Ask a Dermatologist: Should I Get Fillers?

In this series, we explore cosmetic procedures that can help us look (and feel) refreshed as we plan for a return to normal—and excitedly anticipate the opportunities and adventures that await us

The pandemic has been full of challenges and while that toll is felt mentally, it can also manifest physically. Many of us have struggled to maintain our regular routines, while navigating the shifting circumstances influenced by public health guidelines. At this point, it seems like frown and worry lines have become permanent fixtures on our faces (and every single flaw seems to be amplified on Zoom).

But we know that when we look good, we do feel better. So we caught up with dermatologist, Dr. Marcie Ulmer from Vancouver’s Pacific Derm to discuss some popular anti-aging treatments and how to achieve the best results after these tough two years.

From fine lines and wrinkles to volume loss, there really is a solution to address every skin-care concern. If you’re interested in softening lines, minimizing shadows, lifting or enhancing specific features, here’s everything you need to know about fillers…

BCL: What are fillers and what are the benefits?

Dr. Ulmer: The most commonly used dermal fillers are gel-like materials made of hyaluronic acid (a naturally occurring substance in our bodies, including in our skin). They are injected into the skin and soft tissues to help soften wrinkles, as well as to provide and restore volume and balance to areas like the lips, cheeks, jawline and chin for a refreshed, natural and beautiful appearance. Belotero, Juvederm and Restylane are some of the well-known filler brands used in Canada.

BCL: How do you choose a filler type and what’s involved with the procedure?

Dr. Ulmer: The injectable filler products I reach for most often are hyaluronic acid fillers, which have an amazing ability to hold water and each one has its own unique properties. These unique properties help me select the right product for the right area and are critical in helping my patients achieve natural appearing outcomes.

I will choose a soft flexible filler for the lips and I will use a filler that is less soft and less flexible for contouring the jawline or chin. Most hyaluronic acid fillers today are pre-mixed with an anaesthetic that makes the injections quite comfortable. My patients generally find this procedure very tolerable without additional anaesthesia (the exception is the lips which are more sensitive, so I find applying a numbing gel beforehand is helpful).

BCL: What specific areas can be treated to improve what? And where do you typically see the best results?

Dr. Ulmer: Over time, we’ve discovered the many and diverse areas that fillers can be beneficial for—and it’s such an exciting time to be a cosmetic dermatologist. Fillers can be used:

• In the cheeks to replace lost volume, lift and subtly accentuate the cheekbone
• In the lips to define, improve volume and to bring downturned corners of the mouth back to a more neutral position
• In the chin to balance one’s profile
• In lines/folds/wrinkles to soften them (e.g. ‘marionette lines’ that run between the mouth and chin) (e.g. nasolabial folds running between the nose and the lips)
• In the temples or under the eyes for hollowing
• In the nose for improved shape and contour
• And to straighten, strengthen or better define the jawline

Fillers are also used:

• On the body for wrinkles and crepiness of the décolletage, neck or upper inner arms
• And in the hands to correct volume loss helping veins and tendons appear less prominent

If the target treatment area is not only volume deplete but also lax or sun-damaged, combination therapy is usually the best option and I will incorporate fillers in addition to other treatment modalities into my patients’ overall treatment plan.

BCL: Are there any side effects or serious risks patients should be aware of?

Dr. Ulmer: Although a commonly performed treatment that is considered to be safe, filler treatments, like any procedure have known potential risks and side effects. Not uncommon with injectable treatments, patients may experience swelling for up to a few days (particularly the lips) and some patients can develop bruising, which typically resolves in less than a week. Much more rare side effects can occur if the filler is placed into an area that inhibits blood supply to that target tissue.

Although filler treatments are considered to be cosmetic procedures, they need to be done with proper technique in a clean environment and by an injector with true expertise and detailed anatomical knowledge. A huge advantage of using hyaluronic acid fillers is that they can be dissolved at injection sites in the skin and soft tissues by an enzyme called hyaluronidase if needed. The vast majority of patients have no problems when treated by a skilled injector but if a patient has a problem they will want to know they are in the hands of someone who has the tools and knowledge to optimally manage the situation. Beautiful results are the intention and this can be safely achieved with thoughtful placement of fillers and respect for best practices.

BCL: How soon do you see the results of fillers and how long do they last?

Dr. Ulmer: Unlike Botox and other neuromodulators, you will see results immediately after having fillers. I love the moment when I hand the mirror to my patients once their filler treatment is completed and I see their smile. I am so grateful that I can help my patients in a positive way to really look and feel their best.

Temporary fillers such as hyaluronic acid fillers can last up to a year and in certain sites even longer. It may take one treatment to get optimal results, but for more extensive work you should expect more than one session. It is not uncommon for patients to underestimate the number of syringes they may need for optimal results. I like to discuss this prior to treatment. When we talk about volume, it is important to understand that one syringe of filler is 1 ml (to put this in perspective, 5 ml is a teaspoon so three syringes is just over half of a teaspoon of product which is a fairly small volume). A general rule of thumb that has been discussed (and by this I mean very general), and that I find useful to help set expectations, is that one syringe of filler is needed to replace volume lost per decade (e.g. if you are 50 years of age and have never had filler before, your cosmetic physician may initially suggest four to five syringes of filler for optimal overall improvement). Of course every patient is individual and every face is unique and a thorough consultation listening to our patients’ concerns and goals is critical in developing a treatment plan. Some patients will require more and some will require less depending on a lot of things really.

BCL: How obvious are the results from what you’ve observed and does everyone generally respond the same to fillers (are there people better suited to getting fillers)?

Dr. Ulmer: An improvement for our patients with positive change is the goal. It is my experience that the sum of subtle changes in various parts of the face make a noticeable difference in aging beautifully while maintaining facial balance and proportions over time.

I think it’s important to mention that fillers are not the only solution for everyone who desires a refresh. Patients with skin laxity hoping for tightening by way of volumization may actually be more suited for a non-surgical skin tightening procedure (such as Thermage or Ultherapy) or a combination approach, or if the laxity is significant, a surgical approach. A comprehensive consultation is essential to determine what the best treatment plan may be.

BCL: What is the cost (range)?

Dr. Ulmer: Fillers can be either charged by the syringe or by the treatment area and each clinic will do this a little differently.

BCL: When would I choose fillers versus Botox? And do the two treatments complement each other, in your opinion?

Dr. Ulmer: Filler and Botox (or other neuromodulators) are typically not a ‘one or the other’ treatment. They work very differently and are therefore often used together. While Botox helps relax muscles that cause overlying wrinkles due to repetitive contraction, filler is used for restoring volume, contouring, lifting and enhancing. Aging is multifactorial and fillers and Botox address two of these factors. I will often use them both in combination with treatments to stimulate collagen like Thermage or Ultherapy in addition to laser or IPL to improve the complexion.

BCL: A lot of people fear looking like they’ve had “work done.” How do you ensure that your patients don’t end up looking like they have fillers?

Dr. Ulmer: Injecting fillers is so much more than ‘filling’. It is my feeling that if done properly no one should ask you who does your filler because although the improvement of the filler is noticeable the filler itself is imperceptible. What I mean by this is that after having filler placed in your cheeks and lips they should be very much in proportion to the rest of the face. All features should be in balance as that is when a face is most beautiful. Beauty is very individual and it is my strong belief that the individual features of beauty should be respected. Part of what we do may be to restore and part of what we do may be to subtly enhance. Overdoing it will not only risk looking unnatural but can actually make one look older than they are by making them look like they’ve had ‘work done.’

In my opinion, the best and most natural results are achieved over a series of appointments. We are constantly aging and evolving and there is no single treatment option to address that. Having someone you trust that is on that journey with you knowing how your face is evolving can help you age gracefully and stay authentically you. It is my experience that patients bouncing between various clinics, getting mixed advice and being in multiple injectors’ hands can lead to various problems. If you are considering treatment my advice would be to find someone you feel has expertise, someone you feel aligned with and absolutely trust with your face. Once you find your skin expert, I like to think that a long and happy relationship with them will not only bring you joy but help you achieve and maintain your skin goals for many years to come.

BCL: Who would you recommend this procedure to?

Dr. Ulmer: I would recommend a detailed cosmetic consultation for someone desiring a natural appearing refresh. The application of fillers is so broad that there is no one description of the ideal patient. Patients with volume loss over time can definitely benefit but filler is used for so much more than that now (thin lips, recessed chin, hollow under eyes, crepey skin, etc.). When a patient comes into our clinic, if filler is the right procedure for that individual based on their unique needs and goals, we will formulate a comprehensive and personalized treatment plan that is designed just for them so we can help them achieve those goals.