- I've got a lovely patient, Judy, with us here.
She actually was our training patient
four years ago.
- Yes, that's right.
- So we were training a new doctor
and we did some fillers for her back then
in her tear troughs
and actually it didn't go so well (laughing).
To be honest.
- It's not that bad.
- No, it's not that bad, no.
(laughing)
So this is a case in point about
how long fillers last for.
So Judy's case,
we actually had some overfilling of her eyes
and one thing we wanna illustrate here is that
fillers can actually last
for a very, very long time.
So in a previous video,
we've talked about the longevity of dermal fillers
and their unexpectedly long lifespan in the face.
Typically we have said that fillers last for
six to 18 months
but as we see in Judy's face today,
she's still got an excess amount of filler
just under her eyes there,
which is causing some bagginess.
And you said before to me,
what'd you think it was?
- I actually thought it was just old age coming on, yes.
- She's not that old. (Judy laughing)
It's not old age.
When did you first notice the bags under your eyes?
- I was thinking probably about
eight months ago, or so. - About eight months?
- Yeah, yeah. - Okay.
So possibly there could've been
some migration of that filler
up towards the lower eyelid,
from where it sat to slightly further up
and it sort of rears itself
sometimes months or even years afterwards.
But, you know, you've been quite busy with a few things
in the past few years
and you've been unable to actually come in.
And now that you're coming in again we've--
- You were definitely able to pick it up straight away.
- Yeah, so as soon as I saw Judy
I noticed that there was some sort of a
watery, puffy look to the lower eyelid.
Which also probably has a slight blue-gray
sort of color to it,
which I don't think
is your normal color. - Not usually.
- Not usually like that underneath.
- Yeah, no it's not usual for me,
so I knew it was definitely, yeah.
- And did you notice any difference with,
between night and day,
in terms of puffiness? - It was always worse
in the morning when I first got up.
- And that's really indicative of filler as well,
because filler, when you're lying flat,
will always attract a lot of fluid
and when you sit up or stand up
the fluid will naturally drain through lymphatics
away from the filler,
but it certainly attracts and holds a lot of fluid.
So morning tends to be the worst.
In the tear troughs you can really tell,
because the skin is so fine that,
you know, we don't need an MRI to tell
that there's actually filler there.
We can actually just look at you
and say there's possibly filler there.
And the other thing that would ascertain
the presence of filler there
is actually to dissolve it and with hindsight say,
"Yes, that was filler because now the filler is gone,"
with the dissolving agent.
So we'll get you back
and we'll, we'll show everyone
your results after dissolving. - Okay.
- And that will be, in a way,
proof that you had filler there.
So, really this is a great case
that hopefully will show
that filler can last for many years.
And I've seen this sort of problem
last for even greater than ten years.
Many doctors, practitioners would advise
someone like Judy just to let it slide,
it will be fine in a year or somethin' like that.
It will dissolve by itself.
But my experience with this has been that
it will not dissolve by itself.
And basically, this will be,
in a way almost semi-permanent unless dissolved.
How do you feel about dissolving that for you today?
- No, I'd be very happy.
- Sometimes you've gotta do things,
instead of filling you've gotta sometimes take away
to make people look better.
And I think Judy's actually got
quite good volume in her face
so, in her case, she doesn't need more fillers.
She actually needs to have them out.
And also another common issue is,
I often see people like yourself
who come in and say they want more fillers done
and because they see a bit of a hollow
underneath the,
the bagginess, the excess filler
and they take that as hollowness
rather than excess filler causing bagginess.
So it's very interesting.
I actually had that case quite a few times
where people have come in,
clearly too much filler
and we need to take it out.
But they actually ask for more.
And it's very easy, as a practitioner,
to fall into that trap of listening to your patient,
'cause you know, patient, you gotta listen to your patient,
be a good doctor, and just add some more filler in
when the solution
is to dissolve it. - Is just to get it.
- When we take out this filler Judy,
my experience has been also that,
despite the fact that I can clearly see that it's too much,
in some cases patients will often,
sort of miss their filler.
(laughing)
You know what I mean?
It's true, yeah.
And they'll actually,
they often can freak out a bit
because what was once full
- Now isn't so full.
- Exactly. - Okay.
So I'm warning, when dissolving filler is that
you may feel like it's a bit more crepey
or a bit more sunken,
you know the skin isn't quite as firm.
But you haven't seen your true eyes
sort of for four years. - A while.
So it's gotta give some time,
gotta get used to it. - We've gotta get it out.
- Yep. - Yeah.
Not a warning so much but it's--
- Just preparation.
- A preparation for you just what to expect.
Often people ask you to fill it back in.
And that's sometimes not a great idea
'cause you may end up going full circle
and then having to dissolve again.
But I think it's important that
I just set your expectations
about what may occur afterwards.
I think it will look better.
I'm pretty confident that it'll look better.
But sometimes convincing people
that can be hard. - Okay.
- Yeah, 'cause you just get used to it.
Even sometimes people who have real,
like Judy's got a little bit of excess there.
But sometimes people who've got a significant excess,
they look like they've got golf balls under their eyes,
they still actually--
- They're still used to it.
So used to it, that that looks normal to them now.
- That looks normal
and then they end up liking their previous look
before they actually wanna go back towards that.
A lot of this is a psychological concern
more so than the actual physical one
or an aesthetic one.
Because aesthetically, there's no doubt
I think you'll look better.
But psychologically, very difficult to
to get your head around it, sometimes.
Okay.
- Okay, well warned.
- You sure you wanna do it now?
- Yeah, it'll be fine. - Okay.
- Haven't scared you. (Judy laughing)
Okay.
And the other thing I guess, important here,
is to also address other issues around the eye.
So if the patient's got issues such as skin laxity
or wrinkles around the eyes,
then you can look at other procedures like laser,
carbon dioxide laser resurfacing
or blepharoplasty to remove some skin.
So the answer's not always in filling
and I think that sometimes,
as doctors who do a lot of filling
and anti-wrinkle injections,
you gotta be careful because if all we have is a hammer
then sometimes all we see is nails.
So sometimes it's good to think a bit outside
the square and think of what else we could do to improve
someone's overall
beauty or attractiveness.
Dissolving?
- Dissolving.
- Most cases it's not too hard to do.
It involves injecting an enzyme called hyaluronidase
into the lower eyelid
and that will basically dissolve
any filler that's there.
It doesn't dissolve our own skin,
although we do have hyaluronic acid in our skin,
ours turns over every day.
So we get a new fresh batch every day.
But with the filler, once the cross links are broken
between the filler particles,
it basically will hydrolyze.
In other words, it will just dissipate and dissolve.
So, if I were to put it in an area of your face
with no filler,
it wouldn't make a hole in there or somethin' like that.
Yeah 'cause, like I said, we regenerate it every day.
In most cases it takes one, sometimes two injections
to get rid of the filler.
It's very hard to predict how much to put in.
You don't have an idea of exactly what amount or depth
that the filler was placed so,
I just usually tell my patients in one to two sessions
and then we can resolve most of it.
And the other thing is,
we don't necessarily need to
get rid of every drop of filler,
but it's the superficial ones which are on the surface
that we need to get rid of.
So we'll try and do that for you today
and not sink you in too much.
And just try and get rid of
the unwanted parts of that filler.
- Mmkay, sounds good
- Just before we start I'll just explain
the potential side effects of the dissolver.
There's not too many.
I guess the main one is about a one in a thousand
risk of an allergy.
So after doing dissolvers for many many years
and within our clinic also,
I've one serious allergy to it
which required hospital admission
and there was some airway obstruction.
So it's pretty unusual
but that's why we'll need to do a test patch
in your forearm first,
just a tiny bit of dissolver
and see what sort of reaction we get.
If there's no reaction we can proceed
and do some dissolving
in your tear troughs.
Sometimes you do get some swelling,
which isn't really an allergy
but it can just be quite a significant
degree of swelling,
to the point where your eyes can get quite swollen
and shut over,
but there's no obstruction of your airway
or any problems like that.
Most people don't have any issues at all,
but occasionally we do see it.
The other thing is possibly a little bruise
or a black eye under the eye.
To avoid that I'm gonna inject really superficially,
try and be above the veins,
and that way we're going to hopefully avoid
hitting those deeper veins
and giving you a big black eye,
which is not good.
And it takes about a week to recover from.
Okay, and the other thing I guess,
most of the filler that I wanna get rid of
is superficial,
so I'll start with superficial injections first,
in the skin and then this product naturally
does spread itself around.
So it can sort of, even if you inject superficially,
go into the deeper layers, a little bit deeper.
But, if that doesn't work, we'll come back
and we'll do some deeper injections for you.
But we'll start with the superficial ones.
Hopefully we'll get it in one go.
Yep
Is that good? - Right.
- All right let's do it.
So we're going to put a bit of ice on the skin first.
Just give you a little injection.
How'd that feel, Judy?
- Very good.
It wasn't really painful at all.
It was good. - Excellent.
- Yep.
- All done.
All done, Judy.
- Thanks doctor. - A little bit worse for wear,
but it's okay (Judy laughing)
You're takin' it well.
So we'll see you in a weeks time
and we'll see how that has progressed
and we'll fast forward, show you the results.
We're back.
It's actually been five days
and we've got Judy back and,
how do you feel after the dissolving, Judy?
- Yeah, it looks really good. I'm very happy, yes.
- Tell us the things you noticed
after the injections.
- Okay well, initially I certainly noticed
that I don't, didn't have the puffiness under here.
Certainly not the way it was.
And that's pretty much gone down.
- So in the mornings, it's actually less puff now,
oh definitely.
And looking at you, it definitely looks
a lot lot better.
How 'bout now,
how do you feel about it being more hollow than before?
Is that an issue for you at the moment?
- Actually I don't,
no I didn't, I don't see it as being anything
that I need to do anything with.
It looks more normal to me.
- Okay, that's great.
So-- - What do you think?
- I think it looks great, personally.
The reason why I ask you that is because
because I haven't done this so many times,
very commonly I get a lot of patients
sort of get quite shocked at how much is dissolved
and I think because they get used to that certain norm
of being puffy and over full,
that almost becomes the norm. - Oh that's right.
- Then when you take it out,
they can't tolerate it so
they almost request to put it straight back in.
So I'm really glad that you've said that
you don't feel it's too hollow.
So it's almost like a
test question for you. - Yeah, yeah yeah.
- So you passed the test.
- Thanks!
(both laughing)
- In fact, if anything
I've noticed there's still a little ridge of maybe filler
just on the right side, right in the inside of your right
lower eyelid and
I think that might need another dissolving today.
So I'm happy to do that for you today.
But yeah, I mean clearly the bagginess is much better.
You do have a little bit of natural fat under the eye
which is still present, obviously
'cause it doesn't dissolve fat
but that, you know, is not filler now.
So it will just, maybe that tiny bit there but
overall much more natural
and I think that looks ten times better
than when I first saw you,
which looked really puffy.
- Okay.
- So this is a case in point about
how long fillers can last for
and really, you know,
I don't think it's just the tear trough area.
The tear trough area is just sort of where we can see it.
Other areas we can't see it.
But four years is probably
just the beginning of how long the filler would last for.
I think it would've gone on for five, six, seven, ten years.
And I've seen fillers last here for ten years,
or more so
I think this is real evidence
that filler lasts
more than the six to eighteen months
that we expect it to last and
the fact that we cans still dissolve it after four years,
it really shows that you know you,
that filler was sitting there all this time.
- Yeah.
- So that's quite amazing, anyway,
I'll dissolve that last bit for you
after the video, I think. - Thank you.
- But thank you for being,
for sharing you story with us, Judy.
- No problem.
- And I appreciate you coming on our video
to show the world that about your journey
with this tear trough.
- No problem.
- We'll see you next time.
(TV censor beeping)
We got our lovely patient Judy here today which
(laughing) There's gonna be like a million bloopers on this.
- I know.
(TV censor beeping) - Here, we'll do it again.
- You don't want me to wave. - Oh wave! (TV censor beeping)
Videos on...
I might start again.
(both laughing)
Okay.
(TV censor beeping)
On that day, which, with the, blah blah blah blah blah.
- With the.
- Let's start again.
- Okay. - One more time.
(TV censor beeping)
- You see reduction in some of the lines on my forehead.
- Okay.
(laughing)
- Not this one.
- Not this, that's the next.
That's the next video. (both laughing)