Facial Fillers for Beginners (A Clinician’s Opinion)



In this video, I discuss my thoughts on facial fillers and provide insight that can help the beginner make an informed decision when consulting a proper health care provider. I pull back the veil a bit with the full intention of interrupting the cultural stigma we have created when discussing any aesthetic procedures that we do to improve our appearance, feel more confident, etc. The purpose of this video is to be as transparent with you as possible and to create a safe place for discussing all things health, wellness, beauty, and lifestyle! I touch on the history of fillers, how they work--and of course, whether or not I have experimented with it. I give you tips on how to find the right qualified injector as well. You'll want to watch the full video to get a comprehensive overview. Please feel free to share this video or comment below to keep the conversation going!


Today we are going to discuss my take on fillers and I aim to provide perspective that perhaps you haven’t heard before. This is part one of a two part series. If you missed my post on Botox, then watch it HERE. As a physician who sees patients in a medical day spa, new patients frequently ask about Botox and fillers.  My goal in this video is not to convince you that you need them or must try them. My objective is to help you understand their purpose so that you can talk intelligently about what you prefer with your practitioner or with your friends. I want to help you make more of an informed decision when considering your options and help you make an informed decision about what is best for you.  I also feel that it is important that I be transparent with my JTJ family about what I personally do, how much I do, and why I do it. I have noticed that there is a lot of stigma with my generation and older and women and men feel it is vain to discuss their aging well practices. I want to stop the stigma of Botox and fillers and create a safe, open environment for you, here on this channel.  

So, keep an open mind, and feel free to give this post a thumbs up and let’s talk needles...

Have you ever watched a reality TV show and thought to yourself, “she has too much Botox!”  Perhaps, you have thought that the reason someone’s face looks overdone is that they have had too much filler. I used to think this way.  When I first started working in the medical aesthetics realm, I didn’t realize that there is a natural-looking and a very unnatural-looking way to address aging of the face. I also didn’t realize that much of the overdone look that I see is a combination of surgical methods, implants AND too much filler. The truth is we all want to age well, we all want to be educated on what we can do, but most of us don’t know what is truly working when it comes to aesthetics. 

Fillers are certainly a controversial subject, so I want to pull back the veil a bit and allow you to make an educated decision that is best for yourself. I want us to have open discussions without shame, about what we like to do to enhance our beauty and feel more rejuvenated.


Let’s review the science of the aging face:

In our twenties and thirties, our collagen formation slows significantly and we begin breaking down our collagen about 1-2% every year. In addition, we start to lose bone density and when this happens we begin to lose the structure and foundation that our overlying tissues are supported by. To add to the fun, we have fat pads both deep and superficial that help to create volume in our face. However, they shrink as we age and start to slip as the supporting collagen fibers weaken over time. While we have 43 muscles in our face, these tend to strengthen over time while the collagen fibers of the cutaneous tissues begin to weaken over time. This allows your muscles to pull wrinkles into being.

If you think of your face as the structure of your house, we have a foundation, supporting structures, drywall, and exterior. Your bone structure is your foundation, your fat pads are your supporting and framing structures, your collagen-rich tissue is your dry wall and your skin or dermis is the paint and rooftop.

So as we address aging, we want to keep these four areas in mind and treat each area, as indicated for the individual. Just like fixing your roof when you need a new foundation is not going to provide the desired outcome, we must go to the root cause of aging when we are wanting to improve someone’s overall appearance. I hope that makes sense?


In addition to the four structures of the face (foundation, framing, dry-wall, and exterior) we also have four zones of the face: upper face, mid-face, lower-face, and submentum or chin and neck.  If we treat just one area of the face, let’s say upper face, and neglect the other three areas, we run the risk of looking 5-10 years younger in one area, and our age in the other three. This is how we unintentionally create an unnatural look. It is very important that with treating the face, that we touch on all four areas, if needed, to create the most natural, refreshed and rejuvenated appearance. 


Often times on reality TV we see duck lips, fish mouth, or monkey mouth, cat face and we are instantly turned off by the idea of fillers. I don’t blame you. I find these looks unattractive -- and while I don’t judge those who prefer these looks to a more natural appearance, it isn’t my personal taste. The beautiful thing about hyaluronic acid fillers is that your body produces this acid. It is not a “foreign substance” that your body doesn't know what to do with. And it the case of the overdone face, it is accompanied by plastic surgery or facial implants, more than fillers themselves. 


Fillers have essentially been on the market since 2003. There are some that are permanent and some that are temporary. Today, I will only be speaking about the temporary fillers (made from hyaluronic acid) as risk is much lower and technically all hyaluronic acid fillers are reversible with an enzymatic injection. So, if one hates them or there is a complication, this can be addressed. 


Fillers come in three different consistencies and include a vaseline-like consistency, a jelly consistency, and a hot honey consistency. In addition to their consistency, each filler has a different affinity for water and different performance and different flexibility. To determine what is best for you, we have to consider what we are trying to do and the outcomes that we want.  For building up structures of the face or revitalizing signs of bone loss, we may use the vaseline consistencies with very little if any affinity for water. We don’t want these areas to move. For jelly consistencies with some affinity for water, we may want to plump up some of the tissue laxity and deeper wrinkles of the face such as the nasal labial folds around the mouth or we may want to enhance any lost volume in the lips. The honey consistency is great for filling in fine lines around the mouth that prevent our lipstick from staying put or look like smoker’s lines. Some fillers last a year, some last 6 months depending upon the muscle activity in the area. 


Contrary to belief, the key to a more natural look is not determined by the amount of filler used; but rather, the technique and the proper even distribution when trying to remodel or renovate your “house”. For example, if you only fill deep lines and pain the outside of your home, you do not get to the root cause of your “tired look”. You have to create more false fat pads and rebuilding your foundation to provide support for the overlying tissue. IN the right artist's hands, you can apply a fair amount of filler and folks won’t notice anything but that you look more rested and rejuvenated. Each syringe is only about ⅕ of a teaspoon. Seriously, it is not much. So when your injector is discussing using more than one syringe, don’t be afraid that this is too much, especially, if your injector is known for creating a more natural look on his or her patients. 


What do I do? For filler, I usually take between 4-5 syringes. In fact, you can plan on about a syringe per decade of life, so at 44, 4.5-5 syringes is the perfect amount for me. I like the natural application of one syringe per cheek, ½ syringe per nasolabial fold, one syringe in my lips (because my lipstick no longer bleeds and I had full lips to begin with) and 1 syringe for my parentheses lines. The great thing is that once the swelling goes down, none of my friends or family really notice. 


It is really important that you do your research when finding an injector. Looking at yelp reviews is a good idea, going on to Real Self for recommended practitioners, or making appointments for consults, is the best method for finding your match. Start slow. After all, this is all elective. So, there is no rush. You can always add more as you dip your toes in the aesthetic waters. And if you are opposed to injectables, you can always look into facial acupuncture, PRPF injections, laser resurfacing, micro needling, ultrasound, PDO threads, and much more. The options are vast, with new options continually coming on the horizon. 

Congratulations! You made it through this video and I commend you for taking the time to educate yourself in the controversial world of injectables. Again, my goal in this video is not to convince you that you need them or must try them. I simply want to open up the conversation and help people feel more comfortable when discussing their options. I want everyone to freely ask questions in an effort to properly decide what is best for them.

Thank you so much for taking the time to watch this video. Your support means a lot to me. If you have made it through the video this far, I want to commend you, my friend. 

Don’t forget to give this video a thumbs up if you found it beneficial, share it with your friends, and subscribe for more videos like this to help you achieve optimum vibrancy and vitality!

And, as always, strive to supercharge your health by simplifying your lifestyle. 

Until the next video my friend,

Dr. Linné