Talking about fillers so this is something where I would say mid-face fillers are something
where you really want to go to experienced injector someone who understands anatomy. Some
of these things are off-label actually that we do here at the calm very common procedures that we do
but when we're doing fillers which fillers are to add volume. It's really important that you're not
treating lines and I find that when I'm training other injectors that's a big mistake that I see.
They see a line and cool fill that line. Yes, you do not fill lines you fill the why you have
that line so why do you have this line here? Well, it's probably not because over time you're just
getting a divot in your face, it's because you're losing bone. You're losing fat pads and you've
got ligaments that are loosening those kind of things over time and so what Tori and I both do
when we assess you for a filler consult is to say why does she have the lines that bother her
and then we address the why which then gives you a very natural correction because we've corrected
where the aging has happened as opposed to corrected the line and I think that's a great
point Dr. Holman makes. The difference between Botox or neurotoxin and filler you know neurotoxin is
what corrects lines over time, filler is filling in where you've lost volume and like she says the mid
face is some place that really does lose volume and it has an effect lower because gravity
always wins and so when people start talking about jowling and all that kind of stuff look
higher up and that's where we're always looking. With you we're looking at your tear troughs we're
looking at your cheeks your temples and so today you're going to see us do a midface correction.
The patient that we're treating is not old, she's young but she is doing preventative maintenance
and so she notices that she does have tear troughs she notices that she's already starting to see
some volume loss in her cheeks so by doing little subtle corrections we're not we don't have to put
five syringes of filler in your face we can start with two. Patients often ask what's
in a syringe so syringe volume is just a fifth of a teaspoon so imagine how little that volume is
we won't hurt you we can't distort you with just a syringe of filler and I think that's one
of the common barriers to getting dermal filler is they're worried that am I going to get duck
lips am I or my cheeks going to look puffy. Well we can't do that with one syringe of filler so
a good way to come in is let us look at your face and let us do a consultation
and today we're just doing cheeks and tear troughs on this patient so you'll get to see
the full procedure which is really non-invasive, it's really not very much trauma. I'm going to let
Dr. Holman talk through some of the anatomy that we're very cognizant of because again
seeing a professional, a medical professional, that's really aware of anatomy is super important.
The way people get hurt is when people are not aware of and not slightly frightened of anatomy,
right, and so and the other thing to know too when you come in for filler it's really important
that filler is not one size fits all. If you open my filler cabinet you're gonna see like 15 16
different boxes of different filler and that's because it's really important not just how we're
doing this filler but what product we're reaching for in choosing with every different anatomic
area and every different patient that we treat as well and again with all of our fillers. We've got
rewards programs also so in addition to banking your buck and saving that 20 percent ahead of time we're
going to check these rewards programs every time as well to see what does galderma allergan have
to offer you every time you come see us to save money on your fillers because we're conscious of
your dollars as well and so when you're looking at a midface it's always really interesting to me
when someone comes in and like, I hate this flat part of my face right through here, I hate
these lines right through here, and it has nothing to do with those areas it actually has to do with
your cheeks. If you start looking especially at celebrities and those kind of things they
have this beautiful kind of rhombus look through there with these really nice lifted cheeks and
it's that triangle of youth because as we age that triangle flips the other direction and so
by lifting in that cheek area we're really restoring that volume to the mid face but lifting
that lower face area as well and so there's an anatomic compartment that's deep right through
here that's really a nice area to fill and so you emphasize the zygomatic bone you fill that deep
anatomic area lift bring a curve to that lateral cheek through there because with cheeks especially
the problem when people say I hate this liner I hate this you're looking at yourself straight on
in the mirror when we come in and look at you and to be honest when the rest of the world looks at
you too we're looking at you three-dimensionally and that's where that correction happens to
look the most natural is when you're lifting that lateral cheek area through there as well
tear trough correction is something that we do pretty conservatively but a lot of times
you know as we age when we lose there's a fat pad that's right down through here that as you
lose that fat pad you start to see kind of some shadows under your eyes and you just look tired.
Sometimes it's genetic as well I mean some people genetically have that ,you know, that
flatness or that darkening through there and so we typically just split one syringe of filler if
we're correcting that area you want to be really conservative because if you overfill that area
it looks like you've got allergies or, you know, puffy eyes, those type things. We're
always very conservative when we're filling in that area but I'll be honest it's one of those
things it's a small correction just a half syringe of filler on each side here that we're going to be,
you know, showing you on Maddie today. It's a very small correction with a huge payoff. The other
thing you're going to notice is we're treating this patient is that we're using something called
a cannula so there was a guy in New York who started doing filler on his patients and
the biggest limitation, especially even when I started doing filler a decade ago, was that I'd
send people home and it looked like I smacked him in the face with a bag of marbles because they're
all beat up and bruised up and just it was like okay I'm gonna get my filler but I'm gonna have
to block two weeks on my schedule. So with cannulas, and I'll let Tori talk about what that is, we've
changed the game on bruising and trauma. I really get excited talking about cannulas if you've ever
looked at our Instagram I'm always like Dr. Holman and I use a cannula because it's
it is so different than using just a needle. A cannula is a long blunt tipped object meaning
it's not sharp, it's not severing vessels, and severine anatomy under there it's literally
just kind of gliding past everything you need to keep intact and things that are important
so that way there's so much less bruising. There's less trauma and so patients are always really
concerned, you know, like how long is the down time for filler? Really no no downtime you're
ready to go when you leave you know we numb you we always will numb you for filler 10 or 15 minutes
of topical numbing and then by using the cannula you leave and it's pretty painless. I mean there
are parts that are uncomfortable but you leave and you're just ready to go so I think a cannula is
truly what has changed in our practice and that's made a huge difference for patients and made them
say you know what I can go get cheeks and tear troughs and temples filled with really minimal
downtime and bruising. Yeah and so you see for the bulk of the injection sites on this patient it was
just two entry ports and I'm able to do a lot of work and fill a lot of area because that cannula
allows me to do that but just traumatizing her skin and two spots on each side we can work on
that whole midface area. So again, this is an area to treat, just come and let us assess you.