Everything you need to know about injectables
From choosing the best doctor to the importance of taking things slow
It goes without saying that no one wants to look done. Still, we’ve all seen it, or maybe it’s even happened to us: the brow too high, too low, too frozen; the balloonish lips or Angelina-Jolie-in-Maleficent cheekbones that give the game away. Here is a person, these all-too-obvious needle- assisted interventions say, who hoped to look younger, prettier—someone who strove to arrest ageing, à la Blake Lively’s magical imperviousness to time in The Age of Adaline, or even to reverse it, like Benjamin Button—and overshot the mark.
Thankfully, as dermatologists have grown more sophisticated in their methods and the array of fillers, neurotoxins, and fat dissolvers like Kybella has become more diverse and specialized, patently obvious nonsurgical work is becoming the exception rather than the rule. (And surely, if the 9 million-plus injections done in the United States in 2015 had made us a nation of funny- faced freaks, we’d know it.) The best needle wielders now recognize that the most natural-looking effects are achieved incrementally, with tiny, almost imperceptible adjustments.
“I’m a big believer in ‘You don’t fill up the gas tank in one try,'” says Los Angeles-based dermatologist Annie Chiu, MD. “Softly adjusting gives the most beautiful results, and budget-wise it’s more reasonable as well. You can always add, but it’s harder to take away. Hyaluronic acid fillers are reversible, but you obviously don’t want to do that unless absolutely necessary.”
“I call them little tweak-bits,” says New York-based derm Dendy Engelman, MD. “This is the secret behind all the celebrities who the layperson thinks are just genetic phenoms. They are able to age beautifully because they’re not doing major overhauls. They’re not changing their faces, adding tons of volume, or erasing their expressions. They’re just focusing on tiny changes that really fly under the radar. They’re not so perceptible that it’s like, ‘Oh, she went and got her eyes done’ or ‘She’s changed her lips.’ Nobody can tell.”
Nicole Kidman’s youthful appearance has been credited to the use of cutting-edge injectables
With injectables, small hits can have a big impact—and not necessarily in the places one might expect. Engelman, for example, sometimes uses “a tiny bit of Botox at the base of the columella, which is that divider between the nostrils,” to lift the tip of the nose. “There are a lot of small physiological changes that people don’t really notice as signs of aging, which we can address,” she says. Another trick: making the eyes look bigger by injecting a baby dose of neurotoxin just underneath the eye. “If you just put one unit of Botox there,” Engelman says, “it drops the lower eyelid about one or two millimeters and opens up the aperture of the eye. So you look a little more awake, a little younger or prettier—but not noticeably different.”
In more traditionally treated areas, derms tend to stay with standard doses of Botox and fillers—”I believe that if you use too little between the eyebrows, you’re not going to prevent those etched lines from getting deeper over time,” says New York–based dermatologist Whitney Bowe, MD.
“And I find that I need to put in .1 to .2 ccs—the more traditional doses of filler—along the cheekbone in order to get the lifting effect I’m after.” But for the rest of the face, Bowe says, “I’ve completely changed my injection technique.”
To address crow’s feet, for example, Bowe “wraps” microdoses of neurotoxin—delivered with an ultrathin tuberculin needle—around the eye, starting from the tail of the eyebrow and finishing under the lower eyelid. “Instead of hitting that area with just three injections on each side, which is what was studied during FDA trials, I actually do a series of about six or seven injection sites,” she says. “That way, I get a very gentle, natural, widespread effect that opens up the eye and lightens up heavy lids. It also changes the texture of the skin in a way that traditional deeper injections don’t, because I’m actually affecting only the very superficial muscle fibers. So when people complain that they have crepey or cigarette-paper skin around the eye, it helps to smooth that out.”
Similarly, Bowe uses minuscule doses of hyaluronic acid fillers in marionette lines, smile lines, and nasolabial folds, placing them shallowly into the dermis “to gently hydrate the skin from beneath the surface.” This imparts an immediate dewy glow but also, she says, galvanizes a longer-term benefit: “It triggers your own body to make more collagen. I’m deliberately wounding the skin in tiny points down and along those lines in order to tell your body to start healing itself. I find that by doing this injection technique, I’m able to get a much more powerful preventive effect from the filler, because I’m creating ten- sion on the fibroblast cells, making them create more collagen. Again, it’s very off-label, but if I see people every three months and I use very low doses distributed in a lot of different areas, I’m able to get healthier-looking skin over time. So even after the enzymes in our bodies break down that hyaluronic acid filler, the skin looks tighter and firmer.”
The goal, always, should be natural movement (nothing should “stop you from communicating, emoting, showing sympathy or empathy or interest,” Bowe says)—even if that means leaving a few wrinkles unsmoothed and not going full throttle on a particular area, which could create, say, an overlarge lip that’s disharmonious with the rest of the face.
The downside of using injectibles
Indeed, with cruel irony, anything too heavy-handed can actually backfire and make someone’s face read as being older, rather than younger. “It’s always that fine line between doing just enough but never teetering over into too much,” Engelman says. “I think that although Kylie Jenner has had good work, she looks about 15 years older than her real age. All these young girls are doing way too much, way too early. I always say to my young patients, ‘The one thing I can’t give you is your actual youth, so you need to ride that out as long as you can. When that starts to break down—and it will—we can start to do things. But in the meantime, don’t go messing with it. If you start monkeying with it too early, it knocks you into an older-looking category.'”
When we do see overfilled or disconcertingly immobile faces, there can be several factors to blame, but it nearly always involves either an unskilled injector or an unscrupulous one who will acquiesce to patients who want—and are willing to pay for—something they don’t need. “Every time I look at celebrities who have crossed over to the dark side of doing too much, it’s not that I’m upset with them; I’m upset with the doctor who did it to them,” Engelman says. “We all know the right aesthetic.”
It’s important, therefore, to find a board-certified dermatologist or plastic surgeon who will work with you to strike the right balance—and say no to you when necessary. When Bowe encounters “millennials who come in with Instagram pictures of enormous lips,” she says, “I have to counsel them extensively about how we have to maintain the proper ratios and proportions. I can put in only a little bit of product but focus on the pillows of the lips, and give you a beautiful, sexy smirk when you’re at rest. I can turn up the corners or make the Cupid’s bow pop. It’s not about pump- ing lips full of product and giving you two big sausages.” Even when a patient does have naturally thin lips and desires a fuller pout, Bowe takes it slow: “I’d rather do a series of treatments using very small injections at a time. Someone might need two syringes to get to the point where she’s going to be happy, yes, but I’ll do one syringe, and then I’ll have the patient come back in a month or two to do the second. I like to give the tissues a chance to recover, and then evaluate.”
In general, derms are breaking away from a one-size-fits-all approach and tackling individual faces with an eye toward modest interventions that preserve idiosyncrasies and asymmetries; the goal is to make us look like better versions of ourselves, not like everyone else. “I really believe injectables are an art,” Chiu says. “Every single face is different, and there are vast differences, even culturally, in how you approach someone. It’s about enhancing—not changing.”
“When I talk to patients, new or established, I’m actually analyzing their expressions and balance and beauty,” says New York dermatologist and Mount Sinai Medical Center associate clinical professor Ellen Marmur, MD. “By the time we catch up on our news or introductions, I already have an idea of what I might like to offer. I draw out a master plan with each patient, even using an iPad painting tool on a photo of the patient. We start with baby steps and give touch-ups until we’ve achieved a uniquely personalized map of what and where to inject.”
Although it may seem counterintuitive, or even wasteful, to invest money in something so deliberately invisible, Marmur says, “economic analysis has proven that routine, under-the-radar procedures pay off over time more than the big, dramatic antiaging procedures.” No one will know how we’ve managed to sail through time so remarkably unravaged. And isn’t it better to leave them guessing?
From: Elle USA