This is the
Art Beauty podcast, where we are always reaching for truth in beauty.
Remember
the guests on the show are not paying to be here,
so we get to have honest conversations with them
because you deserve to be informed
so you can make the best choices for yourself.
With that said, I'm Amber.
And today my fabulous co-host is Dr.
Konstantin.
He is a board certified facial plastic surgeon.
He is going to be here today talking to us all
about fillers, more importantly, removing fillers.
But before we get into that, welcome to the show, Dr.
Konstantin. Great to have you here.
Thank you, Amber It's a pleasure.
Now, you are a practicing in New York, correct?
Yes, that's correct.
I practice in New York and I am specializing
in facial rejuvenation, facelifts and all the cosmetic procedures around the face.
Now, it's funny, you know, so I have to be honest.
My audience knows this.
I don't have a ton of experience myself with fillers, Botox, you know, forever.
But when when it comes to fillers, I think these days it's like,
you know, people go to med spas people go to their dermatologist,
you know, Do you feel like
that?
Probably going to a facial plastic surgeon, somebody who's
civically specializes in the face is
maybe the way to go when you go in your first time?
Well, it's definitely all those specialties are well qualified.
Cosmetic dermatology colleagues are fantastic at doing Botox and fillers.
And the reason for somebody would be
to go to a surgeon for fillers, for example, is
you might want somebody who is an expert in many different procedures
so they select the right procedure for you.
You are not necessarily you want somebody
who does something very well but doesn't really do anything else.
It's like a hammer and everything looks like a nail.
So they might take certain treatments a little too far.
Now, somebody of my specialty, when people come, we typically start them was Botox.
Then we add a little filler.
Then we might had a small surgical procedure.
Then we might recommend the bigger surgical procedure.
So it's pretty much a comprehensive care, comprehensive treatment for somebody
with who's concerned about the aging process in their face.
Amazing.
And I'm glad you brought that up, because I don't want
my audience thinking here like, well,
we going to have facial plastic surgeon that seems like overkill.
You know what?
The reason I wanted to bring you on today
is because we know it's the holiday season.
You know, I have to
imagine there's an uptick in people looking for that non-surgical
refreshment, let's say.
But I think that it is equally as important.
You know, fillers are a wonderful option, but it's equally as important to know
about dissolving fillers, about what you can do if and when they go wrong.
Am I correct?
Yes, absolutely. That's that's correct.
So dissolving and not many people actually know that we can dissolve the filler.
Dissolving the filler became very important part of the process
and of course, people use fillers when they lose volume
and they have wrinkles when they want to improve the texture
and the contour of the face and the skin,
but not necessarily
somebody would like their appearance after they'd done the filler.
So many times people feel, Well, I think my cheeks need to be a little fuller.
Let me try to put the filler there.
And they go home and in a couple of days they realize how quite like it.
This is not me. This is not my cheek.
Now, fillers, of course, would last for about a year or two after they inject it.
So somebody would just get stuck with that look that they don't like.
But fortunately, fortunately, we can dissolve.
If not all, then most of those fillers and the medication that we use
to dissolve this is called HYALINE, that's no relation to that company.
It's one of them. The other one is called by Trace
and it
became a part of this whole
remodeling of the face or filler use of fillers to rejuvenate the face
because we can adjust, we can get rid of the filler entirely.
Somebody did their lips and they realize,
I can't stand how I look on the pictures with lips like that.
Right?
We can just get rid of the filler entirely or we can gently remodel it.
We inject that certain amount of filler and the patient feels like, No,
it may be a little too much, or I want my lips to be
a little thinner on the sides and maybe slightly fuller in the middle.
We can go ahead and we can adjust those fillers by reading
the strategically removing them in some areas.
So, you know, you bring up a good point.
I want to be very clear here today.
When are the you know, when do fillers need to be dissolved?
So one of them is if perhaps it was overdone
or may be that the patient doesn't like it as much.
Are there other options that people are coming to using
when dissolving filler is the best course of action?
Well, the other situation would be medical,
of course, because fillers, just like any medication, it can have
a side effects and specifically hyaluronic acid fillers.
They attract water. Right.
And this is why they are so great,
because water gives us the plumpness and the elasticity in the skin.
But at the same time, at the same time, they can just attract too much water
to a certain area.
So people end up with maybe bags under the eyes or some swelling
in certain areas and that swelling can last as long as the filler lasts.
So for a year or two, obviously nobody wants to walk around swollen.
So then for medical reasons, we dissolve that filler
to get rid of the swelling that sometimes might come along with it.
So, you know, we're talking about fillers.
And I do know I'm glad you mentioned before, the hyaluronic acid base fillers
is that important?
Are there certain fillers
that can be dissolved and certain that cannot be dissolved?
Yes, absolutely.
So there's the whole range of fillers.
And fortunately, hyaluronic acid is the most common filler that we use.
But other ones, things like silicone permanent fillers,
which typically I don't recommend using, but in some situations,
of course, it could be appropriate.
Those fillers don't get
dissolved at all and they don't go away after they inject it.
Now, there are other fillers like a drugs
appetite that works beautifully well, but it can not be dissolved.
So before you do it,
you got to make sure that you this is the right filler for you.
And, you know exactly what you're doing.
Because if you are happy, you just cannot get rid of it.
And if you don't mind, I don't mean to put you on the spot here, but
can you mention some of the brand names of these fillers?
That may be
because I think that most people might be familiar with them a little bit better.
They can be dissolved, of course. Yes.
So Radius would be one of the fillers that cannot be dissolve.
Bellafill is another filler that's that's either
permanent or near harm or at least very long lasting.
That could not be dissolved.
Okay. And Sculptra is that another one?
Sculptra is the filler that can not be dissolved, but it's a temporary filler.
It goes away on its own.
Okay, great. Okay.
So, you know, with some of these permanent fillers,
you know, before we get on to sort of the process of dissolving,
which were the ones that you
said you don't recommend, the silicone based ones are there? Yes.
So silicone, it's could be appropriate in certain situations.
Right.
But for most people, most cosmetic patients, for people
that are interested in facial rejuvenation or slowing down the aging process,
that may not be the right filler because the face constantly changes.
And the filler that was done ten years ago
now could be completely out of place.
Doesn't serve the purpose. It doesn't belong there.
But since it's a permanent filler, you really cannot do anything with it.
You cannot get rid of it.
So that's why in those situations, silicone would not be, in
my opinion, would not be appropriate way to treat face.
And, you know, we're talking about these kind of quote unquote, permanent ones.
But for most of the hyaluronic acid fillers, they've got a lifespan
of of what, about 12 to 24 months.
Depending on the filler.
And fortunately, we have the whole range here.
So it can last from six months to two years.
Right.
And of course, those are averages because every every patient is different
and every filler may behave differently depending on the patient,
depending on the facial structure and on the purpose
and the location where we inject make it complicated enough.
Yeah.
No, I mean, well, listen, and this is why you want to go to
a qualified professional who one has a range of options available.
I always say this.
Be careful.
You know, don't go to the person who only has one laser
because they're going to push you for that laser.
You want to make sure that you're getting the right laser filler,
whatever it might be for your particular needs.
You know, when it when it comes to this idea of fillers and dissolving them now.
Right. So so what does that process look like?
And also, when should you when should you come in?
Right.
Because I know if you're a filler with most fillers,
you're going to look over swollen at first, right.
So you shouldn't go home like the next day if you wake up swollen and say, my God,
this is too much, I've got to go dissolve it. Right.
What is the guidelines for that? Yes.
So you absolutely right.
Must people and this is where I get those those calls from patients,
especially the ones that do the lip.
They called me the next morning. They say, my God, it's too much.
Can I can I come in and we get rid of it and I have to tell them, look, no,
this is just normal.
This is the swelling. It's going to be going away.
So I would definitely recommend waiting for at least a week,
preferably two weeks after you had the filler injected.
And if swelling persist beyond that time,
then you might consider dissolving the filler or not dissolving.
You have to have a discussion with the your plastic surgeon
or the dermatologist or the person who is injecting it.
And based on the experience, is a trend.
The area or give it a little bit more time.
Now, do you find that people you know, we talked about the lips
and I've heard this before, that if they call the next
if they don't call the next day and they like the way they look,
they generally they're back for more.
And in two or three weeks, once that swelling goes down.
That is absolutely true.
And I tell everybody,
if you like your lips the next day, then you have to get more of
that fullness is just going to go away over time.
Okay.
So when you're getting filler, you've done it for the first time.
There is some normal swelling.
So the recommendation is, don't freak out, this is normal.
Make sure that you wait a week or two, preferably before you consider dissolving.
That said, let's say that you're in a situation.
You're like, This doesn't look like my cheek.
This doesn't look like my lip.
I don't like the placement of this.
What is that process for?
Dissolving filler?
So when it starts was discussion, right?
So we have to sit down and talk and look at the face using the mirror,
maybe take some pictures, go over everything,
make sure we're doing the right thing, because we are not going to end up in
we don't want to end up in a situation when we put the filler
and then dissolve it and put the nasal fillers somewhere else
and then dissolve it again.
So it's not the best way to treat the face, because obviously
every time we do the injections there is a potential side effects.
So we have to make sure that we do the right thing
every time we use some kind of injection on the face.
Now, if we both certain
the doctor and the patient, we're both certain that while
esthetically it's not the best look and we do have to get through it
and then of course we go into a process of dissolving.
Typically in my office, it starts with using the numbing cream
because nobody wants to fill those benches.
And then we use a special device
that creates migration and that really helps with that pain.
I take the medication
typically a
diluted because it's I found it just works a little better
when it's not very concentrated and we inject it to the area
where I know there is filler
and this way it starts dissolving it.
Now, this medication, this enzyme, it just chops the filler
into smaller pieces and the filler gets reabsorbed.
Typically, it happens fairly quickly was in a couple of days.
That patient
should see the reduction of the swelling, and the filler is going away.
On occasion.
It gets worse before getting better, right?
So for the possibility when we it doesn't happen very often,
but sometimes when we dissolving the filler, the swelling can actually increase
for a day or two and then it starts going, okay.
I mean, I'm just thinking about all the people if you're going through this
and then it gets worse before it gets better, I'm here for you.
I feel that that must be an awful feeling.
Again, another PSA.
Why you want to go to a reputable doctor or a surgeon that you trust?
You know,
with this you mentioned before that there are some side effects.
So So what are some of the side effects
of not only getting filler but then having to dissolve it
right. So getting filler, of course,
there could be a possibility of allergic reaction,
be in any kind of,
you know, just anything that goes along with injection, things like infection.
We have to make sure that everything is sterile.
We have to make sure we inject it right, to inject it to the right place,
and then vascular occlusion is one of those dreaded complications
that happens maybe once in a million, but it's real.
So we have to be very mindful of that.
Now, dissolving the filler typically is a fairly safe process.
It's it's considered to be much safer than actually
injecting the filler, and that's pretty safe on its own.
So dissolving the filler, most we have to warn the patients
that they might get some bruising, they might get increased swelling,
they might feel a little bit of pain
for a short period of time, but then it's just going to go away.
Now, are there areas that, you know,
we mentioned that you can dissolve the hyaluronic acid based fillers
Are there areas, though, that you can't dissolve as well?
It becomes hard to dissolve old filler.
Okay.
Not necessarily specific to the area, but when the filler was placed
some time ago, maybe a year ago, and this is the reason why
I recommend people once you see the swelling
that doesn't go away, then go to the doctor and take care of it.
Because the longer
the filler sits there, the further it's going to spread throughout the tissue.
Just with normal facial movement was smiling, was talking.
The filler is just going to be moving all around all those muscles.
So finding that filler and injecting it exactly to the area
where the filler is becomes harder and harder as the time goes on.
So that can create a problem.
And sometimes people
who had the filler done two years ago and they still have swelling,
we go through rounds and rounds of those injections trying to find that
specific area where the filler sits now and where it's causing the problem.
You know, you brought up a good point because you keep mentioning
that, you know, this filler that you have to inject where the filler was.
You need to figure that out.
In general, if you are going to a doctor who you trust,
you know, not a Groupon where you got the filler
and then you go to another doctor to fix it.
But do you recommend sticking with the same doctor if you trust them,
who did the filler to also do the dissolving
because they'll at least know where it was placed?
Or can a regular can another qualified
medical professional generally be able to tell where that filler is sitting?
Yes, you are absolutely right.
So the first thing in
when somebody calls my office and say they want to dissolve filler, my
receptionist would tell them we recommend actually going to the same doctor.
But if doctor is not available or the relationship with that
doctor may be broken and people want to look for somebody else,
definitely we will help to dissolve the filler.
But the best person to dissolve it would be the doctor who injected it
because they know exactly where to place the filler and where to find it.
You know, another thing that's so interesting
is that you talk about old filler, right?
But for these hyaluronic based acids that last between you said six months
to 24 months, about two years.
Well,
I mean, shouldn't it all be gone by that point two years later?
Shouldn't there be no sort of semblance of that?
Or are there, you know, do
we need to make sure that we're keeping track of where we've had everything done?
It's unfortunately, it's not.
And here we entering
there's some some pharmacology and the concept of shelf life.
Right.
So the filler may it might take years and years
and years for the filler to go away completely.
It's just becomes less and less and less of it.
And even though the external manifestations of the filler
are pretty much gone and might be gone for a year or two,
there's still a very small amount of that filler
that could be sitting there in a tissue,
and that's going to be
getting smaller and smaller, but it still can cause the side effects such as well.
So one
thing I have to ask before I let you go is do you find, you know,
there was such a boom in fillers
and I feel like now there are you know, technology is always changing.
As a facial plastic surgeon, are there times when you would say people
to people
maybe don't get filler if you think you might need a facelift
down the road because it might cause scar tissue?
Or are there any concerns there?
You know, for somebody who's thinking about filler,
I know with threads, the reason I'm getting this, those facial threads,
I spoke to a lot of plastic surgeons who say
they won't operate and people would add threading because of the scar tissue.
So when it comes to or presents a lot of problems,
is that the same with fillers?
Is there anything that we should be thinking about
before we go for our first one.
The ending on that type of filler and depending on the area that's injected.
So certain fillers like sculpture
that you mentioned, it's known to leave the scar tissue behind.
So those fillers, definitely if somebody is considering a facelift, may not.
The idea of getting sculpture a few years before the facelift
because it could create sufficient scar tissue to cause not the problem,
but maybe some additional difficulties during the surgery.
Now, hyaluronic acid filler is considered
to be fairly benign as far as creating the scar tissue.
So the only reason not to get them is just
why spend money on something that may not be necessary.
So if you I tell my patients
if you're planning to get a facelift within six months to a year,
there is no point of doing the fillers in the cheek or around the jawline.
Right.
It's just it's just not necessary.
Why spend the money?
On the other hand, if somebody wants to get the fillers in the lid,
that would be perfectly fine if they want to get a facelift fairly soon
because one really would not affect the hazard.
I want to thank you so much for your time today.
Before I let you go, You know, are there any sort of do you have a favorite filler?
Do you have a favorite area?
Do you think that there's one thing I know, people are so different
and every face is different, but is there one that you find really
makes that wow difference?
Well, it's either the cheeks or the lips, right?
So those are the two areas that will create that Wow.
Affect them on your friends.
They will say, my God, you look good today. Right?
So and of course, in the cheeks, I in my practice
and I kind of no relation to the company I used juvederm volume up right.
And then the lips we typically use Val Bela those are two different fillers.
One is much thicker and longer lasting and then another one looks very natural.
And that's the reason why we use them in those specific areas.
Dr. Konstantin, I want to thank you so much.
I really do appreciate because I think that
some of these procedures that might not seem like a big step,
you know, can can not always work for somebody.
So it's, I think, equally as important to know, hey, can we undo this?
For clarification, Botox is not undoable, correct?
No, Botox is not undoable, but it unfortunately doesn't last quite as long.
So even if you're unhappy with the results of Botox,
all you have to do is just wait for a couple of months.
Wait it out.
Thank you so much for being with us today.
If people want to come and find you, what's the best way for them to reach you?
They can find me online.
Of course they can. Google Dr.
Konstantin, New York City, or they can call us 2123803634.
Amazing. And I will make sure to have that information
and those links in the show notes.
I want to thank you so much for being with us today.
And happy holidays to you.
Thank you. The same to you.
And if you have questions you want me to pass along to Dr.
Konstantin or his team, I'm always happy to do so.
You can email me at hello@artbeautypodcast.com.
You can find us on Facebook, Instagram and YouTube @artbeautypodcast.
And as always, we will see you next Tuesday. Bye!