This column first ran in Valerie Monroe’s newsletter, How Not to F*ck Up Your Face, which you can subscribe to on Substack.
Q: Years ago I got injections in my nasolabial folds [those lines running from the sides of the nose to the corners of the mouth]. It worked like magic: I looked like me, minus five years, which is the extent of my aspirations.
Then my plastic surgeon retired.
I went to a new dermatologist. She was my age and had big cheeks. She looked good, but her cheeks were … distracting, let’s say. She tried to shift me from the nasolabial camp to the cheek-filler camp, arguing that filling the cheeks would soften the lines by lifting my whole face. She said this is the direction physicians are taking nowadays and that injecting into the lines is dated. Seems to me that getting my cheeks filled will change my face, whereas just softening those lines with a little filler will hit the mark: age 61 minus five. Do you have any insight into this somewhat confusing dilemma?
A: Because I’m fairly filler-phobic, I’m probably not the best person to answer your question (though I do have thoughts for later). So I turned to the least filler-phobic dermatologist I know: HNTFUYF DermDiva Heidi Waldorf, M.D. She happily admits to having “buckets” of filler in her face, and, believe it or not, she looks totally normal. Great, in fact. I’ve sat face-to-face with Heidi many times and, except for the fact that her face is mostly unlined at age 59, I’d never guess her stuffing isn’t her own. Here are her thoughts on the subject.
“Before discussing where to inject, I’m struck by the reader’s description of the dermatologist’s cheeks as ‘distracting.’ That’s a red flag,” she said. “It’s important you find a physician who’s not only well trained, experienced, and skillful, but also whose aesthetic matches your own. My late mom used to say, ‘The dress shouldn’t wear you.’ Similarly, people shouldn’t notice your procedures — only a more vibrant version of you.”
Getting there requires a holistic approach — which in your case means there’s no either/or cheek/nasolabial camp, said Waldorf. “It sounds like there are two problems here: The doctor’s appearance and that she hasn’t described what she’s suggesting for you in an understandable way. This is how I explain it: The goal is to balance the shape and volume of your face as a whole, which requires an examination at every single visit before treatment. If there’s volume loss in the cheeks and you simply inject the nasolabial folds, you create a doglike snout. If you inject the cheeks without addressing the central face, you create a chipmunk,” said Waldorf.
Oy, Animal Planet!
“Volume may be necessary in the temples and behind the hairline to frame the eyes, extend the side of the cheek upward, and to avoid creating a gourd shape. We see each other from the side, too, which means we have to address the cheek in front of the ears and the jawline. A shortened lower face needs support. And these areas should seem to flow together seamlessly. I tell patients I’m following their face over time. So depending on their need, I can inject different amounts in different areas each visit,” said Waldorf, with visits about four to six months apart.
“It’s also important to understand we can’t achieve a surgical facelift result with filler,” she said. “Studies show we can get small amounts of ‘lift’ of surrounding skin with filler, but we can’t lift the entire face.” Plastic surgeon Alan Matarasso notes that using filler to try to lift the face has been a trend and is often what makes people look “done,” because you can’t lift by adding volume. “Lifts lift, fillers fill!” he said. “Fillers are the icing on the cake, not the cake” — the cake being a facelift.
So how does the effect of filler work? “Much of what we do with fillers is improve light and shadows to create a lifted appearance the way we do with makeup,” said Waldorf. “What I’ve described may sound overwhelming, but it doesn’t have to be done all at once. Small amounts of filler placed strategically over time can keep you looking refreshed. Ultimately, the contour and proportions of your face are improved to create a natural appearance from all angles. That’s my goal for both my patients and myself.”
That strategy makes sense. And dear reader, you wrote that you had injections years ago; your face has likely changed since then, which means the treatment you had might not be the best for you today. Also, filler typically lasts only around 12–18 months, though there have been reports of it lasting much longer.
The larger issue for you, and for the rest of us civilians, is that most of us don’t know what’s required to actually benefit from filler injections long-term: a commitment of time, money, and, equally important, trust in a physician. How many of us are privileged enough to have an abundance of all three? (And if we are, how likely to invest our abundance in filler?)
If you’ve got the resources and the interest, I suggest you interview a number of dermatologists and plastic surgeons to find someone who not only seems more aligned with your aesthetic, but who can also explain in detail how they’ve arrived at your treatment plan and what it will require over time. Knowledge is power and it can help you make a decision you’ll be happiest with. In the meantime, you know the drill.
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