face canulus, marionette canulus,
chin and jaw.
Speaker 2 (45:30):
If you do it the canulus, 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.
Speaker 1 (45:40):
With Yeah, the only areas that you can use it
is if you're trying to eface or flatten out a
tiny little bit of a marionette or tiny little bit
of a nasal avio 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
(46:02):
at the gold standard, 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 filler. So what you can expect
from the recovery of a filler.
Speaker 2 (46:18):
I mean, just like anything else that you do, you'll
have a risk of swellings, risk 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 (46:32):
Yeah, unlike boatox, 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 one hundred bruises. Uh.
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.
(46:52):
We ask you to take no blood thinners. With box,
you can get away with it. It's not ideal, but
it's no problem filler. You're on aspirin, if you're taking
a bunch of motor and advilbry profen. You're light fish oils,
you're likely to bruise more. Secondly, you're more you're definitely
going to bruise from needles, lips, every you're likely to
(47:13):
do it. Even if you're an amazing injector, 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. Temples
(47:36):
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 never
(47:57):
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.
Speaker 2 (48:11):
Oh okay, yeah, I always saw every lippolar patient. I'm like,
you will bruise, you will swell, Like, just don't expect
it from not having If it doesn't happen, great, but
just expect it.
Speaker 1 (48:21):
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
(48:44):
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 provide. I have posted
a thousand times where I am personally very much opposed
(49:05):
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 might like myself,
(49:28):
not a pediatrician. I'm talking about a plastic surgeon or
a dermatologist. I think that that's a different METSPA 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.
(49:49):
So 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 grabbedraduated 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 it's not, let's not say necessarily a complication. But
(50:09):
you can get a hematoma or a big bruise. 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 of.
Speaker 2 (50:30):
That's really it? They're very mild when it comes down
to it for.
Speaker 1 (50:35):
The other two, and we talked about them, and I'll
just hit him one more time. Is blindness catastrophic necrosis?
Tissue dies catastrophic, and those occur with needles. I don't
think there's ever been a reported case of blindness a
few with but let's say the rate of it is very,
(50:56):
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
back and use the drug vitrace your highluranidase. Like you
should ask when you go to get filler. This is
(51:18):
what I would recommend you walk in you're about to
get filler, say do you guys have lurana days also
known as VICH trace here on in house in your
refrigerator right now?
Speaker 2 (51:29):
And as a provider, you should make sure, I mean,
just for you and your safety, that you should always
have them at night, right, No, but I will never
inject a patient if I don't have any.
Speaker 1 (51:38):
Oh well, we'll get it if needed, we'll call the pharmacy.
No no, no, no no.
Speaker 2 (51:42):
I canceled days when I've gone to when I've worked
and had no highlurono days.
Speaker 1 (51:47):
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
(52:10):
for me? Because yeah, yeah, yeah, we have it, And
God forbid you needed that moment. It's not like you
just go get it from CBS. 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
(52:32):
goal 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 filler 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
(52:52):
I have two requests. One, you love our show, Go
write a review, Go write something nice, say oh my god,
we love your show. You're the best mix 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.
(53:16):
All right, Charlie, that's a wrap, guys. Tune in next
week we have yet another episode. We're gonna 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 rudderbaunee 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. Charlene and I.
Charlene are wonderful aesthetic nurse for our SPA restored by Raban, MD.
Charlene and I are tackling, one by one an expansion
(00:27):
of the menu of services that we provide. Even though
a lot of these things are things that people are
accustomed to. They read, they hear, their friends are doing it,
they're doing it. I kind of find that people don't
really have that much knowledge, or at least very good knowledge.
And so what we decided to do is highlight in
an episode. One in each episode a singular treatment that
(00:48):
we provide, hoping that we can really expand on it
for you, so when you're out there and you're in
you're a METSPA wherever you are, you get the knowledge.
So this episode is about volumeizers or fillers, and I
think this is a really important episode because I can't
tell you how poorly and mistakenly and wrong fillers are
(01:11):
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. And then people started
using it, using it, using it, and then over using it,
(01:33):
over using it, overusing 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 before was like, oh my god, that's so great,
(01:54):
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, fill my chicks, fill my job, fill my
chin now because of Oh I can get a facelift.
Oh I'm gonna look now, A filler's horrible. Fillers horrible.
(02:16):
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 volume or fullness. So let's
(02:42):
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, as a person who does this
and is in this space, I'm always blown away. They're like, oh,
(03:04):
have you heard a 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,
and obviously we'll tell you what we like because that's
what we've chosen to you. So by far, the most effective,
by far, in my opinion, the best product for facial
(03:25):
revolumeization is hal uronic acid based products. We 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 percent biocompatible, means
(03:47):
it's made up highly uronic acid. It's made up of
what you're made up of. In the past. This is
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
(04:08):
was you know, a decent number of people that their
body reacted to. We don't do any testing with HA.
Speaker 2 (04:14):
Why because it's biocompatible.
Speaker 1 (04:16):
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
(04:37):
can run into my exam room, go into the refrigerator,
pull up an enzyme called hyluronidase vitrace, 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
(04:57):
as a result, I don't ever recommen and 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
(05:17):
a thousand products. So I would say, by 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 Juveriterm,
which was the original drug, I mean, the original filler Juventerm,
(05:41):
and one world of the Restallan family. And they're both
they're like Ferrari and Lamborghini. 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,
(06:03):
that was it. You got Juveiter, Juveiter plus, you had
restall In, and you had Perlane, which they don't call
it Perlain anymore. And 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
(06:29):
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
(06:51):
stayed away from 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,
(07:12):
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
(07:33):
with a CC one CC, it may in total be
one point six or one point seven. The Juveterim family
of products tends to be more hydrophilic, 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
(07:55):
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 Jubidim product because that provider
will have adjusted for presumably that product. Ye, people really
like it, for example in their lips because they wanted
it that more luscious. Howdy look myself and Charlene like
(08:17):
the accuracy of the wrestling based family. Now again under
that family, I won't get into the belabor it there's Ultra,
there's jubiterm Jujuivern plus jewwderm Ultra plus Voluma Verrabella. Then
there is restall in Wrestlin plus Contour defined. I mean,
(08:39):
I find all of this nonsense funny enough. We use
like two products because at the end of the day,
we are skilled injectors, and I, in Charlene, can get
whatever effect you want everywhere I want with just these
two products. And what I'd rather do is get so
(09:00):
accurate using these products. Then to have, you know, most
med spas, and this is 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 (09:19):
And sometimes I felt was a little overwhelming.
Speaker 1 (09:21):
You know.
Speaker 2 (09:21):
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 (09:32):
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 should be able to
say I think she needs blobbery blah blah blah. A
lot of places because these companies are advertising, the patient
(09:52):
comes in and says, do you guys have valuma? 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
(10:13):
and a moderately thick and in that way, we know
we can put the thin in all the eras that
it belongs, and a moderately thick and all the areas
that it belongs. So that's really important for you to understand.
There are other ones like RHA has 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 next question is, oh,
(10:38):
there's two other groups of products that I'm One is
the world of sculpture. We're gonna just touch on that
briefly because we won't revisit it. Is sculpture is a biostimulator.
This it's a new category, its own drug. It was
really a drug that was predominantly its focus was in
HIV patients. People who got HIV became gone. They lost
(11:00):
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
and their face lost fat. So you would take a
lot of filler and to get it in there. And
(11:23):
so this whole category of biostimulus 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 or tissue so to speak. Wow,
that sounds great. Why don't you use that regularly? Because
(11:46):
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, can't help you. What do you
mean you can't help me? Well, when is this going
to go away? Four years? How long does it take
(12:10):
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 imagine what I just
describe to you. I'm injecting you with something that's you
(12:31):
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 like this product and you find
a provider who likes this, you're a match made in heaven.
In my practice, this makes no sense because it doesn't
(12:54):
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 be aware of
that group. And then the last group is a disaster,
which is permanent fillers.
Speaker 2 (13:15):
Radius.
Speaker 1 (13:16):
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
(13:36):
it's you inject it. Oh my god, doctor R Bond,
this is too much. I don't it's too much in
my cheeks or wherever. I'm sorry. It's going to 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.
Speaker 2 (13:59):
Like a little bit, but not as much as strangers.
Speaker 1 (14:02):
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 silicone for years.
(14:23):
And 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
(14:46):
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 the difference
with permanent filler is that it because it's permanent material,
the body keeps reacting and it doesn't just stay there.
(15:09):
You're like, well, 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, I had this injected. I
(15:31):
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 in your tissue. So I have
(15:53):
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 terear. 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
(16:13):
asked to see the filler, 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,
(16:35):
that was a Chuck E Cheese scandal. And they would
they would go and 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
(16:56):
give it to someone else. They'll just change us, change
the needle, off you go. So you need to be
a savvy consumer. Go to a reputable place like restore
by Ramon 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
(17:16):
are so many and the ones that we recommend, the
ones that we 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
(17:44):
we'll elaborate on it. But there are two catastrophic catastrophic
complications associated with filler. One blindness that is correct blindness,
permanent blindness. Two necrosis tissue diyes turns black gone finished.
(18:07):
The blindness one is associated with 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
(18:28):
has large vessels. And if 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.
(18:51):
The next one is temples. Temples. We like temples, temples
a good one. Why would we inject temples?
Speaker 2 (19:00):
It's one in the air. Is that hollows out very quickly?
Speaker 1 (19:02):
Correct? Because you get peanut head. Peanut head is a
if you guys ever looked through that peanut or that guy,
the peanut guy, the main peanut character, the mascot. What
happens is that you're you have bone hollowness, cheekbones, and
you get a concavity in your temples. My sister actually
(19:23):
had horrifically deep temples. And it is interesting. It really
ages you. Yeah, absolutely superbly ages you.
Speaker 2 (19:30):
Except something that people don't even realize either until you
point it out.
Speaker 1 (19:33):
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 2 (19:54):
Yeah, yeah, done correctly.
Speaker 1 (19:56):
Right. There is under eyes. 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
(20:20):
a 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 restul it,
(20:46):
I 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, that person doesn't look right. You get a
(21:07):
cat look. Yeah, the reason you get a cat look
is your cheeks start to blend into your lower eyelid.
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 eyelid and cheek.
It just cheek is the eelid. So that area needs
(21:32):
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
(21:52):
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, yeh,
camouflage is the bag. You do. Not inject your lower
eyelids for dark circles. People. I hear hundreds of people
(22:17):
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 the hollow.
The hollow looks dark, so when you filled it, it
(22:40):
looked less dark. But yours is literally pigment. So do
not inject for pigment. It's not a good place.
Speaker 2 (22:48):
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 I'm doing less and less under I filler.
Speaker 1 (22:59):
Now, Yeah, 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 is
(23:22):
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 call the
(23:45):
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 when we volumeize them,
(24:09):
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, are very hollow underneath
(24:31):
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 fill a woman
where you want a little volume. So I think the
number one area where filler is amazing. And by the way,
(24:52):
facelifts do not fix entirely is mid face volume depleae.
So the reason why I say facelifts don't think 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 lifted up the muscles
(25:13):
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 and a cheek should be soft.
(25:37):
So I like to replace like with Like something is soft,
we want to replace it with soft. Something is hard,
we want to replace it with hard. So I'm a
huge fan of cheeks. Now we're going to move to
the next controversial area, nasal labial fools. So I have
not injected a nasal labial fold myself, probably in ten
(26:01):
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 zo that was the number one indicator when
we got indication for the filler, it was for nasalabil folds.
(26:25):
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.
It's bad hollow, bad fill get rid of. And what
(26:45):
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 nasalabia fold looks weird.
It's weird, it's flat. It doesn't create a natural dynamic movement.
(27:09):
So I personally, I know Charlene does a little of it,
a little bit.
Speaker 2 (27:12):
It's going to be one of the last areas well.
I'll just do a tiny touch if everything else looks okay. Yeah,
I know they have good midface volume. They just have
the tiniest, you know, little indentation that we just want
to pop out.
Speaker 1 (27:24):
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 labia folds look
so deep, I need you to fill them. And when
you examine them, it's their midface right above it, right
(27:48):
above it that's hollow. So when your midface is hollow,
the naso labia 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 revolumeize the mid
(28:09):
face and it fills back to normal. The nasal alabial
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 my
(28:32):
nasal labil fold looks so normal. Yeah. So if you
were to get into a beasting and your mid face
would expand into a balloon, yes, yes, it lifted your face. Yes,
you're right. Now, naso labial fold is obliterated. But that's
a shit ton of volume. Okay, So I would just
(28:54):
be careful when it comes to your naser labia fold again,
make sure your mid face is filled, otherwise I kin
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, they're
(29:15):
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 inject
(29:38):
so much filler trying to do a nose job, and
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 it in.
(30:00):
And by the way, this is close to the vessels
near your eye, and you fill that radix. As you fill,
the rateis 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 trying to lift
(30:21):
the tip and whatever. If your nose is otherwise, And
sometimes when patients noses it's crooked after a rhinoplasty, I'll
put a tiny amount on one side to straden it.
But again, this is nuanced space 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 many other ways
(30:43):
to take care of yourself other 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 And because
(31:04):
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,
even they distributed here and there, will look elegant. I
(31:26):
do it in older women. It looks beautiful, but it's
a tiny amount amount over time too. 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 2 (31:44):
And then that's when you get a lot of migration too.
That's why all these women were getting.
Speaker 1 (31:47):
A lot of migration exactly. So what is migration.
Speaker 2 (31:50):
Migration is when you're putting too much filler that the
filler has to go somewhere so it'll migrate into other parts.
Speaker 1 (31:55):
Of the tissue very good. 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
(32:17):
common thing was people were 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
(32:39):
unlucky and you put silicone, 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
(33:00):
about why it happens and then how it is. A
marionette is the 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
(33:27):
where your skin is attached, and then there's a nasal
abia fold rather, excuse me, a marionette. So again, your
skin you're forty six, your fifty two, your fifty eight,
your skin relaxes in your upper face. It creates a
hollow in your mid face and a big roll at
your nasalabia fold. In your lower face. It creates a
(33:49):
jowl and a marionette. 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,
(34:14):
you're camouflaging it, 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
(34:38):
so heavy and so 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 old women who should have
(35:01):
been 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 no problem, Mary, but I'm not
going to inject you anymore. Listen to what I just said.
You don't want to face if no problem, but I'm
not going to do assisted suicide. People are like, well,
she wanted it, or she wanted it. You can't just
(35:26):
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 mouths. This was prior to twenty twenty four.
Why prior twenty twenty four was the ozempic facelift era.
(35:49):
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 celebrit We're getting facelifts
at forty five looking amazing, and they realize, oh shit,
filler isn't the solution. Surgery was the solution. So now
(36:11):
we've had a real backlash on filler. People are now going, oh,
I don't want filler, I want to face. If I
don't want filler, I want to facelift.
Speaker 2 (36:18):
But then we've also been getting a zembic face.
Speaker 1 (36:21):
People have gotten a lot of volume 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 too. 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,
(36:43):
I've had filler and I hate it. You're kidding me,
you're joking me. You had a filler. I mean it's
obvious you had filler.
Speaker 2 (36:48):
Yeah.
Speaker 1 (36:50):
The next area of filling I'm not a fan of.
I think you'll 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.
(37:11):
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 volumize, you're trying to get a chiseled,
sharp look, and it doesn't expand, it migrates, it goes downward,
it gets rubbery, and when you put a small chin
(37:33):
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 by Charlatan doctors
are like, look at this surgical non surgical chin og
and they're like fores yringes and they look crazy.
Speaker 2 (37:57):
Yeah, I agree. I mean people have gone overboard, and
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 my chin.
(38:18):
I do like maybe point two ccs. Every 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 (38:26):
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 recessed chins that are going and
getting syring syringe is a filler put in. I just
(38:50):
what 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 and recommending to
them the thing that you do, whereas you should say,
you know what, this has reached the limits of what
(39:12):
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 in the angle can help. But
(39:33):
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 2 (39:47):
In my opinion, oftentimes it can just widen your face.
Membor Fuller does add volume, So putting volume in that
area you can't make you right.
Speaker 1 (39:55):
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,
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. Why
(40:16):
would you put it in an ear lobe? Who wants
a big ear lobe? You don't want a big ear lobe.
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 between the knuckles,
(40:37):
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 majora. Yeah, what you can put it on
your outer labia. When you age and you go through
menopausal changes, your labia atrophy and become flat and have
(41:02):
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
(41:23):
the traditional way to do filler is 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. Yeah, the other way to do it,
and the advanced way to do it, and the more
(41:44):
correct way to do it in most areas is using
a canula. What is a canula?
Speaker 2 (41:51):
A canula is a it looks like a needle, but
it's blood at the end.
Speaker 1 (41:56):
It's a long liposuction like canula, thin in tiny. 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
(42:19):
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.
Speaker 2 (42:32):
Now.
Speaker 1 (42:33):
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 goes through the skin
and into the vessel. Then it's short. So if I
want to 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
(42:56):
out of cobblestones. It's more like to be lumpy and
require a lot of manipulation. Afterwards, I got to 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
(43:18):
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 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
(43:39):
the same risk as blindness. Which is you're injecting into
a vessel. The pain is significantly less with a canula.
So now let's shift over to canula. A canula you
can do a lot of filling from one area. So
we make one poke right an entry point, and then
(44:00):
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 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
(44:22):
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.
So number one, liquid rhino, for the most part, is
done with a needle, because you're putting tiny little droplets
(44:43):
and you want to be 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
canula because the bruising was a tenth of it. I
didn't get the shapening I wanted, so I went back
(45:05):
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 2 (45:12):
Yeah, you could be a little bit more precise, give
a little bit more like shape.
Speaker 1 (45:16):
And that's it. That's it. What do you mean that's it? Temples, canula, temples,
upper brow, canulus, lower iselid canulus, mid face canulus, marionette canulus,
chin and jaw.
Speaker 2 (45:30):
If you do it the canulus, 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.
Speaker 1 (45:40):
With Yeah, the only areas that you can use it
is if you're trying to eface or flatten out a
tiny little bit of a marionette or tiny little bit
of a nasal avio 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
(46:02):
at the gold standard, 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 filler. So what you can expect
from the recovery of a filler.
Speaker 2 (46:18):
I mean, just like anything else that you do, you'll
have a risk of swellings, risk 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 (46:32):
Yeah, unlike boatox, 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 one hundred bruises. Uh.
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.
(46:52):
We ask you to take no blood thinners. With box,
you can get away with it. It's not ideal, but
it's no problem filler. You're on aspirin, if you're taking
a bunch of motor and advilbry profen. You're light fish oils,
you're likely to bruise more. Secondly, you're more you're definitely
going to bruise from needles, lips, every you're likely to
(47:13):
do it. Even if you're an amazing injector, 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. Temples
(47:36):
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 never
(47:57):
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.
Speaker 2 (48:11):
Oh okay, yeah, I always saw every lippolar patient. I'm like,
you will bruise, you will swell, Like, just don't expect
it from not having If it doesn't happen, great, but
just expect it.
Speaker 1 (48:21):
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
(48:44):
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 provide. I have posted
a thousand times where I am personally very much opposed
(49:05):
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 might like myself,
(49:28):
not a pediatrician. I'm talking about a plastic surgeon or
a dermatologist. I think that that's a different METSPA 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.
(49:49):
So 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 grabbedraduated 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 it's not, let's not say necessarily a complication. But
(50:09):
you can get a hematoma or a big bruise. 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 of.
Speaker 2 (50:30):
That's really it? They're very mild when it comes down
to it for.
Speaker 1 (50:35):
The other two, and we talked about them, and I'll
just hit him one more time. Is blindness catastrophic necrosis?
Tissue dies catastrophic, and those occur with needles. I don't
think there's ever been a reported case of blindness a
few with but let's say the rate of it is very,
(50:56):
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
back and use the drug vitrace your highluranidase. Like you
should ask when you go to get filler. This is
(51:18):
what I would recommend you walk in you're about to
get filler, say do you guys have lurana days also
known as VICH trace here on in house in your
refrigerator right now?
Speaker 2 (51:29):
And as a provider, you should make sure, I mean,
just for you and your safety, that you should always
have them at night, right, No, but I will never
inject a patient if I don't have any.
Speaker 1 (51:38):
Oh well, we'll get it if needed, we'll call the pharmacy.
No no, no, no no.
Speaker 2 (51:42):
I canceled days when I've gone to when I've worked
and had no highlurono days.
Speaker 1 (51:47):
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
(52:10):
for me? Because yeah, yeah, yeah, we have it, And
God forbid you needed that moment. It's not like you
just go get it from CBS. 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
(52:32):
goal 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 filler 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
(52:52):
I have two requests. One, you love our show, Go
write a review, Go write something nice, say oh my god,
we love your show. You're the best mix 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.
(53:16):
All right, Charlie, that's a wrap, guys. Tune in next
week we have yet another episode. We're gonna 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 rudderbaunee you next week on plastic surgery
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