When discussing injections, it's important to first understand what it is we're even talking about. There's no question that there has been an increase in their popularity—a recent report from the American Society for Aesthetic Plastic Surgery states that Americans were injected 6.6 million times last year, which is almost 40% more than five years ago. It's so ubiquitous, in fact, that I'm consistently invited to industry events where fillers are offered along with cocktails.
So here are the facts: Beverly Hills–based plastic surgeon John Diaz, MD, explains that "fillers" is a term used to refer to a variety of medical products "designed to fill in areas of volume loss." Popular areas to plump are the hallows of your under-eyes, lips, nasolabial folds (laugh lines), and cheekbones. Plus there are differences in their prices and how long they last.
"The longer-lasting formulas cost more up-front," says L.A.-based injection specialist Lisa Goodman. "Shorter-term fillers can last from six to 11 months based on the patient's rate of aging (i.e., smoking, drinking, sun exposure, genetics), while the longer-term fillers last about one to two years."
What kind of fillers, if any, do I need?
After a ton of research and a few fever dreams on the subject, I decided I wanted to entertain the idea of getting fillers myself. I had a consultation with New York–based plastic surgeon, Scott Wells, MD, and discussed what he'd prescribe to me if I decided to take the plunge. "As the mid-face ages, it begins to bottom out a little bit," he said. "The skin gets a little looser, and the tissue has less support. This line here," he said, pointing to my smile lines, "begins to sag, and what's above it, the under-eye bag, begins to show more. The crease is a symptom of the sag."
What kind of needle should be used?
After meeting with him, I let it go for a while and continued to live my life sans fillers. A bit later, I met the woman behind GoodSkin Los Angeles. She told me fillers were absolutely an option, as, like Wells described, my "mid-face" was aging slightly faster. But she mentioned a method I hadn't ever heard of: using a microcannula to inject them. Lauren Pack, a nurse at the practice, explains, "We use microcannulas—they are considered a blunt-tip needle. The microcannula only makes one single hole, rather than a bunch of tiny ones around the eyes. These sites or 'holes' allow for the blunt needle to place filler deeper under the muscle and onto the bone (depending on the desired technique)." So it allows for a more precise placement, and according to Pack, it will decrease the change of bruising post-procedure.
"Needles are sharp (of course), but microcannulas have a blunt, rounded tip," adds Dr. Dara Liotta, MD. "I have seen a significant drop in the amount of bruising and swelling in patients after filler injections when using a microcannulas. A microcannula is flexible, which often allows multiple areas of the face to be treated through a single needle hole—again, decreasing pain and bruising."
"Additionally," she continues, "the most severe complications from fillers (vascular compromise) can result from injection of filler material into arteries, causing the artery to be blocked, and blood flow to an area of the skin to decrease. This decrease in blood flow can lead to death of the skin that the artery supplies. With microcannulas, the possibility of intravascular injection is essentially zero. Microcannulas are specifically useful in sensitive and tender areas of the face, such as the lips or under the eyes, where bruising is more common, and injection is often painful.
They do take a bit more time and finesse to use (for your doctor) and there is definitely a learning curve. Now that I use them almost exclusively for injection, I rarely have patients bruise, I see a decrease in patient discomfort and swelling, and I would never go back to needles."
Then what happens?
To fill under your eyes, they make a small hole next to your lip and move the needle in and up your cheek, under the skin. I know, it sounds scary. And trust me—I saw videos, and it looks scary too. But, Pack laments, because the one hole is the only site of injection, it closes within two hours and hurts less because it's anesthetized.
"Some injections only require the filler to be placed subcutaneous," Pack continues. "During the process, it is able to glide through tissue and between vessels and not harm anything in its path. There is a big decrease in the number of complications and trauma to your skin afterward. It works better, not only because of decreased risks, but it also allows us to make sure we are on the deepest plane in the face. When fillers are placed deep, they can mimic bone and ultimately look best when the patient smiles or emotes.
The injection steps are simple and seamless. Instead of 10 to 20 pokes, there are only one or two per area."
In the end, I still haven't gotten fillers. But I still think about them. And I know now that I have a better education about what they would actually entail. I know now to talk to doctors before googling terrifying needle videos all night long. In this case, the scarier-seeming option is the best choice—at least it would be for me.