January 21, 2025 • 19 mins
In this episode of Dr. A Explains It All, board-certified dermatologist Dr. Arash Akhavan dives deep into the rising trend of filler dissolving and the reasons behind the growing skepticism about dermal fillers, fueled by social media buzz. Dr. Akhavan breaks down the science behind hyaluronic acid fillers, discusses the potential pitfalls of overuse and improper application, and provides expert advice on achieving natural, long-lasting results.
Discover alternative approaches to facial rejuvenation, including innovative technologies like EMFACE and biosimulatory fillers, and learn how combining treatments can deliver subtle yet transformative outcomes. Whether you’re a filler enthusiast or curious about non-invasive cosmetic options, this episode is packed with practical tips and expert insights to help you make informed decisions about your aesthetic journey.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Arash Akhavan (00:04):
This is the Dr A Explains it All podcast.
A podcast about cosmeticprocedures, skincare,
dermatology and everything inbetween.
I'm board-certifieddermatologist, dr Arash Akhavan.
Announcer (00:15):
Let's get started, but first a quick disclaimer
Medical disclaimer theinformation provided on this
podcast is for generalinformation and educational
purposes only.
It is not intended as medicaladvice, diagnosis or treatment
and should not be relied upon assuch.
Listening to this podcast doesnot establish a physician
(00:36):
patient relationship between youand the host or any
contributors.
If you have specific medicalconcerns or questions, we
encourage you consult directlywith a licensed healthcare
provider or physician in yourarea.
The views expressed in thispodcast are solely those of the
individuals and do notnecessarily represent the views
of any affiliated institutionsor organizations.
(00:58):
Always seek the advice of yourphysician or other qualified
healthcare provider with anyquestions you may have regarding
a medical condition ortreatment.
Never disregard professionalmedical advice or delay seeking
it because of something you haveheard on this podcast.
Arash Akhavan (01:22):
Hi, for today's episode I'm flying solo.
We're essentially sticking toone topic today, so I thought,
for the purposes of efficiencyand getting the information to
you in the most simple way, Iwould just go alone.
And the topic for today issomething that keeps coming up,
and it's been a new thing wherea lot of patients who are
(01:42):
calling to make appointments atour office new patients over the
last year and a half have beencalling and asking about getting
their filler dissolved, and alot of our patients have uh,
that have been calling have alsobeen asking what we can do.
That's like a filler, but notquite a filler, some of them
(02:03):
with sort of wrong ideas aboutwhat we could do.
So that's been an interestingthing and I think a lot of it's
social media driven.
We've been seeing lots of peoplesort of talking about getting
their filler dissolved on socialmedia influencers on Instagram
and TikTok, and so just kind ofthinking about why are we
(02:25):
getting this question?
Our filler is really bad.
Should everybody be gettingtheir filler dissolved?
Um, basically, some people arecomplaining the filler is making
them look puffy.
Some people are complainingthat the filler has migrated and
it's not the way it used tolook six months ago or three
months ago or two years ago, um,and both of these are reasons
(02:47):
why people and then and thensome people have just been
coming in and we're meeting themand they say they just want to
dissolve their filler.
And we asked why?
And they said they don't know.
Um, they just feel like fillershould be dissolved now, um, and
and so what?
What are the bad aspects offacial filler that people are
(03:08):
sort of upset about?
Why?
Why is this a thing over thelast year and a half?
Why is it getting traction onsocial media?
And I think there's threereasons.
One of it is the fillersthemselves have changed.
So there's a few differentcompeting filler companies in
the United States and a feweverywhere around the world, and
(03:28):
they're competing against eachother and they need to come up
with reasons why you should buybrand X and not brand Z, or
check out the new type ofsubtype of filler brand z just
put out, and then they put outanother one six months, another
one a year later, and one of thebig things is they want them to
(03:51):
last a very long time.
And then the other big thing isthey want them to accomplish a
lot with just a syringe.
So one syringe or two syringestransforms this person's lips or
their under eyes or theirjawline or their cheekbones, and
one way that they canaccomplish a lot with filler is
to have some.
(04:11):
When I'm talking about fillersright now, I'm talking about
hyaluronic acid fillers.
That's the majority of fillersout there.
There's other ones too, um, sothe mean hyaluronic acid filler
brands in the U?
S or Juvederm, rha, restylane,and they each have subtypes, and
there's other ones Bolotero,and then the non-HA,
(04:33):
non-hyaluronic acid fillersRadiesse and Sculpture are the
two main ones.
And so right now I'm talkingabout hyaluronic acid fillers.
Those are the only ones thatyou can dissolve, so that's the
trend of dissolving thosefillers.
Those are the only ones thatyou can dissolve, so that's the
trend of dissolving thosefillers.
And one thing about hyaluronicacid that you may know from your
serums and moisturizers andthings like that, is that it's
known for its ability to attractwater.
(04:53):
It loves water, it absorbswater, and these newer fillers
can absorb a lot of water andthat sounds great.
But when you kind of thinkabout a little bit more, is that
makes the results very variable.
So some days your body retainsmore water that does on other
(05:17):
days.
So is your filler gonna swellin those days?
It could, so that one syringeof filler, which is one fifth of
a teaspoon maybe in your cheek,has actually swollen on certain
days to five syringes of fillervolume, five ml one teaspoon,
or maybe three.
Maybe one cheekbone three, onecheekbone five.
(05:38):
So that that's one thing.
And you wouldn't notice that ifyou were injecting one syringe
of filler or two syringes offiller, but if you're injecting
10 syringes of filler and 10 hasbecome the equivalent of three
syringes, 30 syringes worth ofvolume, then that could make you
(06:00):
look puffy and that could be abad thing.
And another thing is that thesefiller companies are sort of
competing on is how long theylast, the longevity of the
filler.
And one way they can make themlast longer is by getting them
cross-linked.
That means the hyaluronic acidmolecules are really bound to
each other.
Um, so they stick around longer, which again sounds great.
(06:23):
But life happens.
And that filler that you putunder your eyes, maybe you slept
on it for four nights in a row,maybe you rub your eyes a lot,
maybe you swim for exercise andyou wear goggles for hours a
week on it.
That can't be good.
This is a gel under your skinand it's under continuous
(06:44):
pressure, chances are it canmove a little bit if it's
sticking around for a reallylong time.
And when I was training, youknow two decades ago that um
wasn't an issue because thefillers would last like five,
six months, so they didn't havea chance to move anywhere.
They'd be gone Um, so wewouldn't see migration.
But now that they stick aroundthey migrate.
(07:07):
So you know that's two of thebad things that people complain
about.
And you know the fillersthemselves have some
characteristic changes that haveoccurred over the last couple
of decades that make thesethings more likely.
Another thing is the peoplethat are injecting them.
There's just too many peopleinjecting filler now.
But I mean I mean providers.
(07:27):
Again, when I graduated twodecades ago, it was after
residency at Mount Sinai here inNew York City.
We all, all of us residents hadsomething called a cosmetic
clinic.
It met twice a week.
We would bring in our ownpatients there.
They knew that we were going tobe the ones injecting them.
(07:48):
They were getting a discountedrate because we were training
for the years that we were therein our residency and we were
training with the mostaccomplished cosmetic
dermatologists in New York City,and it wasn't just hands-on
training, it was also didacticlectures and books and journals
(08:09):
and tests, exams, correction oftechnique on people seeing the
patients back month after monthat these clinics and seeing our
results.
And that was with fillers, itwas with Botox, it was with
lasers, it was with liposuction,it was with hair transplants,
(08:30):
and that was part of ourtraining.
It was part of the plasticsurgeon's training and we were
the only ones, when I got out ofresidency, that were doing
these procedures.
And then you start to see somephysicians that weren't trained
doing it, and then you startedseeing nurses and PAs and
(08:51):
estheticians and and uh, not toknock anybody but you know,
there there's a differencebetween that sort of training
and training that you get on ajob or at a certification course
.
You know, and then you callyourself a certified injector.
I'm not sure what that means.
(09:12):
Um, you know.
So.
So the more people you havewith less training injecting, I
think it makes sense that youwill see some results that are
less than ideal.
Leave it at that.
And then the other thing is thethird thing I think that's sort
of driving bad cosmetic resultswith injectables, with fillers
(09:32):
in particular, is social media.
So everybody trying to competefor clicks.
How do you do that withinjectables?
By having amazing before andafter results.
You really should not haveamazing before and after results
with filler.
They should be subtle.
They should be hard to see.
If they're amazing in a twodimensional picture, you
(09:53):
probably put a lot of filler in.
If you're, if you're saying yougave somebody a lift or if
people are saying, wow, thatperson looks like they had a
lift, you probably put a lot offiller in.
If you're, if you're saying yougave somebody a lift or if
people are saying, wow, thatperson looks like they had a
lift, you probably put a lot offiller in.
You probably put it in veryexaggerated, with an exaggerated
sort of projection, weirdinjection techniques to get that
result and that's not going tolook good in real life.
(10:13):
It may look good in atwo-dimensional picture where
they're looking straight at thecamera, but the second that
person's talking, interacting,bending their head down or up or
eating.
It's going to look weird toeverybody else and that gives
you weird, weird contours andpuffiness and lack of lines in
the proper places.
(10:34):
And a facelift should give you afacelift results and and you
know there are non-surgicalthings that can give you results
, that approach, a facelift,when you combine things.
A little bit of judiciousfiller, a little bit of this, a
little bit of that, we can getinto those alternatives to
fillers.
But filler on its own givingyou a facelift probably bad news
(10:55):
.
So what would be good fillerresults?
Because I love filler, I lovedoing filler and I think we have
great results with filler One.
I mean I'm biased, but go to atrained person, go to a
board-certified dermatologist orplastic surgeon.
If you can Not saying everyboard-certified dermatologist is
(11:17):
better than every certifiedinjector, um, just, chances are.
But again, I'm biased, butchances are.
The person with years ofrigorous training probably is
more trained to do thatprocedure.
Don't dry and do too much umwith filler.
No, it's limitations.
(11:38):
It should be injected verysparingly.
It should ideally be injectedpretty deep um over bone, in
certain areas.
Um, another big thing iscombine it with other procedures
.
Don't try and do everythingwith filler.
Um, combine a little bit offiller, a little bit of skin
tightening and other proceduresthat rejuvenate.
(12:02):
So combination procedures arealways going to look more
natural and if a lot of time haspassed, don't be afraid to
dissolve and redo it.
If we've injected your lips andtwo and a half years have gone
by.
It makes sense that maybe yourright upper lip is a little
(12:23):
fuller than your left upper lip,maybe it's traveled a little
bit this way or that way.
You've kissed, you've chewedfood, you've played your
trombone.
I don't know what you've done,but you know it's not going to
stay right where we injected itfor two and a half years.
Um, dissolve it, take a breakfor a week or two, do it again.
That's the way to have idealresults.
(12:46):
And then, uh, the question ofalternatives.
So my favorite one it'sactually a company I've worked
with in the past, a company, btl, which everybody mostly knows
from M Sculpt, but they have anamazing face rejuvenation device
that I think is a greatalternative to fillers called
(13:08):
Emface Combines two technologiesradiofrequency and the real
thing.
That is the important thinghigh fes.
So radiofrequency, not notimportant, it um heats the
proper level of skin depth tothe proper temperature to get
collagen and elastin generationto help with fine lines and skin
texture and skin firmness.
(13:29):
Um.
And then the high fes, whichstands for high intensity,
focused electrical stimulation.
There's lots of contractions ofthe key muscles in the face, so
in the cheeks, midface, thismuscle called the risorius, the
zygomaticus, major and minor onthe forehead, the frontalis down
here, the digastric under thechin, and you're building muscle
(13:53):
tone in these which gives alifting effect to the mid face,
to the uh jawline, to theforehead and brow area, to this
under chin area, and the underchin does other things that
don't really pertain to here, tohelp with double chin, but
that's a different technology.
But yeah, the M phase is areally cool device.
There's zero chance that you'regoing to have funny looking
(14:15):
results because it's your ownmuscle going back in tone.
So we don't have to worry aboutweird puffiness, unnatural
results, migration, things likethat Looks great and if you want
more, you can add a little bitof filler to it.
But people really do love theEmface on its own.
But it can be combined and, likeI said, that's the most
important thing I think honestlyis combining procedures.
So you could Emfacec the , youcould add a little under eye
(14:38):
filler, a little lip filler, alittle tweak here, tweak there,
without doing too much, andeverybody's going to look
natural.
And the other thing you cancombine it with is skin
tightening.
So that could be accomplishedwith ultrasound, like all
therapy device, fda cleared forlifting, can treat the face, the
(14:58):
neck, the decollete, the brow,and it uses ultrasound to target
deeper layers of collagen toget a sort of a profound
tightening effect, and that thatcan give you a really great
lift, um.
So I really love um that and Ilove that in combination,
(15:19):
actually, with the Emface, um,and all three of these things we
mentioned can be combined theEmface, the ultrasound and the a
little bit of judicious fillerhere or there.
Um.
And then the last thing I wasgoing to mention is as an
alternative to fillers.
It's funny, but when I talkabout alternative to fillers,
I'm talking about alternative tohyaluronic acid fillers.
(15:40):
There's this other type offiller called biosimulatory
fillers.
One of them I mentionedRadiesse calcium hydroxyapatite.
We take this and we dilute itwith saline.
This technology, this technique,sorry, is well documented in
medical literature.
Lots of doctors doing it withgreat success.
We've had great results on theface, neck and body with it.
(16:00):
We inject it and what we'reinjecting most of the volume, is
just saline.
It's water, salt water, andthat water makes you puffy at
the time of injection.
A couple hours later it's beenabsorbed in and what's left is
this fine sort of mesh of thisradius material that was
(16:21):
suspended in water, this calciumhydroxyapatite, and your body
forms collagen and elastinaround it over the course of
months and you get this reallynice sort of smoothing of skin,
tightening of skin, withoutvolume, and it doesn't have
water affinity, so it's notgoing to puff, doesn't migrate,
last a long time, excuse me.
(16:43):
So that's another sort ofprocedure that you can do where
you wouldn't have to worry aboutsome of the things we're
worried about with hyaluronicacid, fillers and then facelifts
.
And again, that shouldn't beoverdone either.
We've been unfortunately that'sbeen the opposite trend People
(17:05):
getting facelifts a little tooearly, in my opinion, before
they need it, and that also canlook very odd in real life.
Looks great in the before andafter in a two-dimensional
picture on social media, butwe've been seeing some very
weird results around New YorkCity, unfortunately, with the
sort of sudden increase in thenumber of facelifts that's been
occurring since the pandemic.
So everything has its place.
(17:27):
Things should be done inconjunction.
That's sort of the lesson fromtoday's podcast, I think.
Um and filler still has itsplace as well.
Just do little amounts, do itslowly, don't do too much, know
its limitations.
Combine it with otherprocedures and you'll be happy
with your results.
(17:47):
Um, check out Emface like .
That can be a good substitutefor it If you really don't want
to do it, or combine the two, um.
But yeah, we can have greatresults without surgery with
little to no downtime.
That you see quickly, um, butyou just have to know.
(18:08):
The person who's treating youand yourself should be educated
on the sort of benefits of theseprocedures and their
limitations.
As usual.
If you have any questions aboutthis episode or any other
episodes or suggestions forfuture episodes, please reach
out to us either by email or atdrapodcastcom.
Announcer (18:38):
Thanks, Talk to you soon.
Thank you so much for tuning intoday.
If you enjoyed this episode,please make sure to subscribe to
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(19:00):
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It really helps us reach morelisteners like you To learn more
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Please visit our website atdrapodcastcom.
That's drapodcastcom.
(19:21):
To see us as a patient at ourNew York clinic, visit us at
dermatologyandlasergroupcom.
Bye.
This is the Dr A Explains it All podcast.
A podcast about cosmeticprocedures, skincare,
dermatology and everything inbetween.
I'm board-certifieddermatologist, dr Arash Akhavan.
Announcer (00:15):
Let's get started, but first a quick disclaimer
Medical disclaimer theinformation provided on this
podcast is for generalinformation and educational
purposes only.
It is not intended as medicaladvice, diagnosis or treatment
and should not be relied upon assuch.
Listening to this podcast doesnot establish a physician
(00:36):
patient relationship between youand the host or any
contributors.
If you have specific medicalconcerns or questions, we
encourage you consult directlywith a licensed healthcare
provider or physician in yourarea.
The views expressed in thispodcast are solely those of the
individuals and do notnecessarily represent the views
of any affiliated institutionsor organizations.
(00:58):
Always seek the advice of yourphysician or other qualified
healthcare provider with anyquestions you may have regarding
a medical condition ortreatment.
Never disregard professionalmedical advice or delay seeking
it because of something you haveheard on this podcast.
Arash Akhavan (01:22):
Hi, for today's episode I'm flying solo.
We're essentially sticking toone topic today, so I thought,
for the purposes of efficiencyand getting the information to
you in the most simple way, Iwould just go alone.
And the topic for today issomething that keeps coming up,
and it's been a new thing wherea lot of patients who are
(01:42):
calling to make appointments atour office new patients over the
last year and a half have beencalling and asking about getting
their filler dissolved, and alot of our patients have uh,
that have been calling have alsobeen asking what we can do.
That's like a filler, but notquite a filler, some of them
(02:03):
with sort of wrong ideas aboutwhat we could do.
So that's been an interestingthing and I think a lot of it's
social media driven.
We've been seeing lots of peoplesort of talking about getting
their filler dissolved on socialmedia influencers on Instagram
and TikTok, and so just kind ofthinking about why are we
(02:25):
getting this question?
Our filler is really bad.
Should everybody be gettingtheir filler dissolved?
Um, basically, some people arecomplaining the filler is making
them look puffy.
Some people are complainingthat the filler has migrated and
it's not the way it used tolook six months ago or three
months ago or two years ago, um,and both of these are reasons
(02:47):
why people and then and thensome people have just been
coming in and we're meeting themand they say they just want to
dissolve their filler.
And we asked why?
And they said they don't know.
Um, they just feel like fillershould be dissolved now, um, and
and so what?
What are the bad aspects offacial filler that people are
(03:08):
sort of upset about?
Why?
Why is this a thing over thelast year and a half?
Why is it getting traction onsocial media?
And I think there's threereasons.
One of it is the fillersthemselves have changed.
So there's a few differentcompeting filler companies in
the United States and a feweverywhere around the world, and
(03:28):
they're competing against eachother and they need to come up
with reasons why you should buybrand X and not brand Z, or
check out the new type ofsubtype of filler brand z just
put out, and then they put outanother one six months, another
one a year later, and one of thebig things is they want them to
(03:51):
last a very long time.
And then the other big thing isthey want them to accomplish a
lot with just a syringe.
So one syringe or two syringestransforms this person's lips or
their under eyes or theirjawline or their cheekbones, and
one way that they canaccomplish a lot with filler is
to have some.
(04:11):
When I'm talking about fillersright now, I'm talking about
hyaluronic acid fillers.
That's the majority of fillersout there.
There's other ones too, um, sothe mean hyaluronic acid filler
brands in the U?
S or Juvederm, rha, restylane,and they each have subtypes, and
there's other ones Bolotero,and then the non-HA,
(04:33):
non-hyaluronic acid fillersRadiesse and Sculpture are the
two main ones.
And so right now I'm talkingabout hyaluronic acid fillers.
Those are the only ones thatyou can dissolve, so that's the
trend of dissolving thosefillers.
Those are the only ones thatyou can dissolve, so that's the
trend of dissolving thosefillers.
And one thing about hyaluronicacid that you may know from your
serums and moisturizers andthings like that, is that it's
known for its ability to attractwater.
(04:53):
It loves water, it absorbswater, and these newer fillers
can absorb a lot of water andthat sounds great.
But when you kind of thinkabout a little bit more, is that
makes the results very variable.
So some days your body retainsmore water that does on other
(05:17):
days.
So is your filler gonna swellin those days?
It could, so that one syringeof filler, which is one fifth of
a teaspoon maybe in your cheek,has actually swollen on certain
days to five syringes of fillervolume, five ml one teaspoon,
or maybe three.
Maybe one cheekbone three, onecheekbone five.
(05:38):
So that that's one thing.
And you wouldn't notice that ifyou were injecting one syringe
of filler or two syringes offiller, but if you're injecting
10 syringes of filler and 10 hasbecome the equivalent of three
syringes, 30 syringes worth ofvolume, then that could make you
(06:00):
look puffy and that could be abad thing.
And another thing is that thesefiller companies are sort of
competing on is how long theylast, the longevity of the
filler.
And one way they can make themlast longer is by getting them
cross-linked.
That means the hyaluronic acidmolecules are really bound to
each other.
Um, so they stick around longer, which again sounds great.
(06:23):
But life happens.
And that filler that you putunder your eyes, maybe you slept
on it for four nights in a row,maybe you rub your eyes a lot,
maybe you swim for exercise andyou wear goggles for hours a
week on it.
That can't be good.
This is a gel under your skinand it's under continuous
(06:44):
pressure, chances are it canmove a little bit if it's
sticking around for a reallylong time.
And when I was training, youknow two decades ago that um
wasn't an issue because thefillers would last like five,
six months, so they didn't havea chance to move anywhere.
They'd be gone Um, so wewouldn't see migration.
But now that they stick aroundthey migrate.
(07:07):
So you know that's two of thebad things that people complain
about.
And you know the fillersthemselves have some
characteristic changes that haveoccurred over the last couple
of decades that make thesethings more likely.
Another thing is the peoplethat are injecting them.
There's just too many peopleinjecting filler now.
But I mean I mean providers.
(07:27):
Again, when I graduated twodecades ago, it was after
residency at Mount Sinai here inNew York City.
We all, all of us residents hadsomething called a cosmetic
clinic.
It met twice a week.
We would bring in our ownpatients there.
They knew that we were going tobe the ones injecting them.
(07:48):
They were getting a discountedrate because we were training
for the years that we were therein our residency and we were
training with the mostaccomplished cosmetic
dermatologists in New York City,and it wasn't just hands-on
training, it was also didacticlectures and books and journals
(08:09):
and tests, exams, correction oftechnique on people seeing the
patients back month after monthat these clinics and seeing our
results.
And that was with fillers, itwas with Botox, it was with
lasers, it was with liposuction,it was with hair transplants,
(08:30):
and that was part of ourtraining.
It was part of the plasticsurgeon's training and we were
the only ones, when I got out ofresidency, that were doing
these procedures.
And then you start to see somephysicians that weren't trained
doing it, and then you startedseeing nurses and PAs and
(08:51):
estheticians and and uh, not toknock anybody but you know,
there there's a differencebetween that sort of training
and training that you get on ajob or at a certification course
.
You know, and then you callyourself a certified injector.
I'm not sure what that means.
(09:12):
Um, you know.
So.
So the more people you havewith less training injecting, I
think it makes sense that youwill see some results that are
less than ideal.
Leave it at that.
And then the other thing is thethird thing I think that's sort
of driving bad cosmetic resultswith injectables, with fillers
(09:32):
in particular, is social media.
So everybody trying to competefor clicks.
How do you do that withinjectables?
By having amazing before andafter results.
You really should not haveamazing before and after results
with filler.
They should be subtle.
They should be hard to see.
If they're amazing in a twodimensional picture, you
(09:53):
probably put a lot of filler in.
If you're, if you're saying yougave somebody a lift or if
people are saying, wow, thatperson looks like they had a
lift, you probably put a lot offiller in.
If you're, if you're saying yougave somebody a lift or if
people are saying, wow, thatperson looks like they had a
lift, you probably put a lot offiller in.
You probably put it in veryexaggerated, with an exaggerated
sort of projection, weirdinjection techniques to get that
result and that's not going tolook good in real life.
(10:13):
It may look good in atwo-dimensional picture where
they're looking straight at thecamera, but the second that
person's talking, interacting,bending their head down or up or
eating.
It's going to look weird toeverybody else and that gives
you weird, weird contours andpuffiness and lack of lines in
the proper places.
(10:34):
And a facelift should give you afacelift results and and you
know there are non-surgicalthings that can give you results
, that approach, a facelift,when you combine things.
A little bit of judiciousfiller, a little bit of this, a
little bit of that, we can getinto those alternatives to
fillers.
But filler on its own givingyou a facelift probably bad news
(10:55):
.
So what would be good fillerresults?
Because I love filler, I lovedoing filler and I think we have
great results with filler One.
I mean I'm biased, but go to atrained person, go to a
board-certified dermatologist orplastic surgeon.
If you can Not saying everyboard-certified dermatologist is
(11:17):
better than every certifiedinjector, um, just, chances are.
But again, I'm biased, butchances are.
The person with years ofrigorous training probably is
more trained to do thatprocedure.
Don't dry and do too much umwith filler.
No, it's limitations.
(11:38):
It should be injected verysparingly.
It should ideally be injectedpretty deep um over bone, in
certain areas.
Um, another big thing iscombine it with other procedures
.
Don't try and do everythingwith filler.
Um, combine a little bit offiller, a little bit of skin
tightening and other proceduresthat rejuvenate.
(12:02):
So combination procedures arealways going to look more
natural and if a lot of time haspassed, don't be afraid to
dissolve and redo it.
If we've injected your lips andtwo and a half years have gone
by.
It makes sense that maybe yourright upper lip is a little
(12:23):
fuller than your left upper lip,maybe it's traveled a little
bit this way or that way.
You've kissed, you've chewedfood, you've played your
trombone.
I don't know what you've done,but you know it's not going to
stay right where we injected itfor two and a half years.
Um, dissolve it, take a breakfor a week or two, do it again.
That's the way to have idealresults.
(12:46):
And then, uh, the question ofalternatives.
So my favorite one it'sactually a company I've worked
with in the past, a company, btl, which everybody mostly knows
from M Sculpt, but they have anamazing face rejuvenation device
that I think is a greatalternative to fillers called
(13:08):
Emface Combines two technologiesradiofrequency and the real
thing.
That is the important thinghigh fes.
So radiofrequency, not notimportant, it um heats the
proper level of skin depth tothe proper temperature to get
collagen and elastin generationto help with fine lines and skin
texture and skin firmness.
(13:29):
Um.
And then the high fes, whichstands for high intensity,
focused electrical stimulation.
There's lots of contractions ofthe key muscles in the face, so
in the cheeks, midface, thismuscle called the risorius, the
zygomaticus, major and minor onthe forehead, the frontalis down
here, the digastric under thechin, and you're building muscle
(13:53):
tone in these which gives alifting effect to the mid face,
to the uh jawline, to theforehead and brow area, to this
under chin area, and the underchin does other things that
don't really pertain to here, tohelp with double chin, but
that's a different technology.
But yeah, the M phase is areally cool device.
There's zero chance that you'regoing to have funny looking
(14:15):
results because it's your ownmuscle going back in tone.
So we don't have to worry aboutweird puffiness, unnatural
results, migration, things likethat Looks great and if you want
more, you can add a little bitof filler to it.
But people really do love theEmface on its own.
But it can be combined and, likeI said, that's the most
important thing I think honestlyis combining procedures.
So you could Emfacec the , youcould add a little under eye
(14:38):
filler, a little lip filler, alittle tweak here, tweak there,
without doing too much, andeverybody's going to look
natural.
And the other thing you cancombine it with is skin
tightening.
So that could be accomplishedwith ultrasound, like all
therapy device, fda cleared forlifting, can treat the face, the
(14:58):
neck, the decollete, the brow,and it uses ultrasound to target
deeper layers of collagen toget a sort of a profound
tightening effect, and that thatcan give you a really great
lift, um.
So I really love um that and Ilove that in combination,
(15:19):
actually, with the Emface, um,and all three of these things we
mentioned can be combined theEmface, the ultrasound and the a
little bit of judicious fillerhere or there.
Um.
And then the last thing I wasgoing to mention is as an
alternative to fillers.
It's funny, but when I talkabout alternative to fillers,
I'm talking about alternative tohyaluronic acid fillers.
(15:40):
There's this other type offiller called biosimulatory
fillers.
One of them I mentionedRadiesse calcium hydroxyapatite.
We take this and we dilute itwith saline.
This technology, this technique,sorry, is well documented in
medical literature.
Lots of doctors doing it withgreat success.
We've had great results on theface, neck and body with it.
(16:00):
We inject it and what we'reinjecting most of the volume, is
just saline.
It's water, salt water, andthat water makes you puffy at
the time of injection.
A couple hours later it's beenabsorbed in and what's left is
this fine sort of mesh of thisradius material that was
(16:21):
suspended in water, this calciumhydroxyapatite, and your body
forms collagen and elastinaround it over the course of
months and you get this reallynice sort of smoothing of skin,
tightening of skin, withoutvolume, and it doesn't have
water affinity, so it's notgoing to puff, doesn't migrate,
last a long time, excuse me.
(16:43):
So that's another sort ofprocedure that you can do where
you wouldn't have to worry aboutsome of the things we're
worried about with hyaluronicacid, fillers and then facelifts
.
And again, that shouldn't beoverdone either.
We've been unfortunately that'sbeen the opposite trend People
(17:05):
getting facelifts a little tooearly, in my opinion, before
they need it, and that also canlook very odd in real life.
Looks great in the before andafter in a two-dimensional
picture on social media, butwe've been seeing some very
weird results around New YorkCity, unfortunately, with the
sort of sudden increase in thenumber of facelifts that's been
occurring since the pandemic.
So everything has its place.
(17:27):
Things should be done inconjunction.
That's sort of the lesson fromtoday's podcast, I think.
Um and filler still has itsplace as well.
Just do little amounts, do itslowly, don't do too much, know
its limitations.
Combine it with otherprocedures and you'll be happy
with your results.
(17:47):
Um, check out Emface like .
That can be a good substitutefor it If you really don't want
to do it, or combine the two, um.
But yeah, we can have greatresults without surgery with
little to no downtime.
That you see quickly, um, butyou just have to know.
(18:08):
The person who's treating youand yourself should be educated
on the sort of benefits of theseprocedures and their
limitations.
As usual.
If you have any questions aboutthis episode or any other
episodes or suggestions forfuture episodes, please reach
out to us either by email or atdrapodcastcom.
Announcer (18:38):
Thanks, Talk to you soon.
Thank you so much for tuning intoday.
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(19:00):
cosmetic procedures and more.
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It really helps us reach morelisteners like you To learn more
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answered on here.
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That's drapodcastcom.
(19:21):
To see us as a patient at ourNew York clinic, visit us at
dermatologyandlasergroupcom.
Bye.
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