Thank you for your question!
It is clear with your question that you are very upset about a situation where you believe
that there has been an over filling of filler in the skin by an expert injector and you
feel like it was botched and the question is: will overfilling result in stretching
of the skin such as that when you use hyaluronidase or something to alter the appearance, will
that be more long term or permanent?
Well, I can certainly give you some guidance in understanding this question.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years.
I’ve been using filler including the original collagen Zyderm and Zyplast.
So, I’ve been doing this for over 20 years and I have a lot of experience with a lot
of the most popular fillers from Restylane to Juvederm, Voluma, Radiesse, Sculptra.
And I can share with you some basic rules of the road which I adhere to what I think
will guide you as far as what your concerns are.
So to begin with, the questions about filler for a large percentage of our patients and
one of the areas of my practice is helping people with facial aging.
So we use a lot of filler for that in cases where we want to restore cheek volume and
jawline volume.
We actually do a procedure called the Y lift and with the Y lift, we can use a lot of filler.
Now, there’s a distinction from “overfilling”.
For example, in Y lift, we augment the cheek bones, the jawline, the vertical aspect of
the jawbone, the chin.
And you can use 2-3 syringes in one given area and what we’re doing is we’re placing
the material adjacent to the bone and below the muscle and using a fair amount.
Now of course, people don’t look overfilled.
They actually look more structurally balanced.
So, to go back to your question about the “overfilling” concern, if you are putting
the material, it depends on where in the skin you are putting it.
Are you putting it in the dermal level which is within the skin?
Are you putting it under the skin?
Are you putting it in the deeper level as we do with Y lift?
To broadly answer this question, let’s just divide the world into correction and augmentation.
It appears that what you perceive as overfilling, and it may be the case, was still intentionally
done to correct or partially enhance for example in the cheek area or even in the lip area.
It’s normal to add volume to create a correction for loss from facial aging.
When we talk about facial aging, you have to understand that you lose bone, muscle,
fat, soft tissue.
And then you want to accentuate so you add a little bit more.
Now yes, the question of age and tissue quality does come in to this situation but I would
say that even in patients who come to us for correction where they’re not happy with
the results like you and I inject not just a little but a lot of hyaluronidase to get
rid of the material, initially, the skin can look a little deflated.
But, with a little bit of time, the skin tends to retract and go back to its original position.
And this is for people who are well into their 70s.
So, I think that in your situation, finding someone who can assist you with dealing with
the “overcorrection or overfilling”, you know it’s not limited to just injectable
fillers.
We treat patients who have been “overfilled” or stretched with fat grafting, with too much
fat and people who have had other types of injectables or even implants.
So it does have to be addressed in a case by case basis.
But I would also suspect, something that also comes to mind, is that when you use injectable
fillers, the fillers are generally not that viscous or thick that they can stretch the
skin beyond a certain limit because there is a physics involved.
There is a certain amount of resistance that the skin will provide against whatever is
being pushed against.
And at a certain point beyond, the skin will push back.
Now, if you’re much older and there’s a lot of loose skin, then that’s a different
scenario.
But if overfilling and skin stretching is an issue, then my perception in the absence
of a photo is you’re basically describing an area where the skin was physically stretched
against an area where there wasn’t that room for flexibility.
In the end, you just have to think about the big picture which is really get the look that
you are setting out to get and do whatever is necessary.
There are a lot of strategies and modalities to help improve skin quality.
For example, in our practice, we help rehabilitate skin for a variety of situations with platelet-rich
plasma.
Platelet-rich plasma, derived from your own blood, stimulates your body’s collagen,
stimulates your body’s ability to generate blood supply.
We’ve had patients who have had chronic infections who had extensive operations to
treat their infections and lost significant amount of volume.
We were able to help them with platelet-rich plasma to the point where the skin looks much
healthier and has more quality and resilience.
So I would say that there are a lot of opportunities and most situations that I’ve come across
where I can help people get to where they need to be even with an undesirable outcome
in whatever situation they underwent or whatever procedures they underwent before coming to
see me.
So I think you need to meet with several doctors.
Get some opinions on what your options are.
This type of situation certainly is valid but it’s a little bit too general without
specific details of a clinical case.
It’s hard to give you a more specific answer.
So I hope that was helpful, I wish you the best of luck and thank you for your question