Everything you ever wanted to know about filler, but were afraid to ask
The one that seemingly EVERYONE has an opinion on
Before I say anything else…
This post will assume that you’ve read the WTF post on filler
…and The Rules and their deep-dives
…and the Research Phase Guide to getting cosmetic work
If you haven’t yet, well…
“Doesn’t all filler always look shit?”
No.
This attitude is maddening and Does Not Reflect Real Events.
Of any procedure I’ve had, people are invariably most shocked that I get my lips done.
Please consider (re)reading this if you’ve been declaring that All Filler Always Looks Shit all over town.
Filler is undeniably higher risk than Botox, but there are great filler results out there.
Where filler is concerned, the biggest danger to your face is you,
Why does it get such bad press?
A few things:
If you’re my age (291), then your first awareness of filler was probably Meg Ryan’s ‘trout pout’2. This was not good work.
Early filler was either silicone or collagen (both often delivering sub-optimal results) until around 2003, when hyaluronic acid was approved for use as a filler and quickly eclipsed its forebears.
Filler is very easy to overdo and hard to undo. It can also hang around for a long time, usually when it’s terribly inconvenient for it to do so.
The best cosmetic work is hard to pinpoint, so it doesn’t make headlines. Anything you’re seeing in print is because it’s noteworthy, so you’re usually only being exposed to the ‘bad’ examples.
You may know people who’ve had great filler, but who aren’t open about it, often because people keep declaring that All Filler Always Looks Shit all over town.
Filler has been overused/used in unwise ways. Trial and error means that its uses have been refined, but, as above, the errors have been widely viewed.
Some (not all) of the photos that you’ve seen of celebs with suspected ‘pillow face’ (i.e. so much filler that your face looks puffy) isn’t pillow face at all and is actually post-facelift swelling.
Too many people get bad cosmetic work still3. That is more of a practitioner problem than a practice problem.
Why does it go horribly wrong sometimes?
Botox and filler are often conflated by People Who Don’t Know Better.
They do quite different things, but the biggest difference is the absorption process.
There are some Botox horror stories, but filler is far more prone to behaving unpredictably. It can ‘migrate’ - moving under the skin and creating volume where it shouldn’t - it can form lumps and it can dissolve inconsistently, leaving more volume in some places, causing asymmetry4.
If filler dissolves inconsistently, it can be very tempting to try to get more injected to even it back out. Even in the most experienced hands, this can lead to an endless cycle of asymmetry and, ultimately, Far Too Much Filler.
Also, some practitioners are doing Stupid Shit with filler, because they can and they don’t know any better.
Places you can get filler (just because you can, doesn’t mean you should)
Lips (for extra volume)
Everyone knows this one.
What you may not know:
A syringe of filler is 1ml. This (or less) is the usual total dosage for both lips. The mega lips that you’ve seen on celebs are 3ml or more. Giant, fat lips are not the inevitable outcome of lip filler.
Getting lip filler hurts like an absolute motherfucker and feels incredibly weird.
They slide the needle from the side of your mouth all along the lip line and then push it in and out, dispensing filler and manipulating with their hands to get the required shape
Sometimes a canula is used. This is also weird and not especially fun.
If you get your filler done by a doctor, you have the option of getting local anaesthetic injected before the filler.
I highly recommend this. You have slightly more risk of bruising as the doctor won’t need to stop every time you start wincing, but you will likely bruise anyway and it really is incredibly unpleasant otherwise.
If local anaesthetic is not automatically offered, ask your doctor for it. I’ve never been refused.
I’ve never been charged extra for anaesthetic either, you shouldn’t expect to be5
Lips (for fine line removal - aka lipstick/smoker lines)
Under eyes (aka tear trough)
Cheeks
Nasolabial folds (nose to mouth lines)
Marionettes lines (corners of the mouth)
Temples/forehead
All of these have been used extensively to promote a ‘fuller’ look in the face and they can plump out fine lines, reducing their appearance.
Exercise caution with filler in all of the above areas. Their usage has decreased over the last 5 years or so, with dermatologists/practitioners using lasers, microneedles and peels instead of filler to improve the appearance and/or texture of the skin in these areas.
Under eye troughs, particularly have fallen out of favour. The results often look odd; filler can end up being ‘bumpy’ because the skin is so thin and it can ultimately cause blindness. I really wouldn’t bother with this one.
Nose (aka non-surgical nosejob)
These have been rising in popularity as the marketing promises fast, long-lasting results, but - as with many applications of filler - questions are increasing about the long term efficacy/safety of this.
I have had this, and the results did not last. It was also excruciatingly painful (I mean, really. I was crying.) although I was having it in the (more painful) fleshy part of the nose, not the bridge.
As ever with noses, do not think about getting this done by anyone who isn’t a specialist ENT. Your regular cosmetic practitioner is not qualified to understand the inner structure of the nose.
Boring reminder that your ability to breathe is more important than facial symmetry/aesthetics6.
Decolletage (cleavage/chest)
Hands
The skin in both of these areas is often thinner than elsewhere in the body and gets a lot of sun exposure so is more prone to wrinkling.
Filler can restore volume to reduce the appearance of creepy skin here.
It’s effective and low-risk here, but it gets expensive as an investment over time.
Mundane advice here is to make sure you apply SPF to both daily as a preventative step rather than trying to undo the effects later.
Earlobes
FFS
If you’re contemplating earlobe augmentation and have this amount of money to spare, send it to a donkey sanctuary7 instead.
You officially have more money than sense at this point.
What to expect at the appointment
So, your Ladybird guide to filler is as follows:
Before the appointment
You have a good idea of what outcome you want, eg:
how much fullness/what effect you want in the body part you’re having injected
for lips, there are some standard shapes that it’s a good idea to be aware of (e.g. Classic, Cupid, Goddess/Rubina, Hollywood, Supermodel). Also be aware of the Paris and Russian techniques.8
You’ve read this before attending your appointment:
You arrive at the appointment without makeup on the areas that you’re having injected
At the appointment
You fill out a weirdly detailed form about your medical history
You have a good chat with your practitioner about what you want. Don’t be upsold unnecessarily, but listen to their opinions and benefit from their expertise.
They may take photos of you. Make sure these won’t be used for promotional purposes if that would bother you9
They swab your face with alcohol/antibacterial. If your face is sensitive to alcohol, mention this upfront before they start cleaning you. Bring a medicated cleanser from home if you’re super, super sensitive.
DON’T FORGET TO ASK ABOUT LOCAL ANAESTHETIC
You typically lie down. If you’re seeing someone who only has a non-reclining chair, they are probably a part-timer and I would be sceptical of them.
The injections happen (reminder: local anaesthetic would happen here10). They massage the filler around in most instances.
They will hand you a mirror and ask if you’re happy. BE VERY CAREFUL HERE.
My internal monologue is always “hmmm… is this enough? I don’t think it’s enough” and then (whether I ask for more or not) am gripped by panic for the next 96 hours that I have irretrievably ruined my face11.
If you have concerns, tell your practitioner what they are
“I don’t think it’s enough” is not a valid concern12
Things like: “I’m not sure it’s even”; “I thought it would provide more volume”; “I’d like more [in this specific place] because I think [the outcome that you’re after]
Then listen to their response and decide between you accordingly
They clean your face - possibly applying pressure if you’ve bled13
You pay and leave
After the appointment
On the day, don’t do anything that causes sweating or excessive pressure to the area(s) you’ve had injected after your appointment. It can displace the filler.
If you bruise (which is likely), I find arnica cream helps14
YOU WAIT FOR TWO WEEKS
By then any swelling should have gone down and you’ll have a good idea of your final outcome although it will keep taking effect for another week or so
Bear this in mind if you are getting filler for a specific event
If you think you have been under-filled, or that it’s not given you the effect you were hoping for, any reputable practitioner will let you go back for a free top-up.
Some will automatically schedule a follow-up 2-3 weeks after your appointment, especially if it’s your first time being injected by them
Otherwise just call and say you want an appointment for a top-up. Don’t be shy of doing this. It’s baked into the cost of your original appointment
Again, bear this in mind from a timing perspective - it’s far better to see a practitioner who is conservative and tops-up as needed rather than one who takes a more cavalier approach, but it may be that you are a month away from your desired end result, all-in.
If you want to repeat the injections, follow your practitioner’s recommendation on how soon it’s wise to receive another dose
If you go to your appointment and, once they’ve seen you, they say it’s too soon, take their advice.
Do I think you should get filler?
As ever, my answer is: If you can’t decide this for yourself, you’re not ready for any cosmetic work.
Tread carefully, make sure it’s the right procedure for the outcome that you want and do not overfill.
Until the next time x
46
Also, if you’re in the UK, Leslie Ash’s fiasco.
This provides a great overview if you want to go deeper
Please let me know if you are
I’m not messing around, this can go life-changingly wrong in inexperienced hands
Or me. I’ll use it more wisely than you, I can guarantee it.
I’m not linking to any of these because every site is an aesthetic practitioner and I’m not interested in sending you en masse to one. You have Google and a list of things to search for. Go wild in the internet aisles.
It would bother me
I know I’m really pushing the anaesthetic here, but it SHOCKS me how many people don’t ask and suffer unnecessarily.
I haven’t. I look GREAT. Ask anyone.
Luckily, I have had many years of ignoring the less helpful parts of my inner monologue
These are injections, you may bleed
I know, I know, *homeopathy eyeroll*, but it’s always worked for me, so it feels remiss not to mention