How different facial fillers work

• Vanessa Lee is a cosmetic nurse and the founder of The Things We Do in Southern California.
• She injects patients with hyaluronic-acid-based fillers that can last about four years.
• Lee takes face shape, ethnicity, and physical and mental health into consideration when injecting.

Following is a transcript of the video.

Vanessa Lee: One of the biggest misconception with fillers is that if you do it once, you'll have to do it for the rest of your life, and if you don't, your face is gonna fall right to the floor. That's completely untrue.

Hi, I'm Vanessa Lee. I'm a cosmetic nurse and skin specialist, and today I'm going to show you how different fillers work on the face.

Essentially, filler is a volume inducer. So, if you're volume depleted or if your face is shifting downwards over time due to the aging process, we can add volume with hyaluronic acid or dermal fillers. Most dermal fillers are made out of hyaluronic acid. It's a sugar molecule, and it's naturally in our body and our skin. So when introducing dermal fillers into the face, your body recognizes it, and it blends in smoothly. This is a slightly thinner filler that is made to move with you really nicely when you speak. This is a filler that is meant to mimic the thick tissue on chin and cheekbones, so it builds up really nicely. Because this is a lot thinner than this filler, you can see when it spreads it holds its shape a little differently, versus this filler here wants to stay nice and high and tall.

So, start off in your consultations with really encouraging positivity. What do they love? And then from there I can go into where is balance possibly lacking, or where do they possibly see their favorite features changing? I would say the most common areas that patients request are the eyes, the cheeks, and the lips.

So, when receiving filler in the face, the initial poke feels like almost an eyebrow pluck. It's a tiny sting, and then you feel a bit of movement underneath or a cooling sensation. And then we move on to the next spot. So typically on a pain scale of maybe 0 to 10, 10 being the worst pain you've ever experienced, most of my patients feel like filler is around a 3 at worst.

So, again, working into the mid-cheek, this is going to help elevate the mid-cheek to take some of the pressure off of the nasolabial folder laugh line. We're also indirectly treating the under eye at the same time. It's really interesting to watch the needle or the cannula move underneath the skin. What the patient is experiencing is a feeling of maybe a little bit of pressure and movement and possibly also a cooling sensation because the filler is entering the tissues. But it's nothing more than that, and it definitely looks a lot more daunting from watching a video than what it actually feels like.

So, this area is very common for women noticing a drag downwards at the corner of the mouth. What I like to do is anterograde, so inject as I'm going upwards, where typically everywhere else in the face you would retrograde, inject as you're coming out.

Right here, we call this the pyriform, these shadows that come at the corners. That lifts the sides of the nose up and actually narrows the nares a little bit. And then, right underneath, this is called the anterior nasal spine, going all the way down to the bone. When we lift that underneath, what's happening is, if you can picture if I put my finger underneath her lip on the inside, we're just positioning the nose upwards, but it's filler underneath.

Lip injections tend to be the most uncomfortable injection in the entire face. And so we do make sure you receive plenty of numbing before we get to that area to bring you back to that 3 out of 10 discomfort level.

Some of the risks with filler are swelling and bruising at the site of injection. Also, we worry about the risk of infection if any bacteria is dragged into the tissues during injection. If makeup is placed on the skin after injections and it's carrying any bacteria, it can get into the skin and cause an infection. Another risk that we're worried about is very rare but is possible. It's called a vascular occlusion, which is where a little bit of filler can make its way within a blood vessel. This often happens by chance, but can happen when someone is being a little too cavalier while injecting, injecting too fast or too much in one area. What can happen, if it's not treated, is possible blindness or blurred vision. So you want to make sure, even though it's a rare complication, that your provider is equipped with the knowledge and the experience to know what to do if you have an occlusion.

Immediately after your dermal fillers, you'll see a result, but it looks better after two weeks when you've completely healed. So, post-care instructions after your fillers are make sure that you keep your skin clean for the entire day. So really avoid touching your face and make sure that you don't place on any makeup, and no firm pressure on the face for the next two weeks following.

One syringe of filler can cost anywhere from $500 to $1,000 per syringe. If someone is doing a full liquid lift, like a complete makeover, where someone is getting a nice rejuvenation of under eyes, cheeks, nasolabial folds, chin, and jawline, that can cost anywhere from $6,000 to $10,000. Those results can last up to three to four years. Now, if someone is only doing a little bit of under eye and maybe a little bit of lip, that cost might be around $2,000 or possibly a little less than that. And those results may last you up to maybe a year, two years at most. And if for whatever reason you're just not pleased with your fillers, it can be completely dissolved, which is why we use the hyaluronic acid fillers that we do use.

Our job as providers is to make sure that we're looking out for your safety first and making sure that we're enhancing and boosting your confidence, not tearing you down.