Are Fillers Over? Plastic Surgeon Explains Growing “Filler Fatigue” Trend

Monique Ramsey (00:04):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramey. So we're seeing more and more celebrities, everyday people moving away from fillers or maybe using them just a little bit less and towards sort of a more natural appearance, whether they're dissolving their fillers or they're thinking, I just don't need to have as much, and maybe I need a facelift instead. And so people are sort of rethinking their approach to aging gracefully and fillers are great in the right context. And so we're going to unpack this trend today. And I have Dr. Diana Breister, she has a specialty in facial plastic surgery, and she's a board certified plastic surgeon. And so we're going to cover everything from what you hear, filler fatigue, to dissolving fillers, to sort of the rise of younger patients getting a facelift or a mini, and thinking about their facial rejuvenation in maybe a more lasting way.

(01:06):
But one thing before we get into it, I want to encourage you to subscribe to the podcast, because we're almost to four years of doing this podcast on a weekly basis. So whether you're listening on Apple Podcasts, great, just subscribe there. Or if you're watching now, you can watch us on Spotify. So we have the video there or on YouTube. So you're going to get amazing content every single Tuesday, and I really encourage you to go ahead and watch us, listen to us, like us, subscribe us. And leave us a comment about what you want to hear about. So one of our favorite guests is Dr. Diana Breister. Welcome back to the podcast, Dr. Breister.

Dr. Breister (01:45):
Good morning.

Monique Ramsey (01:46):
The thing that made me think about this episode and really getting excited to dive into it, was there was an Impact x Nightline, and it was a Hulu, it's currently on Hulu, about facelift after fillers. And one girl said, I feel like fillers make everybody look the same. Do you think that's the case?

Dr. Breister (02:11):
I definitely think that fillers can evoke the same look in many, many women, and I think we all have seen that look. And it boils down to, I think, lips that are essentially overdone and not natural looking, followed by some higher cheekbones. And that can certainly kind of morph everyone into looking kind of like a mannequin. People kind of start looking the same, kind of like a caricature.

Monique Ramsey (02:47):
And do you think, I mean based on your experience talking to patients in consultation every day, do you feel like more people are sort of kissing the filler goodbye?

Dr. Breister (02:57):
Well, I definitely think there's been a trend maybe over the last five or six years where we see evidence of fillers that have kind of been overdone. And we see that in the mainstream media. I mean, at least in the media that women we're consuming, it catches your eye, it gets picked up. Say like, Courtney Cox is looking really weird. So oh my gosh, too much filler. I mean, I have numerous examples. I think not that long ago, Kylie Jenner was on a red carpet and she had a strange look in her upper cheek. Even Jennifer Aniston also had it. So it is becoming more apparent, there are limitations to what filler can accomplish. And it certainly can sometimes do more harm than good. It's an amazing tool, as you mentioned, but I think it has been pushed to its limits.

Monique Ramsey (03:55):
Yeah. Now, Blac Chyna, I'm going to read a quote about her. So she decided to get a facelift in her thirties because after losing weight, she felt like her face was sort of starting to look strange. She'd lost some volume from the weight loss, but then there's still some filler in there, and she just didn't think she'd looked very good. And so here's what she said. As I started to slim down, my features started to really come out like my cheekbones and everything. So with all the filler that started to really protrude out now that my face had become slimmer. So what happens to your face if you have a face full of fillers and then you lose weight

Dr. Breister (04:33):
With weight loss, whether it's Ozempic or natural weight loss, we're going to lose some facial fat. So when the face is a little more plump because you have a little few more pounds on whether it's five or 10 or 15, that's kind of serving a purpose, a pretty good purpose of giving us volume. So with her weight loss, and it looked pretty dramatic from what I could tell, I hadn't really followed her that closely, but she did look like a different person that I even remember her. So she had probably quite a bit of weight loss. So yeah, the fillers that she had don't go away when you lose weight, they stay there. So they probably became just over accentuated in the areas that didn't look natural.

Monique Ramsey (05:18):
You brought up seeing things on social media, and that's kind of where we see all these stories. And in that Hulu special, there was an influencer named Ryan Joers, and here's what he said. He said, "I had always seen on social media, other influencers. Kylie Jenner at the time was, I think 16 years old getting her lips done. And just seeing that kind of noise everywhere, seeing the influencers apply products to their lips, they were beautiful and full, and that was a big motivator" for him to get his lips done. So Dr. Breister, do you think that social media kind of plays a big role?

Dr. Breister (05:55):
Absolutely. No doubt that we are just inundated with images on every tangent, basically from skincare to lip fillers to plastic surgery. These things do influence young people tremendously. And I think that it's a conversation to be had even on a more global level, that it's about beauty and our standards. I mean, it's kind of gotten out of control. I feel sad for younger people because these images that they see over and over is constant, that you can fix yourself, you can do this, you can do that. It's a constant never ending stream of things that you can do to fix yourself. And I think it starts happening too early.

Monique Ramsey (06:42):
And I think especially for somebody like Kylie Jenner doing it, obviously she's an outlier completely because most 16 year olds aren't getting their lips done, but there's a lot of 16 year olds who are looking up to her and admiring her. And so that's a whole different conversation of what should you be doing when you're a person in the media.

(07:05):
But let's talk about migration because I saw a video yesterday where this lady's going on and on about it can migrate and dah, dah, dah. And then this surgeon came on and he's like, no, it can't. And I'm like, well, I had it migrate for me right up under my eye, and it had been seven or eight years since I'd had the filler under my eyes. I mean many years where you would've thought it was gone. But all of a sudden I was getting that with a tyndall effect where it's sort of greenish blue and weird. And I was like, what's happening? And our nice nurse injector was saying, oh, well, this is the filler. I'm like, wait, how is it still there? So we dissolved it. So let's talk about can filler migrate, and if so, where do you see that happen?

Dr. Breister (07:49):
So I believe yes, filler can absolutely migrate now. It's not the great migration, it's not going to go from one hemisphere to the other in your face. No, but it can absolutely move. I've seen filler placed in a cheekbone that can get distorted and go up or down the forehead. I mean, fillers in the forehead are just absolutely can move around. There's planes of tissue that it can freely move. So I mean, filler in the forehead is pretty uncommon, but sometimes if someone's had a little defect from an acne scar or something, we can put some filler in there, but it can move. And the eyes, the lower lids, the tear trough area, we absolutely see that sometimes in the lips, it can migrate a little bit upward into areas we don't really like. It can be very hard to control that sometimes from preventing it from going where you don't want it.

Monique Ramsey (08:45):
And so while filler is reversible like Blac Chyna, I'm going to get rid of it. I'm dissolving it all. So then what happens sort of once you're back to baseline?

Dr. Breister (08:56):
For the most part, you can dissolve the high hyaluronic acids pretty well. That's your standard Juvederm type filler, and those can definitely be dissolved. When those get dissolved I mean, they're taking up some volume, they're taking up some space. So once they completely go away, yes, there's going to be a loss of volume. There's going to be not to the point where things are hanging off your face. That's a little unrealistic. But the reason we started getting fillers was to restore a little bit of volume here and there. So once that is dissolved, those deficits are going to come back and they're going to be there, and especially if you add weight loss with that. So it's not always easy to predict where they're going to be dissolved, some places more than others. So it can be kind of tricky and a finesse type thing in dissolving them.

(09:52):
But what you really want to know or be aware of is that there will be a return of loss of volume that you may not like, and so you might want to think of another solution to compensate for that or restore it. So that's where you end up with maybe a facelift. And now facelift doesn't restore volume per se. It can reposition volume though. We can take tissues underlying and help kind of move them into places that it's a lack of volume. So a facelift can for sure, it removes skin and it can reposition the underlying structures to look a little more natural. It's now your own structure and it's not a filler per se.

Monique Ramsey (10:35):
Tell me, when you're in the OR and you're doing a facelift on someone who may have had a filler in the past or may have had a volumizer like Sculptra or bio stimulator in the past, what do you see when you get in there and is it problematic?

Dr. Breister (10:51):
What I can say is that those fillers can distort tissue a little bit, meaning they've changed the architecture and the texture of the tissues, so they can be a little more challenging to work with, but it's not impossible. It's never caused me a severe impediment, and we can kind of work around them, remove them. It's not difficult as it may sound.

Monique Ramsey (11:18):
So if you're giving advice to somebody who's maybe around 30 and they're thinking, okay, maybe I've had some Botox, but should I get fillers? So it's okay. It's not like you say, Hey, you can't have any.

Dr. Breister (11:31):
Absolutely. No, absolutely. It's okay. My advice is just be judicious. Don't overdo it. Selectively replace volume. Don't try to distort or make things bigger than they need to be. Replace the natural volume, and that should be fine. If a young person is thinking about it, I would just say, go to someone who's pretty conservative, judicious is going to give you some good advice. You don't need too much. Basically don't overdo it.

Monique Ramsey (12:03):
And are things like threads, so a lot of people get thread lifts. I've had one before and I think that thread eventually dissolves. So are thread lifts an issue for you? If somebody had a thread lift three months ago and they want to come in for facial surgery,

Dr. Breister (12:18):
I haven't encountered problems from thread lifts. Basically the thread lifts in their worst thing, they didn't do much or it didn't stick around. So I just haven't really seen that to be problematic. I think the biggest limitation of the thread is that it's not that dramatic and it doesn't stay around that long. Sometimes I will even recommend younger people who are coming in and asking for facelifts, and I think it's just a little too young. I say, look at a thread lift might be a good option for you to help reposition that volume for now. It doesn't involve a lot of cutting. We're not creating any new scar tissue. So I think the threads are pretty powerful tool in the right circumstances for someone who just isn't ready to have the amount of incisions a facelift requires.

Monique Ramsey (13:10):
One of the things about these different tools, and so whether it's Restylane or Juvederm, any of the hyaluronic acid or fillers, is that when they say it, last 12 months lasts 18 months, are we learning more now that maybe it lasts longer than that? It's not all gone at that 18 month mark?

Dr. Breister (13:31):
Yes, there's definitely, we all have different biochemistry in our bodies. So those are just generalizations. They're ranges, but it certainly can last and stick around longer than that. And like you mentioned that you even had a lump under the eye and that tyle effect, there's just like that. So the filler can remain there for a while and create more swelling around it. So it's mere presence is stimulating a reaction that it's not just all filler, it's your body's reaction to that filler. So the filler, although it is a naturally occurring molecule that we have in our body, it is something we're putting in there. So it's natural for our body to create some inflammation around it. So every person's individual reaction to that filler can be a little bit different.

Monique Ramsey (14:23):
So in the Hulu special, there's a Dr. Madnani and he mentioned that many facelift patients are opting to get things done younger in their maybe late thirties in their forties. And even the American Society of Plastic Surgeons found that in their report. And so are you seeing more younger people coming in?

Dr. Breister (14:42):
So I absolutely see younger people in the last several years coming in more aware these procedures, wanting those procedures, and I filter them very selectively. I really try to analyze what are their expectations, what is their influence? And I really try to be honest, and I really try to guide them in the right direction. And there are definitely women who can have a bit of dysmorphia when they're looking at their own face. They spend too much time just analyzing the little differences and things in that, and somehow they're under the impression that we can fix everything or there's a fix or a thing. So how young is too young? That's hard to say. I would say the youngest facelift type things I'll do is maybe in early forties, individuals can have different amount of laxity to their skin. So it's not to say that a 38-year-old may truly have some laxity because her skin is looser just genetically. So there's no age that's a cutoff. You just have to really analyze. There are lots of gals that come in and their mid thirties and they've done a lot of different things already, and it's kind of taken aback by all the different either, whether it's laser or fillers or all these things they've done already. So they're kind of, what else can I do? And I try,

Monique Ramsey (16:17):
It's like a kid in a candy store. There's so many fun things.

Dr. Breister (16:20):
I think they're starting too early. So I try to educate those women. I try to just focus on the fact that they look really beautiful and they have to slow down. They have to slow it down a little bit because there is going to be procedure fatigue, honestly. And financially how they afford all these things is kind of a mystery. But unfortunately, we're in a culture now where there's a lot of things available. There's a lot of information available. So for people who tend to be very self critical and striving for perfection gives them a lot to digest and think about.

Monique Ramsey (16:59):
So now something I've seen that you do a lot is you'll use fat in conjunction with the facelift. And so explain to the audience when you're doing a fat transfer and how that works if you're doing it at the same time as a facelift.

Dr. Breister (17:14):
So fat has, other than it being fat, we think fat is a negative thing. It's a globule of oil, but actually fat has a tremendous amount of growth factors that help stimulate collagen and stimulate rejuvenation. So fat is a wonderful tool, not only for volume, but also for rejuvenation. Think of a vampire facial where you're taking someone's blood and they're putting it topically, those factors theoretically creep in into the skin and rejuvenate. I say fat, when I'm doing a fat transfer, but there's something called micro fat and nano fat. So we have technology that can take the pieces of fat and break them down to very smaller, smaller aliquots, not as chunky, if you will. And what that is is almost like a serum that is chockfull of those factors. So I very much like to use that at the time of the facelift because we're already there. We can use that to help fill in areas that might be lack of volume. We can put that in the cheekbones sometimes in the tear troughs, nasal labial folds, marionette lines or various regal or areas that we can use that for volume. We can also use the nano fat, which is kind of more like a liquid to just inject, to help rejuvenate the skin. So it's a twofold win there. We can use it to restore volume. We can use it as a wonderful type of rejuvenation.

Monique Ramsey (18:58):
And I guess the advantage of using your own fat over a filler is that it's yours and maybe it sticks around longer, so there's no chance of rejection by the body. But then what about longevity?

Dr. Breister (19:13):
So in a fat transfer, not every single bit that we put in actually takes the fat cells have to get a blood supply. The statistics are a bit different, but anywhere from 30 to 60% of that fat should get a blood supply and be there permanently as it's transplanted, if you will. So it's a pretty good retention rate, and I think it's absolutely something worth doing in every facelift. Like I said, just for the rejuvenation, you're there anyway. It doesn't add a lot of time to the procedure. It doesn't add a lot of recovery, so it's a very powerful tool we have. And you're getting the fat from some lipo. We can't, the fat we take for the fat transfers is a pretty small amount, so it's not like two for one, if you will. I get my whole tummy lipo. We take a little bit. It doesn't make that much of a difference, but obviously you could add lipo if you wanted to. We're right there doing it, so it's pretty straightforward.

Monique Ramsey (20:20):
And so what percentage of the facial rejuvenation that you're doing with a facelift or eyelid lift, what percentage of the time are you using fat transfer at the same time?

Dr. Breister (20:33):
I'd say 60% of the time.

Monique Ramsey (20:35):
Wow.

Dr. Breister (20:37):
Yeah, yeah. A lot of them involve that, hand in hand, because most of us women as we age, why we need a facelift, we're losing volume. Not only skin is stretching out or just losing volume in certain select places. Usually this is an area where we get a little crease there that can always use a little volume. This can use a volume. Women, if they're thinner, we start losing volume in the temple area, so that's a nice area to add some fat. So it's a popular thing to do and done properly. It really goes hand in hand with the facelift.

Monique Ramsey (21:11):
Well, and if you think about a youthful face and they talk about the heart shaped face and a heart or a triangle, an upside down triangle is fuller at the top and slimmer at the bottom. And as we get older,

Dr. Breister (21:23):
That reverses.

Monique Ramsey (21:23):
The triangle is flipping upside down. So yeah, that thinking about sort of suspending re-suspending the tissues and the structures underneath the skin makes a lot of sense. And using the fat to sort of help polish it and get that glowy. I mean, I'm not naming names because I don't do that, but I know several of your patients and it's stunning to me to not just see how beautiful the facelift is, but that fat transfer on top of it is so perfect.

Dr. Breister (21:56):
What I love about it, it is very natural because it's just your own material. It's done very conservatively and it's really powerful.

Monique Ramsey (22:06):
Yeah. Well, thank you, Dr. Breister for joining us on this little fun ride to learn about facelift after fillers. And I myself had a facelift in my late thirties, and so now I'm finally 20 years later thinking about getting, okay, now I'm ready for a little something, something. But it is something that you can do when you're younger, and it depends, like you said on your tissue. My tissue was sort of maybe older than my chronological age where it was like, wow, there's fair amount of laxity here and it makes sense. But I think that the beginning to think of is having the conversation and really, because you're going to be honest and say, you know what? You're not ready yet. Maybe go upstairs and have some threads, or no, well, we could consider X, Y, or Z, and sort of make a plan. It's like you make a plan for a house renovation. You also might make a plan for surgery and how you want to do your own renovation so you can be thinking about it in terms of time.

Dr. Breister (23:07):
It's always good to have, you know information as power, so it's good to get opinions and hear it from the people who perform it, know the recovery, know the potential complications, the upsides, the downsides, so that you're informed. That's the main thing is information.

Monique Ramsey (23:25):
Absolutely. Well, thanks everybody for listening or watching today. Thanks again, Dr. Breister for joining us.

Dr. Breister (23:32):
My pleasure. Have a wonderful day. And anyone out there if they have questions or just want some opinions, come in and see me. I love to educate people and create a plan.

Announcer (23:44):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment, or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the Ximed Building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram @ljcsc. The La Jolla Cosmetic Podcast is a production of The Axis, theaxis.io.