# Fillers: How Much Is Too Much?

An episode of [Vain-ish](https://invisiblenetwork.ai/podcast/1824105551), 24 Feb 2026, 54 min.

Audio: https://enrichment.soundstack.com/4vjqq8/episode.flightcast.com/ak1teshq5nh6zun9wrwfdlqz.mp3

Dermatologist Dr Cara McDonald explains how fillers interact with the skin and underlying facial structures - and why more isn’t always better. From overfilling and migration to the risks of under-qualified injectors, she explores perception drift, social media’s influence on our choices, and the importance of knowing when to stop. Find us on Instagram: @vainishpodcast and thanks to our guest Dr Cara McDonald Hosts: @becjudd and @jessierobertsx Producer: Liza Altarejos Audio Imager: Chris Marsh Video Producer: Justin Hill Find more great podcasts at www.listnr.com See omnystudio.com/listener for privacy information.

## Transcript

[0:02] a listener production.
[0:05] I'm Bec Judd.
[0:06] And I'm Jess Roberts.
[0:07] And we're done with the smoke and mirrors.
[0:09] Fainish shares honest stories about what it takes to look amazing because we did not wake up like this.
[0:15] And you should know the stuff that we chat about on this podcast is based on our personal experiences.
[0:21] We're sharing it for your entertainment.
[0:23] It's definitely not medical advice.
[0:26] And we'll always be clear with you when something is a paid endorsement.
[0:29] Please always chat with your qualified healthcare team before making any decisions about your health.
[0:49] Hey, I'm Jess Roberts.
[0:51] I'm Bec Judd.
[0:52] And welcome to Vanish.
[0:53] How are you doing, babe?
[0:54] I am in such a bloody good mood today.
[0:56] I can tell.
[0:56] Even in colour.
[0:57] I'm in colour.
[0:58] Yeah.
[0:59] Right?
[0:59] Hey, do you think I do that as like a subconscious thing?
[1:02] Yeah, I reckon you do.
[1:03] You wear colour when we go out to an event because you're excited.
[1:06] Yeah.
[1:07] You wear colour when we go to a rave.
[1:10] Always.
[1:10] Yeah, yeah.
[1:11] Yeah, I never wear black to a rave or a festival.
[1:13] I would never wear black to Coachella.
[1:15] No.
[1:15] Ew.
[1:16] No.
[1:17] That's sad.
[1:17] I know, but I would because I just always wear black.
[1:20] Yeah, why do you do that?
[1:21] It does look good on you.
[1:22] Do you know what?
[1:23] I think because I'm so fair in my skin, it's like a contrasting thing.
[1:27] I feel like if I'm so fair and wear light colours and I just, yeah, it does not.
[1:31] Yeah, when you wear bright colours, you're always like, oh, it's a bit bright for me.
[1:34] Do you know what you look amazing in pastels?
[1:36] Like mint, baby pink, lilac, baby blue brings out your eyes, doll.
[1:41] Right now my eyes are a bit crazy.
[1:43] But if I wore baby, like wearing those colours is fine, but you say when I have a spray tan, it looks great.
[1:47] If I didn't have a spray tan, it wouldn't look great.
[1:49] Yeah, yeah.
[1:50] When you wear butter yellow, I can't wear butter yellow.
[1:53] You can be a white girl Jess without a spray tan, wear butter yellow and look bloody good.
[1:57] Yeah, I learned that from Geri.
[1:58] Did you?
[1:59] Oh, because she got her colours done.
[2:01] Yes.
[2:01] And you're all the same colours as her.
[2:02] We're the same colours.
[2:02] Oh my God, you didn't have to pay for it.
[2:04] No, exactly.
[2:04] I got free advice.
[2:06] It was great.
[2:07] And I said, why are you happy?
[2:08] Okay, I've worked and I'm driving in today.
[2:10] I'm driving along the bay, the palm trees, the sun's out and I'm just like loving life.
[2:14] And I'm like...
[2:15] Why am I loving life today?
[2:17] Why am I in such a good mood?
[2:19] I love it and I wish I felt like this always.
[2:21] Three things I put it down to.
[2:23] First and foremost.
[2:23] Got a root.
[2:26] No, but I am up for one, Jaddy, if you're around.
[2:29] I'll text you after this.
[2:32] That's how good my mood is.
[2:34] Oh, my God.
[2:34] So good.
[2:35] So sun.
[2:36] Sun out.
[2:37] Okay.
[2:37] Sun makes me happy.
[2:38] Cloud, grey rain makes me really like sluggish and a bit icky.
[2:43] So, son, I played cardio tennis this morning and I ran so far and when I wanted to give up, I kept pushing.
[2:52] And I feel like when you push yourself through, we call it like the gray zone in our house.
[2:56] You push yourself through the gray zone, even though you feel like giving up, when you come out the other side, you feel amazing.
[3:02] How long is that grey zone for?
[3:04] I think it was about 45 minutes of running.
[3:06] But like I made sure in cardio tennis, I never stood there without moving.
[3:12] So even when I was like receiving the ball, I was like doing a little dance on the spot.
[3:15] Yeah.
[3:15] So it was like full on cardio.
[3:17] Yeah.
[3:18] Mixed with sun.
[3:18] Yeah.
[3:19] You're going to love this one.
[3:21] Mixed with?
[3:21] What?
[3:22] What?
[3:22] About day five to 14 of my cycle.
[3:25] So I'm day five.
[3:26] Okay.
[3:26] So you know when your period finishes.
[3:28] Yes.
[3:28] The good hormones kick in and you're like, I love my life.
[3:33] I love my husband.
[3:35] I love all my kids.
[3:36] She's ovulating, guys.
[3:37] I just love everyone.
[3:38] And you can all come, all four kids at once.
[3:41] You can all touch me, hang off me, want to cuddle for the next.
[3:44] Two days.
[3:45] Maybe.
[3:46] Maybe for the next week.
[3:47] Okay.
[3:48] And then.
[3:49] don't fucking touch me.
[3:49] Yeah, yeah.
[3:51] I'll bite your head off.
[3:52] Yeah, yeah.
[3:52] I get it.
[3:53] I get it.
[3:53] What is that?
[3:54] What is it about hormones that just make that kind of, at the end of your period to ovulation, that is living to me.
[4:02] I know.
[4:02] You know what?
[4:03] You've always been really good and in tune to your body.
[4:05] I would have no idea.
[4:08] my hormone levels or when my cycles do.
[4:10] I just like, I go off by everybody else's cycle.
[4:13] I've got my period.
[4:14] I'm like, oh, I have my period roughly around your time.
[4:16] So, you know, I'll go off.
[4:17] I have no idea.
[4:19] So you don't notice like the feeling of just being like more optimistic or loving or being comfortable with being touched more?
[4:28] No, don't like to be touched.
[4:30] You're just PMSing all the time.
[4:32] I'm just always angry.
[4:35] No, I just, I don't notice the shift in my hormones at all.
[4:39] I've never, never noticed.
[4:41] Never?
[4:41] Not even as a teenager in my 20s.
[4:44] I don't, there's not like two days I'm like, ooh, or you know, I'm ovulating.
[4:47] I don't even feel that.
[4:48] So you don't feel horny when you're ovulating?
[4:51] I get, I get.
[4:52] You're just horny all the time.
[4:53] I'm just horny all the time.
[4:55] Literally, that's what it is.
[4:56] I don't know.
[4:57] But you used to be like never horny.
[4:59] I know.
[4:59] And now you're always horny.
[5:00] I'm just always horny.
[5:02] So bad.
[5:02] Are we going to have to delete this?
[5:04] Nah.
[5:04] Nah.
[5:06] I just look like an epic wife right now.
[5:08] It's like, you keep that in.
[5:10] Wife goals.
[5:12] So you're grumpy and you don't like being touched, but DTF.
[5:15] I'm still witty.
[5:15] DTF.
[5:16] Always.
[5:17] Always, always, always.
[5:19] Well, I'm DTF for the next week too.
[5:21] So there you go.
[5:22] As long as the sun is shining, I've had some exercise.
[5:24] It's everybody's lucky day.
[5:26] Everyone's lucky day.
[5:28] I love that.
[5:36] So as our faces change with age, some people naturally become curious about injectable treatments.
[5:42] Oh, yeah.
[5:42] I was curious.
[5:43] I've been curious for two decades.
[5:45] Yeah, same.
[5:46] Yeah.
[5:46] And doing all the things.
[5:48] Yeah.
[5:49] So we wanted to talk about cosmetic injectables, specifically...
[5:54] dermal filler today.
[5:56] So filler's been around for a while.
[5:58] Yeah.
[5:58] Lots of people all around the world have been doing it for a very long time.
[6:02] Yours truly does it.
[6:03] Yeah.
[6:04] You've done it.
[6:04] We've all done it.
[6:05] I just did it today.
[6:06] Yeah.
[6:07] Right.
[6:08] And...
[6:09] Right now, there's so many other different products on the market.
[6:12] And depending on, you know, your social media feed and maybe experiences of your friends and family, filler, dermal filler is getting a little bit of a bad rap.
[6:22] It is.
[6:22] Right?
[6:23] And we have seen some things go wrong.
[6:24] I mean, look what happened to my under eye filler, right?
[6:26] It ended up in me having to dissolve it and then be surgically treated to kind of, I guess, treat what went wrong in the end, which was hollowness and stretch skin and...
[6:38] Filler's come a long way, but it's still, I don't know, I feel like there's a bit of a negativity around it.
[6:44] There is, and they call it filler-phobia.
[6:47] Okay.
[6:47] And so there's a term to it, and I think it is because people have had filler in areas that probably should not have had filler there, and you see migration and stuff.
[6:55] So we've got on today Dr. Cara McDonald to come in and talk about filler.
[7:00] Yeah, all the facts you need to know to make informed choices because there's still people...
[7:07] doing it.
[7:08] There's been, I guess, advances in treatment product technology.
[7:13] So she's an expert.
[7:15] We thought we'd get her on and answer all the questions we have about dermal fillers.
[7:19] Dr. Cara McDonald, welcome back to Vanish.
[7:22] Thanks for having me.
[7:23] Yeah.
[7:24] Tell us, what are your qualifications?
[7:26] Yeah.
[7:27] I am a cosmetic dermatologist.
[7:29] So as you would know, that means I studied medicine and then went on to subspecialize in dermatology and then subsequently have done further training.
[7:39] And most of my practice is now in procedural and cosmetic dermatology.
[7:43] So lasers, skin cancer surgery as well, but a lot of injectable skin treatments, skin quality, anything skin.
[7:51] Yeah.
[7:51] So in terms of
[7:53] having someone on who's an expert to talk about dermal fillers, it doesn't get more expert than you on this topic.
[8:00] Well, yes.
[8:01] You've done the 15 years training or whatever it is.
[8:03] Yeah, and I do a lot of teaching and presenting in this space as well.
[8:07] So I have literally travelled the world
[8:11] presenting and listening to other people speak on this topic.
[8:15] There's a lot of fear out there about injectable products, dermal fillers in particular, and a lot of it is warranted.
[8:22] Don't get me wrong.
[8:24] We've sort of expanded this industry so rapidly that the training and the standard of care hasn't probably kept up with where it should have.
[8:35] And so there have been a lot of problems, but there are also a lot of good things about, you know, these products.
[8:41] So I still love to talk about them.
[8:43] Yeah.
[8:44] Awesome.
[8:45] So as we get older, our faces obviously deflate and we lose a lot of collagen.
[8:50] Why is that?
[8:51] Well, much like everything in the body, you know, we just slowly deteriorate.
[8:56] But in the face, it is unique because it's exposed to the environmental ageing factors as well.
[9:01] And you can Google, you know, what the sun does to your face and you can really see it just damages the protein, damages the collagen.
[9:08] But then there are a lot of genetic factors as well, how we lose bone, where we lose bone, where we lose fat, whether we've gained weight, lost weight.
[9:16] chronic disease, stresses.
[9:18] There's all sorts of different things, but ultimately we are losing bone, which is the structural component of the face that holds everything up and out.
[9:28] We're losing or, you know, displacing our fat pads as well.
[9:31] So sometimes they've descended rather than shrunk.
[9:35] Bloody gravity.
[9:35] Yeah.
[9:36] Damn it.
[9:37] Damn it.
[9:38] And then, yeah, the skin quality changes dramatically over time.
[9:41] So there's all sorts of different things going on when we age, sadly.
[9:46] What is actually dermal filler?
[9:48] That's a great question.
[9:51] Because funnily enough, most of the time it's not injected in the dermis.
[9:55] And so it's really a misnomer.
[9:58] And when we think about injectable products in general that we use to address ageing or to address...
[10:06] you know, beautification and changing the face as well.
[10:08] I think we can broadly divide it into two groups.
[10:11] We see people who are looking for correction and restoration and they're usually trying to correct signs of ageing or slow them down, restore balance and harmony in the face.
[10:21] And then there are the group of people that are actually looking to look different.
[10:25] They're looking at what we'd call augmentation or beautification.
[10:28] So they're looking for bigger lips than they actually were born with or different cheeks or a different face-shaped bone structure.
[10:35] So they are quite different groups of people that we treat with different objectives and expectations.
[10:42] And it's important to differentiate whether you're looking for that augmentation, beautification versus, you know, managing your ageing.
[10:51] Absolutely.
[10:52] So to answer your question about what a dermal filler is, it really is a generic term to describe a group of products we inject under the skin.
[11:00] They're most commonly injected into the subcutaneous layer, which is actually the fat layer, sometimes on the supraperiosteal layer, which is actually down on the bone, sometimes in the skin.
[11:09] And they can be a product that just occupies space and gives volume or structure.
[11:15] And they can be other products such as
[11:18] products that stimulate your own cells to create more collagen or provide an environment that's more appropriate for healthy skin.
[11:26] So more hydration, nutrients, building blocks for the skin.
[11:30] And dermal fillers is really used as a generic term to encompass all those different products we use as an injectable under the skin.
[11:37] Okay.
[11:38] With the last category you mentioned, are they biostimulators or are they still dermal fillers?
[11:44] Well, they can be differentiated and broken up into dermal fillers, biostimulators, bioremodellers, bioregenerators.
[11:51] Every company kind of comes up with their own term to describe the product.
[11:54] I think that's why people get confused because they're like, what is it that they see all this stuff on Instagram?
[11:59] They're like, is it a filler?
[12:00] Is it a biostimulator?
[12:01] What is it?
[12:01] I don't know.
[12:02] And then they go to a place that might be...
[12:04] just pushing a certain product because that's what they have in stock.
[12:06] Yeah.
[12:07] So I'm so glad we've got you on to kind of break it all down.
[12:09] Exactly.
[12:09] And it is very confusing and some products are a combination of different ingredients.
[12:14] So they've got hyaluronic acid, which is your classic dermal filler, and a biostimulator mixed in the same ingredient.
[12:21] But dermal filler is a term that's often used across all of those products and...
[12:26] It's not exactly accurate.
[12:27] And most of the time when people are talking about dermal fillers, they're talking about the hyaluronic acid fillers, which are really a space-occupying filler to create structure or volume in the face where it's lost or you want it.
[12:40] Yeah, there's a few biostimulants that are...
[12:42] is hyaluronic acid.
[12:43] So I think that's where everyone gets really confused.
[12:45] Yeah, like the one I put on my neck.
[12:48] That one.
[12:48] Yes, that one.
[12:49] That's not like a filler per se that you put in your lips.
[12:51] Yes, but it's a hyaluronic acid.
[12:52] Yes.
[12:53] I wanted to ask just what we touched on before about when someone comes in because they want beautification or to feel more attractive.
[13:02] And I remember hearing or reading about, is it like the golden ratio or some triangle thing?
[13:08] What is this recipe for beauty?
[13:12] What is it?
[13:13] I love this question and I have a whole presentation on it I could give you actually.
[13:18] Because what's really fascinating is that true beauty is actually rare.
[13:24] True beauty is her favourite K-drama show.
[13:26] It's the best.
[13:27] Well, it's all about.
[13:29] Maybe not that rare.
[13:31] You're right.
[13:32] True beauty is rare.
[13:33] And it is unique.
[13:35] So it is not the same as attractive.
[13:39] And actually when we are looking at what we do to people in terms of injectables, often we are making them more attractive, definitely.
[13:48] But I would argue that we're not usually making them more beautiful anymore.
[13:52] we often make them more sort of average.
[13:54] And there's some really interesting studies where they take photographs of hundreds of people and merge them into one photo.
[14:01] And the person is extraordinarily beautiful.
[14:04] So when you average everything, it becomes sort of more beautiful.
[14:08] But it's not true beauty.
[14:10] It's not unique.
[14:11] And those people that you look at and you think they are a true beauty...
[14:15] they don't fit necessarily all the classic ratios and the things that people are trying to mimic and copy with the OG curve of the face and the correct lip ratio and the correct, you know, height of each third of the face.
[14:29] Often those people who are beautiful and stand out, they are actually a bit different.
[14:33] Yeah.
[14:33] Yes.
[14:33] It's funny.
[14:34] When we like go and see our injectors, we always go, I want a symmetrical face.
[14:39] And then a lot of injectors say, that's not beautiful.
[14:42] No.
[14:42] So it's actually a real thing.
[14:44] I agree.
[14:45] And asymmetry is actually more attractive than…
[14:48] Symmetry.
[14:49] As much as read all.
[14:50] Perfect symmetry looks weird.
[14:51] Yes.
[14:51] I've done it to my face.
[14:52] There's this app where you could get, so my left side of my face is my better side.
[14:57] It's made.
[14:57] And I've taken that and then I've flipped it.
[15:01] And it looked not good.
[15:03] It was not right.
[15:04] It was cooked.
[15:05] It was bloody cooked, mate.
[15:05] We all think we want two good sides, don't we?
[15:07] Yeah.
[15:08] But actually, you're right.
[15:09] And when people try to make your face more symmetrical, you look weird.
[15:14] It's weird.
[15:15] You don't look right.
[15:16] No, it's not pretty.
[15:17] And it's not prettier.
[15:18] And actually...
[15:19] I don't get it.
[15:20] It also means you're constantly chasing.
[15:22] You're trying to, okay, this side's a bit bigger now.
[15:24] I'll make that side a bit bigger now.
[15:26] I'll make this.
[15:26] And generally it's a very quick way to look a little bit odd.
[15:30] Okay.
[15:30] You've got to work with what you've got in front of you.
[15:33] And there are some...
[15:36] asymmetries that would be noticeable to other people, right?
[15:38] If I said to you, what's asymmetrical on Bec's face, you probably can't tell me what she would tell.
[15:44] Oh, she knows because I always point it to her.
[15:46] Okay, let's say someone else.
[15:48] Someone else, yeah.
[15:49] Well, Jess would always say to me, oh, I've got this concave...
[15:52] side of my face and I hate it and you'd always got it treated.
[15:55] Yeah.
[15:55] Different product.
[15:56] Yeah.
[15:57] I never noticed it.
[15:58] Yeah.
[15:58] Until she was always pointing it out and I'm like, oh, yeah, I see it.
[16:01] But I would never have noticed it.
[16:03] And I know the things that I've always pointed out to people about my face.
[16:07] So my left side of my face is slightly higher than my right side.
[16:10] My left eyebrows up, my left nostril slightly up.
[16:13] I've got one ear higher.
[16:14] Yeah.
[16:15] I left boobs bigger.
[16:16] That's my party boob.
[16:17] But then when I point it out to people, they're like, oh, you're right.
[16:22] They don't notice it.
[16:22] Yeah, yeah.
[16:24] So I always talk about whether it's a distracting feature or not.
[16:27] So if you've got someone who's so asymmetrical it's distracting to someone else because there are asymmetries that are distracting, then treat it.
[16:34] Absolutely.
[16:35] But if it's not a distracting feature, then generally you don't want to chase it.
[16:41] And it's funny because it is like I've got this like
[16:43] concave thing on the side of my face.
[16:45] Well, you did until you filled it up.
[16:46] I filled it up.
[16:47] But that's the thing.
[16:47] I am chasing that filler, like, you know, putting filler in that to kind of make my face more symmetrical.
[16:53] Yeah.
[16:53] And it's okay so long as, you know, you don't tip over that.
[16:56] It's a very fine line between attractive and odd.
[17:00] Yes.
[17:01] You know, and you need someone that can walk that line with you and not step over it because too many people go over it because you...
[17:10] as the patient, all of us as patients are very bad at assessing our own face.
[17:16] Yeah.
[17:16] We are terrible.
[17:17] We criticize our own faces.
[17:19] And we always put down the things we're feeling to kind of one or two things.
[17:24] So if we look in the mirror and go, oh, gosh, I feel tired.
[17:26] I look tired.
[17:27] I look old.
[17:27] Oh, my God.
[17:29] You go, oh, it must be that line there.
[17:31] That must be it.
[17:31] And you go to the injector and you say, I want this line fixed.
[17:33] And they go, yeah, sure, I'll fix the line.
[17:35] Yeah.
[17:35] But that doesn't actually account for everything you're seeing because you're not a good diagnostician.
[17:40] It doesn't actually come from one thing.
[17:44] It's the whole picture.
[17:46] And patients are very bad at looking at their whole face.
[17:49] We never do.
[17:49] We focus in on certain things we don't like.
[17:52] We've got massive negativity bias where the things we don't like outweigh the things we like.
[17:58] And the biggest disaster is going in and requesting everything we think we should have.
[18:03] because it's a very quick path to looking a bit weird.
[18:06] Yeah.
[18:07] How do you call that out with a patient who's like, I hate this line and this blood vessel and this mole?
[18:13] Well, like I said, first thing I think of is, is it distracting?
[18:17] Like, is it something that is fair and reasonable to fix and would make them happier and make them look better?
[18:23] And in that case, that's fine.
[18:25] But if not...
[18:28] I mean, I have a saying I use 18 times a day, which is it's better to look old than odd.
[18:33] Yeah.
[18:34] And most people agree with that.
[18:36] Oh, I don't know.
[18:37] I want both.
[18:39] I don't want either.
[18:40] Yeah, I don't want to be old.
[18:41] I don't want to be old.
[18:43] Is there another word?
[18:43] Is there another one that you use?
[18:46] Perfection?
[18:46] Perfection.
[18:48] Okay, yeah, that makes sense.
[18:49] You need a therapy.
[18:50] Yeah, yeah.
[18:50] You need a therapist, yeah.
[18:52] But the most important thing also is to really assess the whole face because as patients and sadly most injectors do not do that.
[19:00] A lot of injectors have a limited skill set.
[19:03] So, you know, for example, if they only really can treat cheeks and lips, that's all they're ever going to see.
[19:08] They're not going to look at how the whole face is ageing, where the balance is, where things are changing,
[19:18] restoring everything a little bit rather than just one thing.
[19:22] Because if you do one area, the first time it probably looks fine.
[19:26] If you do that same area over and over, you will look very out of balance and unusual very quickly.
[19:33] Whereas if you do a little bit everywhere...
[19:36] other areas that are less common to treat, then you'll usually maintain that balance and harmony and you can kind of put that whole brakes on aging and maintain a younger, fresher appearance.
[19:47] Yeah.
[19:48] There's a lot of talk that filler kind of moves around the face and migrates and doesn't actually dissolve.
[19:54] Is that correct or does it dissolve?
[19:56] Filler does dissolve over time, but usually over quite a long time, much, much longer than people first appreciated.
[20:06] And to some degree, we still don't know exactly how long.
[20:09] Every product varies.
[20:11] Some products are designed to stay there a long, long time and others are going to break down more quickly because of just the way they work.
[20:20] And genetics, I guess, as well.
[20:21] Yeah.
[20:22] Your body breaks it down.
[20:23] Exactly.
[20:23] And, you know, how much exercise you do, how much sun, smoking, all these things can impact it.
[20:29] But the thing about migration is that it's very poorly understood.
[20:35] Migration in 90...
[20:37] plus percent of cases is due to overfilling and placing the wrong product or placing it in the wrong layer, you know, for that product.
[20:48] And so over time, filler usually migrates if the pressure in the compartment it's in.
[20:56] is too great and it's constantly under shearing forces and tension in the face.
[21:02] And if it's just got too much in there, then it just gradually pushes it out, pump, pump, pump, as the muscles in the face and the movement happens.
[21:10] And if there's only an appropriate amount to refill that volume that's been lost in the first place, usually it doesn't migrate.
[21:20] And so it's more common when you're trying to kind of put more product in a tighter space in perhaps someone that didn't lose that volume, maybe they just never had it.
[21:29] Yeah.
[21:30] And that's where you'll see that migration.
[21:32] And most of the time people blame the product, but actually, you know, really the injectors should take the blame most of the time.
[21:40] And we're getting better at understanding how these things work.
[21:43] So there was, you know, there's a bit of catching up to do as well.
[21:46] I remember back when I first started getting filler, it was this will last 12 months, then you've got to come back for more.
[21:52] So every 12 months you'd go back for a little bit more in your cheek, a little bit more in your lips, but it hadn't really dissolved underneath.
[21:59] And then, oh, what do you know?
[22:00] I got all this migration of not just the filler that was already in my tear troughs under my eyes, but it was like the filler from my cheeks kind of migrated into those spots as well.
[22:09] And then I had this puffy face of old filler that had –
[22:14] started to draw moisture to it and get really, really puffy.
[22:18] I've shared this on my Instagram.
[22:20] It's in a highlight on my Instagram page.
[22:22] If you want to look at what happened to my overfilled filler face, jump on my profile.
[22:28] I've saved all the photos.
[22:30] I ended up needing it dissolved surgically.
[22:33] treated, fat transfer, lower blepharoplasty, upper blepharoplasty.
[22:36] We've done a potty on it.
[22:37] But I wanted to talk to Dr. Cara about physiologically what actually happened to my filler that was 10 years old because it didn't always look like that.
[22:45] The first five years looked pretty good, right?
[22:48] And then it went bad.
[22:49] This was a long time ago.
[22:51] I bet you're seeing a lot of this.
[22:52] Yeah.
[22:53] Millennials who got their tear troughs filled and now... You just said it yourself.
[22:58] It's the going back and it's getting it added to and added to that often causes the problem.
[23:05] It's like a sugar hit.
[23:06] You know, you go, you have some filler and you think, oh, I look good.
[23:10] I look better.
[23:11] That's great.
[23:12] I look amazing.
[23:12] But then we have this perception drift where that suddenly becomes our new normal.
[23:17] Yeah.
[23:18] And we start to think, oh, maybe it's all gone.
[23:21] Maybe I need some more.
[23:22] I really liked it when I had it put in.
[23:24] Perception drift.
[23:25] That's what it's called.
[23:26] Yes.
[23:26] You just, your brain plays tricks on you.
[23:30] Absolutely.
[23:31] So you go back, you want a bit more.
[23:32] And you go back, you say, I loved that.
[23:33] Yeah.
[23:34] And the injector goes, yeah, sure, let's do it again.
[23:36] Yeah.
[23:36] And...
[23:38] it very quickly becomes too much in that space.
[23:42] And as you said, people didn't appreciate how much it was breaking down.
[23:45] Injectors aren't good at saying no a lot of the time.
[23:48] Someone's there in front of them, they want the business or they're just not good at saying no to people.
[23:54] Yeah, conflict.
[23:55] It's easier to say, yeah, okay, cool, and then get them out of the chair.
[23:57] Yeah.
[23:58] Yeah.
[23:58] Then we see that over time it gets overfilled and the pressure in the compartment is too much.
[24:05] There's too much.
[24:06] You know, it's like jelly and it's all through the tissue.
[24:09] You don't want more jelly than normal flesh in there.
[24:12] Yeah.
[24:13] So you've got your fat pads, your muscles and your skin and they all become over hydrated like with water, like this kind of sponge that's oozing water out of it.
[24:22] that's when it starts to become a problem.
[24:24] As well as certain products also over time can become more hydrophilic.
[24:31] So they attract more water when they break down than they did initially.
[24:36] So that's not good.
[24:37] That's not good for filler.
[24:38] Is that because there's different brands and different
[24:41] recipes in each filler.
[24:43] Yes, absolutely.
[24:44] Every different product has a different rheology, which is what we call the science behind, as we were talking about before, how much it flows, how much it stretches, how much compression it can take before it moves, how much it sticks together.
[24:57] Some fillers, you want them to hold really tight together so that they
[25:02] maintain their shape and give you a structure.
[25:04] And others, you actually want them to spread into the tissue and kind of behave like your normal skin or normal layers.
[25:11] So every filler needs to be chosen for the area.
[25:15] It's injected for the patient, for the space.
[25:18] And a lot of the time, people just don't understand their products properly.
[25:22] And they don't understand that.
[25:25] It's not always a bad thing that that filler attracts,
[25:27] water.
[25:28] Water's great.
[25:28] I mean, we're all shoving stuff in our face to get our skin more hydrated the whole time.
[25:33] But if there's too much of it, then it becomes a massive problem.
[25:35] And you just don't want that under your eyes because that's puffy.
[25:38] But I guess maybe in another area of your face, can you give us some examples of that and the face?
[25:44] We as injectors always think in layers rather than, you know, what do I need in my forehead?
[25:48] What do I need in my cheeks?
[25:49] What do I need in my chin?
[25:51] It's more about thinking in layers.
[25:52] So first of all, think about the bone, the structure.
[25:55] And as we age, we lose bone and we lose it in different places at different speeds.
[25:59] So we lose it fastest in this sort of central cheek area, which is called the maxilla.
[26:03] This is like kind of just under your under eyes, right?
[26:05] Yeah.
[26:05] Where everyone gets very hollow.
[26:06] Exactly.
[26:07] Yeah.
[26:07] What that means is you end up looking like a bit of hound dog, like your eyelids sort of sink down, your nasolabial folds become heavy, it even contributes to jowls, and that's all from the bone that you've lost deep in the cheek.
[26:20] The bone shrinks, right?
[26:21] Yeah.
[26:22] We start doing bone grafting in our cheeks.
[26:23] Yeah.
[26:24] Well, they do do that sometimes when you have a facelift.
[26:27] Okay, all right.
[26:28] Sign up.
[26:29] Anyway, and you also lose a lot of bone around your orbit.
[26:32] So the bone that surrounds your eye socket, eyeball, and that shrinks down.
[26:38] So your eye socket becomes bigger and that's why your kind of eyes become more hollow as well and you can look kind of googly-eyed.
[26:44] You lose bone along your jawline.
[26:46] So you lose the shape of your jawline, the sharpness, the structure there.
[26:51] So they're all the kind of places that we're looking for.
[26:53] Have you lost bone?
[26:54] And then if you've lost bone, you want to use a product
[26:59] give you, it's never going to be bone.
[27:01] You don't want to inject bone into the face really because then it can be weird.
[27:07] But you want to inject something that holds its shape, holds its structure and is going to stay where you put it.
[27:13] Okay.
[27:13] So if I want a sharper jawline, I want it to stay on that jawline.
[27:17] I want it to give some structure.
[27:18] If I want volume in the mid-face, we're going to go deep.
[27:21] We want it to be down.
[27:23] If you put filler, for example, above the smiling muscles, so all the muscles that we smile with attached to our top lip, up into our face,
[27:31] And if we put filler above those muscles, so between the skin and the muscle, which is in the fat layer, every time you smile, you look like a chipmunk and your eyes get smaller, right?
[27:42] Sometimes you can see the edge of the filler, especially if you don't have a lot of natural fat.
[27:46] And those people who you feel like their cheeks are squishing their eyes shut because their filler's in the fat layer.
[27:52] But actually if you put it below the muscles, so between the muscle and the bone, and it's a product that's going to be cohesive so it sticks together and it stays there and it doesn't move, move, move,
[28:01] then actually you get that lift of everything and it repositions the tissue above it and gives you a nice kind of cheek contour without ever looking puffy.
[28:10] Yeah.
[28:11] So that's like the bone.
[28:12] Then you, same thing, you look at fat.
[28:14] Like where have we lost fat?
[28:15] We typically lose fat in the upper and outer face.
[28:18] So in the forehead, it's a great place to rejuvenate the face by using some filler that sort of basically simulates having more fat there.
[28:27] The temples, we lose muscle, we lose fat.
[28:30] The mid-face, the fat tends to actually descend rather than lose it and that's why it's more important to kind of lift it up rather than just refill those fat compartments.
[28:41] Mm.
[28:41] What about lips?
[28:43] Lips.
[28:43] So, yeah, lips, basically, we are losing the volume in the muscle and the skin.
[28:49] There's no fat layer in the lip.
[28:51] I find that amazing because all we do is talk.
[28:53] You'd think those muscles would be so strong.
[28:55] Big and bold.
[28:56] Yeah.
[28:56] Blood flowing.
[28:57] There's 200 muscles around the mouth.
[28:59] You'd think it'd just be epic all the time.
[29:00] But it's not.
[29:02] No.
[29:02] It's all sagging.
[29:03] Yeah.
[29:05] They do.
[29:05] They do.
[29:05] They shrink away.
[29:07] But a lot of the time, again, it's actually the bone around it.
[29:11] So if you lose that bone in the maxilla and the jawline and all that bone shrinks, what happens is the lips kind of shrink in on themselves.
[29:18] And one of the... God's bum.
[29:19] God.
[29:20] Yeah, and one of the commonest problems I see with lips, particularly in the slightly older people, are that their lips have disappeared.
[29:27] They've gone and had lip volume replaced, but nobody's treated the surround, which is where that's all collapsed in.
[29:35] And so then their lips look really obviously treated rather than the whole area looking rejuvenated.
[29:41] So often it's really important to put a little bit everywhere type
[29:45] philosophy rather than just treat individual bits of the face.
[29:49] And that's why that facial assessment is so crucial.
[29:51] Yeah.
[29:52] So is there parts of the face where you think filler should not go?
[29:56] That's a loaded question.
[29:59] Yeah.
[30:02] Like under eyes.
[30:02] Do you put filler in under eyes anymore?
[30:04] In the right person, yes.
[30:05] In the right.
[30:05] Okay.
[30:06] And what do they look like when they come in where you go, you're a good candidate versus you're not a good candidate, that's going to get puffy and lumpy and you're going to need it dissolved.
[30:13] Yeah.
[30:13] First of all, there's always a chance, like I'll always tell people there's a chance that the filler could change over time and that we need to do something with it down the track.
[30:23] Although I would have to say in my hands it's very, very rare that I have to dissolve anybody's filler because it's kind of become a problem.
[30:30] So if somebody has a really defined tear trough, so they really have a deep hollow in that tear trough area and their cheek structure is good, so the cheeks need to support the eye area, you only need the tiniest little bit.
[30:47] You're not trying to
[30:49] fully correct it.
[30:50] You're trying to take it from an overly hollow, distracting feature to something that's just softened.
[30:57] And I always talk about how in our children or when we're younger, everything is a smooth transition.
[31:03] So your forehead has a smooth transition to your temple and your eyelid actually has a smooth transition to your cheek and your cheek has a smooth transition to your chin.
[31:11] And then as we age, everything starts to get a bit more harsh and hard in its
[31:16] Yeah.
[31:16] So you get kind of the round forehead and then a flat temple, so you get a kind of square.
[31:21] They're quite sharp.
[31:21] An angle.
[31:22] Yeah.
[31:22] You start to get angles.
[31:23] And the eye hollowing's a big one.
[31:25] It's funny you say this because I was just looking at my kids the other day.
[31:27] I was giving them a cuddle and I was looking at my twins, Tom and Darcy.
[31:30] They're both lying on me.
[31:31] They're nine years old and I'm looking at their face structure just going, wow, like the transitions, how you call them, we're just perfection.
[31:38] Like there's no eye bags.
[31:40] It's just perfect skin, perfect contours.
[31:43] And I'm looking at them just going, I'm so jealous.
[31:46] Yeah, yeah.
[31:47] I don't look at my people saying.
[31:48] I used to look like that.
[31:49] Yeah, yeah.
[31:50] And then everything kind of sags.
[31:51] The eye hollowness with gravity just comes out.
[31:55] So if we can restore those contours, so we just take away the harsh angle.
[31:59] Whereas most people are just trying to overcorrect everything.
[32:02] And again, it's the injector's fault and the patient's fault because what happens is it's become like a McDonald's drive-through where they go and they're like, I'd like a burger and fries, please.
[32:13] And they're like, okay, here.
[32:15] Instead of going...
[32:16] What's really going on?
[32:17] What's the anatomy?
[32:19] What's the diagnosis?
[32:20] What's possible to achieve?
[32:21] What could happen if we do do what you're asking for down the track?
[32:26] If you overcorrect things or even try to get that perfect, then you're more likely to get into problems down the track rather than take the edge off things, you know, and turn it from something that you feel like that's all you see when you look in the mirror or that you can't hide with concealer.
[32:43] So if you can't hide it with concealer, usually some volume actually works.
[32:48] And you can try salmon sperm until the cows come home, but sometimes you can't get enough volume in there.
[32:54] That's what we smoke about.
[32:55] Because I had the salmon sperm, I think, three times, and it was great for skin texture, but it does nothing for volume.
[33:01] Yeah.
[33:01] Absolutely nothing.
[33:02] Skin texture, beautiful.
[33:04] Yeah.
[33:04] And I think a lot of people go into that thinking it's going to add volume.
[33:07] Going to be volume.
[33:07] It's not.
[33:08] If you're listening, salmon sperm does not add volume.
[33:10] And they think, you know, oh, well, I don't want fillers because I've heard under eye fillers are bad.
[33:14] Yeah.
[33:14] So I'll just do this instead.
[33:16] But it's not the same product.
[33:17] It's not going to achieve the same result.
[33:19] Is there a timeframe before you can fill it up again?
[33:22] It's not an exact science.
[33:24] So it depends definitely on that person.
[33:26] Sometimes you can build it up.
[33:28] I think putting too much in in one go is often also a problem because, again, you haven't let that filler integrate and sort of form
[33:37] you know, structures around it to hold it in place so it's more likely to move around.
[33:41] So sometimes you can build it up if you feel like you could achieve a better result rather than put it all in in one go.
[33:47] But on the whole, for an under eye area, it would be a few years at least before I would want to top it up.
[33:54] Okay.
[33:55] And...
[33:56] Again, I'm always about setting expectations.
[33:59] I'm not aiming for perfect.
[34:00] I'm not aiming for this hollow to be gone completely.
[34:03] You actually want a hollow.
[34:05] I mean, we spend half our lives putting bloody eye shadow on our top lid to make it look more hollow, make a shadow.
[34:11] And then if you take away that hollow completely under someone's eye, it's odd.
[34:15] They look different.
[34:16] Yeah, you're right.
[34:17] So many people chase perfection, right?
[34:19] They're on social media.
[34:20] They don't realise that half the faces they're looking at have AI filters on them.
[34:23] Yes.
[34:24] And they come in and they want to look like that.
[34:26] And if that's your mindset that you're chasing perfection, then you probably need a therapist and not a dermatologist, right?
[34:31] Because you actually, you can't achieve it.
[34:34] Even with surgery, with what all the things I've done, I've gone in going, this isn't going to be perfect.
[34:39] And it's not perfect.
[34:40] It's been an improvement for me.
[34:42] It's not like there's always, things always leave.
[34:44] There's always a side effect or there's, everything always leaves its mark.
[34:47] Wouldn't you say?
[34:48] There's
[34:49] It leaves its mark.
[34:50] So if perfection's what you're chasing, you're not going to get it.
[34:53] Yeah.
[34:54] I think everyone needs to know that.
[34:55] And also know when you're looking at an AI filter.
[34:57] If you did get perfection, it won't change your life.
[35:00] No, it won't.
[35:00] That's the other thing.
[35:01] It doesn't.
[35:01] Yeah.
[35:02] This is the thing.
[35:02] People think, oh, I need to look like this.
[35:05] Oh, I need to be perfect.
[35:07] One of the biggest issues I see is that people think what they see, everyone else will see.
[35:13] Like I was saying before with asymmetry.
[35:15] You know, you look at your under eyes and you're like, oh, my God, they're so hollow.
[35:19] But no one else would see that because it's not detracting from your face.
[35:22] It's so true.
[35:23] It's what your face is that makes you you.
[35:25] And they love you for your personality actually, not how you fucking look, all right?
[35:30] And if they don't, maybe work on that.
[35:32] You get rid of them.
[35:33] They're bad friends.
[35:34] Yeah.
[35:34] Yeah.
[35:35] Yeah.
[35:35] So what you think will change your life usually doesn't.
[35:39] Okay.
[35:39] And I think as we get older, we start to realize that more and more.
[35:43] I think it's just that whole like you're so youthful and young and gorgeous and all that.
[35:47] And then all of a sudden you wake up one day and you see fine lines.
[35:50] And I think that whole transition for that first five years of
[35:54] going, okay, I'm starting to age.
[35:56] It's a real shift in your mind.
[35:58] You just wait.
[35:59] I'm going through it now.
[36:00] Like I kind of woke up at 35 and went, oh, my God, what is this, this, this, this, this?
[36:04] Don't worry.
[36:05] At 45, you'll be like, okay.
[36:06] Yeah.
[36:07] Yeah.
[36:08] Yeah.
[36:09] I'm just going through that.
[36:10] At 45, she's going to look 25.
[36:11] Yeah, yeah, yeah.
[36:13] I'm not aging.
[36:13] I'll be a psychiatrist.
[36:23] I want to flesh out a little bit about what you said before.
[36:26] True beauty is so rare, right?
[36:29] And it got me thinking, I've written it down as a note to not let you go without talking about this.
[36:34] Remember in the 90s, the 90s supermodels were like, wow.
[36:39] So gorgeous.
[36:40] They were all copying their makeup look.
[36:41] The Cindy's, the Linda's, the Christy's, the Naomi's, the Claudia's, right?
[36:47] They were so incredible looking and so rare.
[36:51] Like women did not look like that.
[36:53] But they also all looked a bit different.
[36:55] They all looked a little bit different.
[36:56] They weren't all same, same.
[36:58] And, I mean, of course, they're six foot happy, these incredible bodies and these incredible faces.
[37:04] And there was a comment I heard from someone the other day saying, everyone's looking the same now.
[37:09] And I feel like there has been no time like there is right now where –
[37:15] People, what's that saying?
[37:16] You're not ugly, you're just poor.
[37:18] People, and there's shows like The Swan, people can, I mean, they'll never be those supermodels, but with resources, people can buy beauty.
[37:28] Oh, my God, 100%.
[37:29] Yeah.
[37:29] Look at Korea.
[37:31] Yeah, look at South Korea.
[37:31] They're all gorgeous.
[37:33] But you kind of look at befores and afters and reality TV shows and there are so many incredibly attractive, beautiful people around.
[37:43] because of biostimulators, injectable surgeries.
[37:46] And it used to be so rare and now it's bought.
[37:49] Yeah, yeah.
[37:50] Yeah.
[37:50] Everyone can look like Claudia Schiffer now.
[37:52] If you have money.
[37:54] Yeah.
[37:54] You can go in and you can order.
[37:55] Like when we're in South Korea, there's different clinics for all these different things.
[37:59] Order a face.
[38:00] You can like, you can order a face.
[38:02] What?
[38:03] I know.
[38:04] You can order eyes.
[38:06] You can change the colour of your eyes.
[38:07] You can order any nose you like, a smile.
[38:10] People love a gap.
[38:11] You can get a dentist to carve out a gap.
[38:13] I know.
[38:13] Like, you can change everything.
[38:16] What are we going to look like in the future?
[38:17] Oh, I'm not going to look like me in five years.
[38:21] But I just thought it was really interesting when you said, oh, true beauty is so rare.
[38:23] And I'm like, man, every time I go to a club or a bar and let me tell you, every chicken, there's a 10.
[38:29] I know.
[38:29] But you know what?
[38:30] True beauty like isn't natural beauty.
[38:32] It's not natural.
[38:33] It's not natural.
[38:34] So maybe that's the thing.
[38:35] Natural true beauty is so rare.
[38:38] It's so rare.
[38:38] But beauty can be bought.
[38:40] Yeah.
[38:40] Attractiveness can be bought.
[38:41] Attractiveness.
[38:42] And that's the thing.
[38:43] None of them stand out now.
[38:44] None of those people.
[38:45] Everyone looks the same.
[38:46] Like you say, it's like, oh, people look the same.
[38:48] So let's talk about risks.
[38:50] And, you know, we're talking about going into different planes and under muscles and onto bone.
[38:55] To me, I'm like, oh, there's nerves and there's so many different things there.
[38:58] What can go wrong?
[39:01] Look, there's a lot that can go wrong, but it's very uncommon.
[39:04] In the right hands.
[39:06] In the right hands, yes.
[39:08] The common risks and side effects are injection-related, so bruising, swelling, tenderness, pain, those sorts of things, which are not serious.
[39:17] The serious problems are very uncommon or rare, and they can involve inflammation of the product down the track
[39:27] And that can be like a painful, tender lump where your immune system starts reacting to the product.
[39:33] And that can be very difficult if it's hard to get rid of that product.
[39:36] So some products can be broken down and dissolved, but not everything can.
[39:41] And if you start reacting to a product that's not a dissolvable product, that's much more difficult, the product can become swollen or puffy.
[39:49] Again, at least that's a treatable issue usually.
[39:52] And then
[39:54] The most serious risk, as you were alluding to with blood vessels, is if you actually block a blood vessel with a product when you're in there, then whatever that blood vessel supplies is going to get damaged.
[40:05] So that can cause tissue damage, even vision damage to your vision if you were in the wrong area where...
[40:12] So how do you know if you've hit a blood vessel?
[40:15] Can you feel it as you go in?
[40:17] No, I mean, there's blood vessels all over the face, everywhere.
[40:20] And, you know, most of us, well, some of us have studied a lot of anatomy, but not everyone's blood vessels follow the same roadmap.
[40:28] So you need to inject as if you could be in a blood vessel at any time.
[40:31] You need to inject in a way where you are going to reduce the risk if you do hit a blood vessel.
[40:38] So for example, if you're constantly moving so that you don't dump a whole lot of product into one vessel, that's going to be much safer than if you're very still and injected into one vessel.
[40:48] But there are certain rules and techniques, of course, and we'd need a day to go through them all.
[40:55] But...
[40:56] The most important blood vessels are bigger and they are more reliable where they travel and they're in certain planes of the face.
[41:02] So you need to know where you are.
[41:04] I think that's the most critical thing where a lot of injectors are just putting their needle in.
[41:09] They don't actually know where they are under the skin.
[41:12] They don't have that feel of, okay, I've just felt a little bit of resistance.
[41:16] That was a ligament that I know I've just gone through.
[41:19] Now I'm under the muscle.
[41:20] Now I'm going to be here.
[41:21] Okay.
[41:21] It should be a slow, it should be very precise, knowing what you're doing, where you are, and thinking the whole time, could there be a blood vessel?
[41:29] If there is, am I going to avoid it?
[41:32] I think the most common complications or side effects are actually, as we talked about before, injector related.
[41:37] They're overfilling, they're migration, they're product swelling by choosing the wrong product, putting it in the wrong layer, and...
[41:47] making people look a bit weird.
[41:48] They're the most common problems and they're, you know, not serious, but they are out there.
[41:54] Yeah.
[41:55] I want to tell a personal story now about my lips.
[41:58] So I first got my lips filled with dermal filler.
[42:02] Gosh, I couldn't even tell you a long time ago, in my twenties, just a little bit.
[42:05] I'd always just get a tiny bit, tiny bit.
[42:07] And then over time- Did you have it when you had the red dress?
[42:10] No.
[42:11] Can you tell?
[42:11] Yeah.
[42:12] Have a look.
[42:12] The red is.
[42:13] There's no lips around there.
[42:16] So over time, a little bit, little bit, little bit, and then it got to a point a few years ago where it was so lumpy.
[42:25] And I've naturally got asymmetry in my bottom lip, like the left's bigger, the right's smaller.
[42:30] And...
[42:32] When I'd talk and I'd do a piece of camera, you could see like a lump on the bottom of my lip.
[42:36] So I had it all dissolved.
[42:38] And then once that had settled, we just went back in with my injector and to add some more dermal filler and kind of like start again.
[42:46] We've got a clean base.
[42:47] Let's start again.
[42:48] And what we noticed was that the filler moved to the spots where it had migrated to and almost caused like –
[42:57] a cave or for want of a better word.
[43:00] A cavity or a track.
[43:01] What's it called?
[43:02] Like a track, basically.
[43:03] A track, yeah.
[43:03] And so we tried to like pop it back in and even it out and it just went back to where it had came from.
[43:10] So we put less in so it's not lumpy, but I just thought that was really interesting.
[43:13] Do those tracks close?
[43:15] Should we have left it longer or are they permanent and that filler will always find its way to where it's been previously?
[43:21] Yeah.
[43:22] Again, we don't have good evidence, but it's not uncommon that you see that.
[43:27] And I think it is like a kind of tunnel that's been formed, but like, you know, you pierce your ear and that track stays there when you take the earring out because it's sort of healed over.
[43:37] And so it may never...
[43:39] fully closed down if you even if you left it for longer but chances are it probably would I mean the key is absolutely to be very superficial very small amounts not very much at once and usually you avoid that happening but it can certainly happen
[43:59] So we just went in so small and conservatively.
[44:02] Now I just overdraw my lips.
[44:03] I do the contour that JK came on and told us about, and I overdraw like a mofo.
[44:08] So my lips look so much bigger than they actually are now.
[44:11] It's so true when you don't have lip liner on.
[44:13] Yeah, because of those tunnels.
[44:15] I know if I put filler in, they're going to go lumpy again.
[44:17] So I'd rather not have the lumps and just paint it on with makeup.
[44:22] How can someone listening, if they've never had injectables before,
[44:28] distinguish between safe and unsafe practices when researching cosmetic injectables online or social media or when they go and see an injector.
[44:36] How do they identify risks?
[44:39] Unfortunately, this is really hard and sometimes you just don't know until it's too late, especially in Australia because we are so tightly regulated even more now than ever about what we can and can't speak about online.
[44:54] So we can't freely discuss treatments if it can look like we're
[45:00] suggesting somebody have those treatments, which is what a lot of injectors are doing if they're speaking about them.
[45:06] So we have to be very careful.
[45:08] It makes it really hard if you're a consumer trying to look for people who know what they're talking about and most people are too scared to broach the subject online.
[45:18] So most of that has to happen in a consultation.
[45:20] There are a few kind of red flags I would look for.
[45:23] I think before and after photos, everyone loves before and after photos, but they are just photoshopped.
[45:29] Well, how do you know they're not photoshopped?
[45:31] Okay, so there's many, many problems with before and after photos.
[45:35] First of all, most of them are not consistent.
[45:37] So you look at them, they've got slightly different skin colour, different lighting, magnification is different, different position of the patient, different makeup.
[45:46] Mm-hmm.
[45:47] Any inconsistency between the before and after that you can see generally makes it dodgy and you just shouldn't trust the result.
[45:55] And then even if it's a perfect match in terms of the lighting, the photo system used, everything, it's still that injector's best work ever.
[46:04] You know, they're only going to put their kind of best efforts up as a before and after.
[46:09] So going in thinking, well, that's what I can get is just fraught with danger because you're going to have a different face, different budget, and you should not rely on before and after photos for your expectations.
[46:21] So I always tread with caution when I see people kind of posting this before and afters all the time.
[46:26] You know, I think you also want to look out for people who look weird themselves as an injector.
[46:31] It's always a bit of a red flag.
[46:33] Oh, yeah, you walk in and you see some.
[46:34] Oh, yes, I've seen some.
[46:35] When the lips walk in first and you go, no, you're not touching my lips.
[46:37] Yeah.
[46:38] You are not.
[46:39] I am leaving.
[46:39] Goodbye.
[46:40] Also injectors that promote...
[46:43] certain treatments or products as the only sort of option.
[46:46] This is the only thing I'd use or this is the only one you should have or, you know, you should never have fill.
[46:51] You should only have surgery.
[46:52] Like anyone that does that, they've got an agenda and whether it's that they're being paid or whether it's that...
[46:58] They've got other bias.
[46:59] There should always be multiple options for people and it should always be a discussion.
[47:04] It should never be that black and white.
[47:06] And so that always makes me a bit concerned.
[47:09] That's a good one to know.
[47:09] That is a good one.
[47:10] Yeah.
[47:11] So the things you should be looking for is a really thorough consultation.
[47:16] That's when you're really going to be able to work out whether or not you're in the right place or not, hopefully.
[47:23] Yeah.
[47:23] And make sure that you really are given the risks.
[47:27] I see so many people when I go through their risks and complications when I'm consenting them and they're like, I was never told this before.
[47:32] I was never told that.
[47:33] And I just think you really should be told the good, the bad, and the ugly for everything.
[47:38] And what to do if something goes wrong.
[47:40] Who's going to help you?
[47:41] Who's the person that's going to fix it if something does go wrong?
[47:43] Yeah, and if something does go wrong, how do you fix it?
[47:46] Exactly.
[47:46] Yeah.
[47:47] Lastly, looking back, what are the most important lessons you wish everyone knew before considering cosmetic injectables?
[47:56] Wow, there's so many.
[47:57] I think, again, when you go to your consultation, that is the most important part of any treatment.
[48:05] And if you feel like you're going in there and you're just being given what you want, that's not a thorough consultation.
[48:13] Yeah.
[48:14] Like I said, the patient shouldn't be going in saying, I want X and Y.
[48:17] They should be going in thinking, okay, I don't like this, sure, or I feel like this, or I feel like my face is doing this.
[48:24] But you shouldn't really be going in.
[48:27] I mean, if you know you're injected and you've had, you know, 20 treatments and you're like, yeah, I'm here for this today, that's a different situation.
[48:33] But if you're going in for a consultation trying to find someone to trust and to treat you, you want to be going in and thinking
[48:41] You want to see that they are listening to you.
[48:44] What are your goals?
[48:44] What's your motivation?
[48:46] What's brought you there?
[48:47] What are you actually worried about?
[48:49] What are your expectations over the next few years?
[48:51] It's their job to work out whether they can meet your expectations, whether your expectations are reasonable, whether they need modifying, whether they need setting differently.
[49:00] and that should be very thorough.
[49:02] And then you should have a full facial assessment.
[49:04] You know, you should be told what is going on in your face.
[49:07] I mean, if someone comes in and says, I just want some anti-wrinkle in my frown, I'm like not letting them out of there before I've gone through.
[49:13] Okay, well, obviously you want that because you're seeing signs of ageing.
[49:16] So I'm going to go through what is going on in your face because this might be a two, five or ten year process.
[49:21] thought process, but you never have that opportunity to do that first consultation again and actually sit down and educate someone about their face, what actually does happen with their ageing process so that they know that just by fixing their forehead wrinkle
[49:37] It might not actually achieve what they were hoping, which was to look less tired when they look in the mirror.
[49:41] They didn't realise it was their under-eye bags or their downturned mouth or whatever else is going on.
[49:46] They just go frown, line, I need Andy Wrinkle.
[49:49] And then all of a sudden they're like, I don't feel like I look better.
[49:51] It's because no one's actually gone through what else is happening.
[49:54] And so you should have all these things explained to you during that consultation and then a thorough session about the risks and complications and side effects and what to do and where to go and how to manage it if there is a problem so you feel confident that that person is there to look after you.
[50:12] I mean, you shouldn't need to ask that many questions because you should actually think, oh, they've answered all my questions.
[50:17] Yeah.
[50:18] All the things I had.
[50:19] You know, what do I do?
[50:21] You know, what happens to it?
[50:22] Where do I go if something goes wrong?
[50:24] What's your qualification?
[50:25] You know, you should feel like, actually, I just got all that information.
[50:28] Yeah.
[50:28] So people always say, oh, what questions should I ask?
[50:31] It's like, well, hopefully you just feel like, gosh, I don't need to ask questions.
[50:35] That's what I want, you know, people to feel.
[50:37] Yeah.
[50:38] Other than that, you know, find someone you trust.
[50:40] Find someone that you really feel like they've got your best interests at heart and that you can trust them to help you make the decisions because we are not good at making our own decisions, like it or not.
[50:50] I mean, you guys are super educated in this space, but most people don't know what they don't know and the decisions they make are not usually the best for them in the medium long term.
[51:01] And I always want to be thinking, I want this person in 10 years' time
[51:08] people they don't know and for people to go, God, they look good, but I cannot tell if they've done anything.
[51:15] That's my goal.
[51:16] Want them walking out, you know, 10 years into a room going, I still love my injector.
[51:20] Yeah.
[51:22] It's so good.
[51:22] And I don't care if everyone knows I've got stuff in my face, but I don't want them to look at me and go,
[51:27] She's got it there and she's got it there because you can see it.
[51:30] As soon as you can see it, as soon as you can see what someone's done, it distracts you from actually what they look like and what they're saying.
[51:38] Can you tell me when I look like mutton's dress as lamb?
[51:40] You look like what?
[51:42] Was it mutton dressed up as lamb?
[51:43] Mutton dressed as lamb, yeah.
[51:45] I always sit there looking at myself in the mirror going,
[51:47] Do I look like that yet?
[51:48] Because sometimes I look at some women and I go, oh, my gosh, what have you done, girl?
[51:52] And then I'm like, don't let me be that person.
[51:54] And then I'm like, I don't know if I'm going to be that person because that person clearly doesn't know that they're that person.
[51:58] Yeah, and that person's friends never told them and that person's injector never told them.
[52:01] Yes.
[52:02] How does that happen that they don't know?
[52:04] I just, it blows.
[52:06] What is it?
[52:07] Perception drift.
[52:08] Yeah, perception drift.
[52:09] It must be.
[52:10] Perception drift.
[52:11] It's a thing.
[52:12] Yeah, it is.
[52:13] And we're all prone to it.
[52:14] I know.
[52:15] Perception drift, body dysmorphia.
[52:17] Yeah.
[52:18] Probably needs a therapist.
[52:20] Yeah.
[52:20] I think everyone just needs to be really honest with each other.
[52:22] Have you ever had a patient and been like, oh, no, like referred them on to therapy for their mindset and their confidence then actually treated them?
[52:33] Yes.
[52:33] Yeah.
[52:33] Yeah.
[52:34] I think if people really think that –
[52:40] something about their appearance which is not, you know, dramatic.
[52:44] You know, they weren't in a fire or, you know, have a severe scar or some sort of congenital, you know, they really think that everyone else is looking at that.
[52:55] Everyone's talking about it.
[52:56] You know, some people truly think that when you walk into a room, everyone's like, oh, my God, look how hollow she's under the eye.
[53:02] Yeah.
[53:02] You know, that kind of a level of, that is true body dysmorphia.
[53:06] I had to talk to a friend of mine off the ledge yesterday about something that I was like, babe, you can only say that.
[53:12] I cannot say that.
[53:12] I had no idea that that's there.
[53:14] I just think everyone needs to be really honest with everyone.
[53:16] Say it when you've gone too far.
[53:18] But yeah, so you have actually...
[53:20] Yeah.
[53:20] Sent people away.
[53:21] And sometimes they have realistic expectations.
[53:26] They've got really good insight.
[53:27] They're just perfectionists and type A personalities and they know that, you know, they want everything perfect.
[53:34] And that's just them.
[53:35] And other people, you know, think that it's a real problem what they're seeing in their face.
[53:41] And you are never going to be able to help those people.
[53:44] No.
[53:44] Oh, that's sad.
[53:45] Yeah.
[53:45] You're never going to make them happy.
[53:47] So the worst thing you can do is pretend you can, you know, and make them think that you're going to be able to give them the answer and fix their life.
[53:55] You're not the person they need.
[53:56] No.
[53:57] You're not the help they need.
[53:59] Yeah.
[53:59] God, I've learned so much today.
[54:01] That was awesome.
[54:01] It was really good.
[54:02] Yep.
[54:03] Thank you so much for coming on.
[54:04] Hopefully it's cleared up a few things.
[54:06] It has.
[54:06] It has.
[54:07] Thank you for having me.
[54:08] It's an absolute pleasure.
[54:09] Thanks for coming on.
[54:10] Bye for now.
[54:11] Bye.

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