Speaker 1 (00:07):
You are listening to The La Jolla Cosmetic Podcast.

Monique Ramsey (00:14):
Welcome to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. And today I'm excited to welcome back into our studio, Julia Jowett. She's one of our injectors in our med spa and she's a seasoned injector to say the least. So Hi Julia.

Julia Jowett (00:31):
Hi. It's good to be back.

Monique Ramsey (00:32):
Good to see you. So how long have you been injecting now?

Julia Jowett (00:36):
I've been injecting for over five years and working in aesthetics for over 10 years.

Monique Ramsey (00:42):
Oh, wonderful. So today we're going to talk about lip injections, injections in general. What can go wrong when fillers go wrong? Go rogue. So we're going to kind of go into, we have some really good pictures to show, so don't leave. And if you want to hop over, hop over to YouTube if you're listening to this because we've got some really great before and afters of some starlets who've had some issues with too much filler. So let's first dive into just some basics about fillers. So why do patients typically consider lip injections?

Julia Jowett (01:17):
I think lip filler is it makes people feel more attractive. It's one of the first areas if people have never done filler before, they do a consultation, it's the first area that they ask about. It's what makes them kind of walk away feeling a little prettier, a little bit more feminine and just kind of adding to their look without changing their appearance too drastically. So I think it's a really easy area for people to wrap their brain around versus cheek filler, chin filler, something that might more drastically augment their structure of their face lip filler. It's like a little plumping. It just makes 'em feel more feminine.

Monique Ramsey (01:51):
And you just mentioned that fillers can go in other places. So tell us a little bit about where can fillers be used besides the lips?

Julia Jowett (01:59):
Fillers can be used really anywhere in the face when we do assessments for patients. Typically injectors are looking at an overall global assessment. So we're not just looking at your lips, we're looking at what's around. We're starting with temples under eyes, cheeks, nasal labial, folds, lips, chin, jawline, every kind of component. Each area ties into the next. And so you want these smooth transitions, nice structural points, nice balancing, so you really can inject filler in most areas of the face.

Monique Ramsey (02:31):
And in terms of fillers, there's a whole range. I mean there's families of fillers, there's, Juvederm has a whole collection and Restylane has a whole family of fillers. So I'm sure every injector's a little bit different. But for you specifically, do you have certain favorites for certain parts of the face or is it more that you're deciding on that patient and it's a specific to that patient?

Julia Jowett (02:57):
It's a combination and it can change by the month you ask me. I like to think of it as like, and I explained it to patients, it is overwhelming when most patients have heard of Juvederm or Restylane, and that's about as far as it goes. But then when you dive into the different types of fillers within those product lines, and then we've also come out with other product lines in the United States in the past couple of years, it gets really overwhelming, especially if you're completely new to it and you haven't had anything injected in your face. Some of the filler companies provide these really nice touch and feel boards. We have 'em in each of the treatment rooms at our office and I love that because I can actually say, squeeze this, this is Voluma, it's more firm, squeeze this. It feels like squishy jelly and based on what we're trying to do with the filler is going to dictate which product we choose. I think also from an artistic standpoint, it's nice to have your hands on all the products and really understand the feel, the push, the effect that it elicits in different types of tissue because every lip is different, every face is different and you want to kind of know what's going to give you that best result that the patient wants.

Monique Ramsey (04:02):
So is it sort of that the density is different in these?

Julia Jowett (04:07):
Think of it as like say you have a gel that's kind of just like a squishy gel and then on one end you have something that kind of spreads like honey and on the other end you have a gel that sticks to itself even when you try to stretch it out. What's that stuff we played with as kids like gagger, the little stretchy putty. That's kind of the variance in some of the properties of fillers and within each product line they have different, we describe them as the ability to withstand pressure or the ability to stick to itself or the ability to spread. And when you're putting something in an under eye where there's not a lot of space, the tissue's really thin. You want to make sure that product can spread and melt in versus if you're putting something at the edge of a jaw line, you want to make sure it gives that pop and it can withstand that pressure and show itself a little more.

Monique Ramsey (04:54):
And it doesn't move around.

Julia Jowett (04:56):
Exactly.

Monique Ramsey (04:57):
That makes a lot of sense. So fillers in general, and not all of them are, but a lot of them they'll say, so tell us about what stands for what fillers are mostly made of?

Julia Jowett (05:10):
Fillers are mostly made of hyaluronic acid and they weren't always made that way. So fillers in the beginning were more collagen based. There's even fillers now that are still collagen based and they just don't act as predictably in the tissue. They don't give that nice kind of plumping effect in the tissue. The hyaluronic acid fillers that are used especially today, are very predictable, which is nice. So they have these really well-studied products, the longevity of the products, what they do when they're in the tissue, they're made of something that your body knows how to break down, which is good. We hear about these long lasting fillers, which is great, but you don't want permanent fillers because your face changes. You change as you age and if you put something in there that's permanent, what's it going to look like in 15 years or 20 years when it's stuck in the tissue?

(05:58)
But the tissue's in a different place now. So these fillers are longer lasting, which is nice. We're talking instead of six months. It might last you one to two years and longer in some cases, but it really is something that your body recognizes. It doesn't react to it very often and it is dissolvable if for some reason there is a complication or there is a reaction, we need to take the filler out. We have medication in the office that we can use to do so. I always make patients feel more comfortable with that, especially their first time. If for some reason you hate it, which you won't, we'll go so slowly and so cautiously that I know you'll love it, but if you hate it, I can just inject something to take it away. So that's nice with fillers.

Monique Ramsey (06:39):
I think that's wonderful. And in terms of people who do want them dissolved, is it more of a case? Well, I guess there's different reasons. So one could be if they had a reaction, do people ever have a reaction or allergic reaction to an HA filler?

Julia Jowett (06:55):
So allergic reaction is pretty rare. I personally have never seen a true allergic reaction with filler. It is possible and there's also lidocaine mixed in the filler and some people have allergies to lidocaine. So there's some types of fillers we can get without the lidocaine component, but it's more of a immune response that what I've seen in practice and a little bit more common is immune response further down the line. So say you have this gel injected into your body and then six months from now you get really sick with an upper respiratory infection and your immune system is like looking for this virus, it is looking to fight it. Everything is flared. It's going to say, what is this filler here? I don't really recognize this. This isn't my own body and it causes inflammation and that inflammation can be just swollen for a couple days.

(07:44)
That inflammation can potentially create more of a nodule. In the cases that I've seen in practice, and this is probably two to three in the almost six years that I've been injecting, they just resolve on their own when the illness recovers. But it is possible to have a reaction and have an immune response reaction to that. And patients that have autoimmune disorders or things that their immune system might be a little bit more reactive to things, we take that into consideration. You can always start small with a smaller amount or with a less reactive product than some of the other products that are available.

Monique Ramsey (08:17):
And that's why I think it's so important that we as consumers, we can go do a lot of research on our own, but really at the end of the day it's talking with you as an expert who can you have all this knowledge of maybe my particular health situation and how do we go to get me the best product because not only does it need to be the right product for that body area, but also for me, each person individually and their own health.

Julia Jowett (08:47):
Absolutely.

Monique Ramsey (08:49):
And I do remember the days with collagen in the early nineties. Yes, it was collagen, you had have a test, it was coming from cows, I think bovine collagen and you had to wait 30 days to see if you were allergic to it.

Julia Jowett (09:04):
There's still a product on the market today and we offer it to patients in the clinic on a case by case basis that request it, Bellafil, which used to be Artefil. And there are patients that love that product. There's also patients I've seen, not to bash it, but I think over time maybe when it first came out they had it injected and over time they just don't love the way it looks. But there's nothing that can be done because those little microspheres stay in the skin and you can't dissolve it. It's just surgical excision. So in my practice I only use HA products unless I'm using something like Sculptra or it's more boosting collagen. But especially in lips, especially in under eyes where the tissue is really delicate, it's really important. It's, it's very important to use something that's dissolvable like an HA filler.

Monique Ramsey (09:49):
Now in terms of fillers, I know they're all slightly different, but how long in general can people expect them to last?

Julia Jowett (09:56):
I think in general for lips specifically, the timeline I would expect is six to 12 months. That's just what I see no matter what product is used. With that said, there are these one end of the spectrum where I have patients come back and they feel like they're chomping at the bits to try to get even before six months because they have a high metabolism. No matter what product we use, they kind of eat away at it. They might be the same way with their neuromodulators. They just feel like they burn through things. There's other patients where I'm like, I did your lips two years ago and they still look wonderful and you don't need anything and it just stays in the tissue. And in other areas of the face, I find that it can last even longer. That's not to say it's going to have the full effect it did when it was injected or even a year or two after it was injected.

(10:37)
But you look at these before and afters the patients and you're like four years ago this was your baseline and now I haven't injected your under eyes in two to three years and you still clearly have volume there and it looks really good and refreshed and we don't need to add anything more there. So I think there's definitely this compounding effect of over time some of that product stays there. So maybe instead of needing a syringe every six to 12 months, you need to half syringe or you need some of that put in different area of the face to compliment it.

Monique Ramsey (11:04):
Yeah. Now in terms of we see in aesthetic medicine, whether it's plastic surgery or the med spa type procedures, we always see trends. And so tell us a little bit, Julia, about some of the hottest trends in injectables right now.

Julia Jowett (11:23):
Okay, so I am very proud to say that I don't even have to think about this answer because it is the number one thing people ask is to look natural right now. And people are not coming in at least our practice asking for the Russian lip or the overfilled make me look like the celebrity or that celebrity. I'm not hearing that anymore. I am hearing overwhelmingly, I want to look like myself. I want to look natural. I don't want people to be able to tell, I just want to feel better about myself. And that is the best trend we could have asked for because that is going to make this not scary to people that are new to it. When you look at your neighbor and you just say, you look great, you're not like, oh my gosh, she had her lips done with that weird technique, taping it up and people aren't asking for those. I think that there's people out there doing them, and I'm sure in some places that is requested, but it is just the most common trend I see. And I'm so excited about that. I'm so excited. I can sit here and say that 10 out of 10 consults on most days are asking to look natural.

Monique Ramsey (12:21):
That's a wonderful thing. I think that's how you say if you've never done a filler, we always, our mind goes to the most extreme in the media. I saw this. So one of the things that, we talked a little bit about some of the common complications, but I would say from the patient point of view, almost the complication or the one thing they don't want, do you hear this every day? I don't want to have duck lips. So how do you as an injector avoid that or how does a patient know to not get that, I guess.

Julia Jowett (12:56):
I mean it's the second most common thing patients will say, they'll say, I want to look natural. I don't want to have duck lips. My husband, my boyfriend would kill me if I came home with duck lips. And it's just kind of notorious for lip filler that gone wrong. What you'll see happen with lip filler is most people, when they want to enhance their lips, they're either just hoping to add a little bit of volume or they want a little tiny bit of e-version, having their lips show a little bit more, but they don't want it to project out. And really when you look at your side profile, which you'd have to either have somebody take a picture of you or kind of catch yourself at an angled mirror to really see if you have filler that's kind of placed in this upper part of the lip or too much in the lip in general, it's going to project this way and that duck lip is what really makes it look like all of a sudden it's poking out. Like Marge Simpson is another term I call it just like it's out. And that's not natural. And I think the hard part can be if people add filler on top of filler, on top of filler because they just really want to see that plump pink part of their lip enhanced, then it just starts to project there's nowhere else for it to go. And so it eventually gets that effect if you're adding too much too faster in the wrong way and the wrong injection techniques.

Monique Ramsey (14:07):
Are there any health risks that somebody could face if they were overfilled or I guess you talked about improperly injected or if there was an occlusion, but is there any other health risks?

Julia Jowett (14:20):
Specific to health risks, I would say you can have something called a pressure occlusion. So if there's so much filler that's placed in tissue and the amount of filler or the body's inflammation, the inflammatory response that's happening because of the filler swells the tissue so much that you can't, the blood vessels are compressed and the skin is blanching. That's the same thing that's happening in a mechanical occlusion where there's filler blocking the blood vessel and the blood flow and can be just as dangerous. So we are always watching the tissue and kind of making sure that that doesn't happen. But if you were to say put two syringes of filler in the lips and then the patient had a lot of swelling as a result of that and their tissue isn't getting perfusion, that could definitely be a complication. I think from a safety standpoint, as far as systemic absorption, there's not a risk of having too much filler in an area per se, but more locally there could be that risk.

Monique Ramsey (15:15):
And when it goes away, does it just go, what happens? Is it like a bruise where your body just sort of resorbs it and it goes out via elimination?

Julia Jowett (15:25):
Exactly. So it's something that your body is just kind of breaking down really subtly. It's not like overnight it's gone. Your neuromodulator, sadly, it seems like all of a sudden when it starts to wear, if it's gone with filler, there's all these different little particles and every day, some of them that are kind of just being absorbed and breaking down and it's like a really gradual kind of slow process.

Monique Ramsey (15:49):
Now, last question before we go into our bad filler slideshow. So for someone who's never had lip injections before, what would be your advice for the best amount to start with?

Julia Jowett (16:03):
I think it really depends on the person and what they're comfortable with. Anatomically, I'll start with either a half syringe, both Juvederm and Restylane, they sell products in a half syringe. Most of the time though, when you have filler, say you need a little bit of filler in your lips and say you don't necessarily want the full syringe in your lips, but you also have some shadows around your chin or you have shadows by your nose or areas that framing the lips would look really nice to add that volume to. So it looks like this nice airbrushed effect. That's usually what will happen with some, if not more of the syringe if we want to be on the conservative side. As far as the amount as well, it depends on the anatomy of your lips. If you are naturally starting with really small lips, it's not going to go well long term if you try to put a ton of filler in there on the first session.

(16:46)
So if you're anatomically small walking into this, start with less, add more build slowly. If you have anatomically larger lips at baseline, you can start with a full syringe. And sometimes it's not even that. It doesn't even look like that much product. There's some patients I inject and I'm literally like, oh, I could probably use a little more. I won't. But I mean there's space for it. So it's kind of all that, how much space is there on this person and what is their goal? If their goal is for it to be almost undetectable because they're so nervous, then I might say, let's do a small amount so you're comfortable. But if their goal is like, I want noticeable change, do what you can. Usually that is up to a full syringe in that area.

Monique Ramsey (17:23):
And you have pictures or tools I think in the office because people go, oh, a syringe, that's a lot or two syringes and heaven forbid three if we're adding to our cheeks and here and there and everywhere, but in reality, it's not that much product, right? Correct. It's really like a small amount.

Julia Jowett (17:43):
It really is not a lot. When you squeeze it out into a spoon, a syringe is a fifth of a teaspoon. And when you really imagine that in your head and then you're like, okay, I'm going to have three of these, it sounds like so much, but a fifth of a teaspoon here, here and here, all of a sudden there it goes. And then you're not even at your lips yet. You really need that for,

Monique Ramsey (18:00):
Yeah, and that's where I think, again, as a lay person, we're like, whoa, that sounds like a lot, but it really, in reality it isn't. And so especially when you're moving it in different places. So here we go. I'm going to share my screen and show some things. So we're going to go into some botched and overfilled injections that have been in the media. So these are all just, and we'll start with the lips. So we've got here Chloe Cherry actress and star of euphoria. So tell us, Julia, what we're looking at here and what might be wrong or what causes this look and how would you avoid or correct this look?

Julia Jowett (18:40):
Well, I see a couple of things when I look at this face. So I see in general the lips. She's a beautiful face, beautiful structure, and her lips are dominating from a proportion standpoint. When you naturally with our lips and what most people you're going for natural, most of the volume should be on females, especially if you're measuring from the sides of your nose down. I usually actually draw those lines when I inject lips. That should be where most of the volume is. When you taper out to the side that much and you have that much fullness laterally, it looks like I call 'em little sausages and not to be mean at all towards her. If some people like that fullness and they request it and they want to have that, and I think that's important for people to know that oftentimes if a patient has a certain look, it's not always the injector just doing it.

(19:31)
The patient will specifically say, I want this part really full, or I want that area to look a certain way. And it is their face. So to each their own, it's like a haircut. You might not like the person walking down the street with the spiky blue hair, but that's how they choose to do it. And that's totally fine too. We're all unique, but in this specific photo, I think that of course there's also too much volume. I think that the volume is adding a lot of pressure. And so you have this effect where there's no natural looking crinkles, it's just completely stretched thin, and the volume is pretty almost uniform in thickness from the edges of her lips all the way through. So it kind of looks like this full circle fish like appearance without lack of a better word.

Monique Ramsey (20:11):
Well, and I bet she would look kind of interesting from the side too. You were talking about that profile and how far,

Julia Jowett (20:16):
Projection. Yeah, so it really is too much in the wrong places and then too much in general on top of that, she really doesn't need that to her face. It takes away from her other beautiful features.

Monique Ramsey (20:27):
Yeah, yeah. Okay. Now here's Bella Thorn and tell us a little bit about her lips.

Julia Jowett (20:34):
So what I can see in this picture, which is what I see is a little bit of this migration look where it almost looks like there's a white cast above her lip. This is the only picture I've really seen of her. So without seeing a more closeup, one of her lips, I would imagine that she's had lip filler over time and has had some migration settle and adds more. And once it kind of gets into this pattern where you run out of space in the lip, it kind of finds its way to push up and then you add more without addressing this. So you have these full lips, and then you have this ridge, and then you add more and it kind of compounds on itself. And that's what I see a little bit in this image.

Monique Ramsey (21:13):
We can't have a podcast about lip filler without talking about a Kardashian. Right. Okay. Here's Chloe. And what do you see here, Julia?

Julia Jowett (21:24):
Well, what I think is also important for patients consumers to know, especially Instagram, especially social media, when you're seeing images like this, the lips do not look like this without makeup on. And if you ever see a picture of Kylie Jenner or some of these celebrities without their makeup on their lips, their lips look completely different. And a lot of that is the tricks that they do with the lighting and the shadows and the lining. So they'll line their lips above it, they'll add, you can even see where it's hitting her, a little bit of paleness. It's all these tricks with makeup that make it look like it's this beautiful crisp border. It has this fullness to it, but you can't overfill a space. And if expect to get that effect, you're going to have some muting or dulling at the border when it hits a certain point of being overfilled. So I think when I see pictures and people are like, oh, I want lips like this, and you look at what you naturally have, trying to get to a certain size to be like a celebrity is not the best approach because it might end up looking a little more muted, and maybe when you put some overline dark lip liner, it looks a little bit better. But when you take that off and you just see kind of that puffy border, it's not going to have that same effect.

Monique Ramsey (22:33):
And some people too, have a better defined vermilion border than others. I know I don't have a good one just because that's what I was told, like, oh, you really don't have a vermilion border. And that's really where you're relying on your injector to help create that definition if you need it. And here, like you said, it's looking at the makeup, not necessarily the reality. Now it looks to me, and again, I don't know a whole lot, but there's a lot of fullness in the middle of the lip. Now can filler be put on the edges and the middle, or how do you go about where the plumping goes?

Julia Jowett (23:13):
It really is about, when I usually talk with a patient about what their goals are, I'll ask them to show me pictures of what looks they like, because there's different shapes of lips, there's different proportions. Some people like their upper lip more full than their lower or more fullness laterally. And so you kind of look at the face, look at from an ethnic standpoint, from a age standpoint, maybe a younger patient might want a more dramatic look versus a more mature patient might want something that's just a little hydrating. Yes, you can focus lip filler so that it tapers out more gradually so that it's not too full in the middle, causing that projection in the middle, which also causes more of a beak like appearance. And then if it tapers up to nothing. So alternatively to the other patient that was so much filler on the edges that it just created this big kind of o shape. If you do not enough here, then you're going to have that be more centrally heavy and beak looking, and that doesn't look good either. So it's about kind of making sure that it's being tapered out, but in a gradual way.

Monique Ramsey (24:10):
That makes sense. Okay. Now we're going to go into some filler, not just in the lips. Now, Lisa Rena been around a long time, so I can say that because I've been around a long time. She's had a lot of fillers over the years, and I think she gets some flack about being a bit overdone. What do you think, Julia?

Julia Jowett (24:29):
I think she likes it that way because I think I used to watch a lot of housewives, and I'm just speculating of course, but I know that back in the nineties and early two thousands, she had lip implants and she got a lot of flack for, she was kind of ahead of her time in that way where she was like she wanted the full lip. She wanted that permanence. And what seemed that as she became more famous, her lips actually kept getting bigger and her cheek kept being bigger. So instead of backtracking a little bit of that and saying, I want a more natural look, she's like, I'm going to go in for this exaggerated look. And I always tell patients when they're kind of concerned, they'll name a celebrity me, I don't want to look like X, Y, Z. It usually, in most cases, does not happen overnight. You're not going to walk in and get three syringes, a filler and look overdone like the celebrity of your nightmare. People that go that far either don't see themselves the way that they should or see themselves, and they ask for more and they push to have more. And so from what I know about her and her awareness on her own appearances, she likes having that fullness. And you see her on different seasons of housewives where at ebbs and flows, and she ends up adding more to each their own.

Monique Ramsey (25:41):
Right, exactly. This one just terrorizes me as a kid of the eighties, Madonna kind of hit the scene when I was in high school, and so now it's like, whoa, what happened? Because this looks like almost alien to me. I'm sorry. She's a beautiful woman and she's older. She's in her sixties, I think, but what's happening here?

Julia Jowett (26:05):
Well, and there was a lot of controversy on is this fat or is this filler? And I can't answer that. I can say that what makes her look, of course, there's a lot of volume in general, I think, in every aspect of the face, but what's making her look the most augmented is kind of the fullness around her eyes. And when there's too much filler, especially in the front part of the cheek or superficially when you smile, it makes your eyes look smaller. It kind of dominates that portion of the face. And we're always looking, as humans, we're looking at proportions of the edge of the lateral canthus to the edge of your face or the thirds, how it divides both vertically and horizontally. And when those proportions are off, when your face gets drastically widened, your body immediately recognizes that as unnatural. I think, again, this would be really, really hard. You'd have to try to do this with filler. I mean, you'd have to do multiple sessions of 20 syringes per session just to get to this point. I have no idea how she got to this point, but it is not something patients come in and do filler and walk out of looking like this is really a situation where I'm not sure what happened. I don't even know if it was filler, but

Monique Ramsey (27:11):
Right. So it could have been, we need like fat or filler?

Julia Jowett (27:14):
Yeah,

Monique Ramsey (27:15):
How do you guess? Very interesting. And I guess the alien part is maybe also her extreme eyebrows in this case.

Julia Jowett (27:23):
Yes.

Monique Ramsey (27:24):
Which is a whole nother thing, but gosh, it's like a pillow face or something. Okay, so here's another one. Now, Chrissy, Tegan, some people were saying, and we have a link, there was a article in Evie magazine saying she's almost unrecognizable. And so what do you think, Julia, because she's a beautiful woman, but what's happening with her?

Julia Jowett (27:47):
Well, again, I can't say specifically with her. I know that naturally she has full cheeks. I think what happens with people in general, and what our job as injectors is to kind of catch this when it happens, is you start to see your face in features versus your face as a whole. And if you lose sight of that a little bit when you're just looking at like, oh, I love it when I have really full cheeks, or I love it when I have really full lips. I want more cheeks, I want more lips. And you're focusing again and again on that specific feature, it can lead to an unnatural look when your proportions are not being balanced out, how it best suits your face. So I think anyone that goes too far, whether it's just a matter of her not being told no, whether it's a fact of her being guided in the wrong way, or whether she knows exactly how she looks and she likes it, and she just likes her cheeks really full because she already had full cheeks and she likes them even bigger.

(28:40)
I mean, that's just the way it is in each scenario. I think what feels the best for me as an injector is if a patient will come in and they'll say something and then we'll kind of talk about it. I'll see it a little differently, look at the mirror together, and I'll tell them, I don't necessarily think you should add more here, and here's why, but instead, maybe we redirect to this area you weren't even thinking about. And they look and they're like, oh my gosh, I wouldn't see it that way, but thank you. And you think in your head, if I don't do what they want, they're not going to be happy. They're going to leave here feeling like they didn't get what they wanted. And instead they thank you for being honest with them and guiding them because they can't see it the way that you do. And I think there's a balance of some injectors maybe aren't confident enough or just afraid to tell a patient no, or you're just thinking if you're not going to do what they want, then you're going to lose them as a customer. Versus having that conversation and being brutally honest. And there's times where I have that conversation, I'm brutally honest, and they're like, I hear you. I see what you're seeing, but this is what I want to do to my face. Decide your judgment call at that point.

Monique Ramsey (29:39):
Right? And think you bring up a really, really good point, which is the injector, not being afraid to say no. And I am going to bring up a very specific example, and I know I have permission to do so because she's talked about it publicly, but one of our patients is Laura Kane. She's part of the Laura Kane after dark podcast. And when she very first came to us, she wanted filler under her eyes and she wanted it like today because she had an event, and the provider who was seeing her said, you've got some things going on here. We really need to dissolve the filler. And she's like, no, no, no, I want it done.

(30:25)
There was some back and forth, but our provider won and they had to do, I think two or three rounds of dissolving to get her back to baseline and then do the filler, and she's so happy. But she said, I realized in that moment, and she had kind of done what you were talking about earlier, where the patient maybe does some shopping around and they go to this person and then they go to that person and this person and all these different injectors over, they don't know what the last one has done. They don't have the patient records and the patient can't remember. And so pretty soon you've got who knows what in there, how much where. And so sometimes we need to as the consumer or the patient to say, okay, you're the expert here, and if I really want to get to my goal, sometimes I have to listen and comply and then we'll get there.

(31:18)
And so I think it's a really important lesson for us as a patient in that chair sometimes to go with, I'm not the expert in that topic. Let the expert in the topic help you get to your goal. And I think that's important. Alright, so now we're going to do a couple the filler horror stories. Okay, so here is somebody that was in the Daily Mail. She's a 27 year old woman issues. There was a warning, she issued a warning about giveaway beauty treatments after she was left with what she called botched lips. So this influencer, Jessica Burko, had a nightmare lip filler experience after visiting a doctor who was doing a lip filler giveaway for influencers. And she said, if your lips, look how minded you should be concerned, get them instantly dissolved and go to someone else. So Julia, what do you think happened in Jessica's situation?

Julia Jowett (32:14):
I mean, this looks like, of course there's filler injected, but an inflammatory response to the filler that's injected. I highly doubt this was injected to look this way. So this is her body's swelling or response. And to be honest, after filler dissolve or sometimes people can swell to look not quite the severe, but almost the severe, where you get this really robust inflammation temporarily, usually like an hour or two, and then it starts to go down. But she's just having a reaction to something and whatever was injected and without knowing the where or the what. I think that's the variable. If you don't know for sure that you're going to somewhere reputable and say they're buying products off of Amazon or off of a filler dealer that's getting things from another country, black market, the safety regulations are there for a reason. And we're lucky in the United States, we don't have as many products as some other countries do, but we also have really tight regulations for what is used here and why and how it got cleared to be used.

(33:12)
And they have very good safety profiles. Also, who's injecting it is very important. Was their technique as septic, was it somebody who's really qualified and credentialed to be doing that? Could they handle a complication if you were having a reaction to the product? Do they have something and what would they do? So those are all important questions. As a consumer, I would be asking, and it's hard, I think I hear stories and I've had patients who tell me that they've gone somewhere, whether across a border or somewhere else to get procedures. And whether as you know, Monique like plastic surgeries, this happens with injectables, it's just as common. There's always that temptation of what if I could just save a little money on this? It is so expensive. But I will tell you it's expensive for a reason. These products are expensive because they put tons of research into their safety data and all the clinical data that goes into them and manufacturing them. And the quality and the service is expensive because it takes years to learn it. And it only can be done by certain qualified people. So it is there for a reason.

Monique Ramsey (34:09):
Okay, we're going to do one more here. So this one was a story that we found in insider, and it said viewers showered an influencer with compliments after she revealed that she regretted getting botched lip filler dissolved after she had gotten her filler dissolved, she said, all my confidence has gone. It went away with my big lips. So this was a girl, Ellie Scales, the influencer. She dissolved her lip filler after a series of botched treatments. And she shared that her lips had been uneven for years because she had a series of botched procedures that used different techniques and by different people. So what do you think here, Julia went wrong with her fillers before she had them dissolved?

Julia Jowett (34:56):
Well, and I would say that this is a really common theme in patients where A, we have the conversation like we were talking about earlier, where I have to approach, say they come into my chair for lip filler, I look at their lips and I say, oh my gosh, I see lumps, I see bumps, I see old filler, migrated filler, who knows how many different types, who knows what was used where this doesn't really look like something that I want to build on aesthetically to get a better result. I think it's just going to look kind of swollen and fuller and then still have all the same issues that it did when you sat down. So having that conversation, it's a hard conversation to have. And I think to refer back to what you were saying earlier, if you as a patient are having that conversation with injector, listen to them because they're really coming to you with good intent.

(35:41)
We're in the business of making you look and feel your best. And if we think that there's a way that we can get you there, we're not going to put you through that. I don't want to say trauma, but the process of going through dissolving and taking away something that makes you feel good about yourself to make you look worse, we're going to do it knowing that we can make you look better. And I think that, I warn people though, when they agree to this and when they say, I see the same things you do. I really don't like these things, but I'm scared. I don't want to take away my lip filler. It is my security blanket. And I'll tell them, it's like having your hair done a certain color your whole life, but you naturally have brown hair. But when you have your brown hair, it makes you feel really insecure and it doesn't make you feel like your best self.

(36:18)
And guess what? This is temporary. We're going to dye your hair brown for a month and you're just going to have to suck it up, and then we're going to fill you up and it's going to look beautiful, and we're going to get you back to where you want to be and it'll be worth it. And I've had this conversation with patients. There's this one patient that stands out to me because she's the most amazing person. And she came to me from a clinic in a different state. She was so overfilled and has beautiful features, but you couldn't see any of 'em because all you could see was filler. And she sat in my chair and said, I want to have cheek filler. And I sat down with her and I just really said, you know what? Let's look at each area of your face.

(36:51)
Let's look at your cheeks and the proportions and the width and the fullness, and you're getting heavy because you have so much gel in your face and it shouldn't be there. And she trusted me and we dissolved everything. And it was a scary process. It really took some time to kind of build her back up in different ways. And I used different modalities to get there, and I threw in some threads and we did some sculpture. And there's so much in the toolbox now to get you to that result where you feel like the best version of yourself, but you're not looking augmented. And I think that that's where that line is, especially with lips. People that want that fullness, they want that wow factor, but in the best looking way possible. It's a hard process to go through, but it's always worth it in the end. And every time I've gone on that journey with a patient, we sit and we look at the photos at the end of it and we're like, wow, that was quite the journey. But look at how good it looks.

Monique Ramsey (37:38):
And I think what's the risk if a person continues to get filler treatments knowing there's existing concerns with what's already in there? I mean, is that even safe?

Julia Jowett (37:53):
Well, I mean, I think you could have a potential risk of reactivity if there's a lot, say you have lumps and bumps and then you're putting another product that's a different brand on top of that, it's not something I see it's a potential risk. I think the risk is mostly cosmetic in nature when you just have a lot of filler that is not doing you any favors, it just needs to be kind of refreshed, and it's not a failure either. I think some people look at this as like, oh, I had to have my lip fillers dissolved. Something had gone wrong. Sometimes you just have too much filler in your lips and it's not breaking down, and you just need to take some out. And it doesn't always mean you have to dissolve everything. I'll look at some patients, I'll say, you know what? You have a little bit too much filler right here. So it doesn't have to be the scary, dissolve everything. You can dissolve parts of it or some areas that need improvement, if that's the case as well.

Monique Ramsey (38:43):
Yeah, that makes sense. So I think we did, this was really fun with our screen sharing into diving into some of these interesting tips. So now I want to go into a couple things before we close out. One is cost. I think one thing that's great is we have all our prices on our website, not only just our pricing per type of filler and how many ccs is in the syringe or whatever, MLs, but we also have our glam fam, which is our VIP loyalty program where you pay one member price for the year and you get discounts on everything. And so you have an automatic 15% off on your filler, and if you have two or more syringes in the same treatment, it's 20% off. So we have ways internally in our office for you to save. But then there's also each of these companies, so Allergan has their all rewards program, and they're the ones who make Juvederm and that hold Juvederm collection of fillers.

(39:47)
So you can earn points or have rebates sometimes, or they have different promos where you can combine, you can double dip your discount. And then Galderma has the same thing with their own loyalty program called Aspire, and that's part of the Restylane family. So there's lots of ways, and our team is great about helping you make fillers affordable so that when you do go into something where you're thinking, oh, I think it's time to, let's look at my cheeks or fill in some indentations in the temples as you age, or going and making that jawline a little more crisp where you're like, oh, but can I afford it? A, there's the glam fam plus then the rewards programs. And then also we have cherry financing, so we have financing plans. It's awesome, and you can pay it over time. And so that's something that you can kind of have your cake and eat it too, I guess, as they say. So what would you say the ballpark, Julia is for filler treatments? Like let's just say one syringe in your lips, around.

Julia Jowett (40:56):
I would say depending on the product, it can range between like 500 and 700 is average for lip filler.

Monique Ramsey (41:05):
And I went through some of those special deals. And then the last thing I wanted to say, and again, we'll have the links in the show notes on those prices where it takes you right to that page, and we'll have you have a column for the regular price and what the glam fan price is. Last question for you, Julia. So if patient's ready, they're like, okay, yeah, I want to come in. I want to maybe have filler in my lips or somewhere in my face. How do they see you for a consultation?

Julia Jowett (41:36):
We have made it so easy, which I love this process. I've even played with it myself to see how easy it is for a patient. But you can go on our website, there's a link that usually comes up on the top right part of the screen that says, I believe book a consult or inquire about the med spa. And when you click on that, you can pull up a page to see our services and actually book a virtual consultation or an in-person consultation.

Monique Ramsey (42:00):
But at the top of the, just go to lj csc.com. Top right, it'll say that you can book medical spa services. Of course you can call us. We're going to answer the phone, but if you don't want to call, you can do it yourself. And then it'll walk you through setting up a consultation. And so then they'll come see you and you'll help kind of create that treatment plan for them.

Julia Jowett (42:27):
Yeah, yeah. It's a really nice process. We've been doing it for a few years now and have it really smooth for patients where they can get all their questions answered, do all their research, really feel comfortable. So when you're actually working up the nerves to come in on the day of your procedure, you're not having all these what ifs, what will happen. You have all that answered ahead of time.

Monique Ramsey (42:45):
And something that I think patients don't know. We just did a podcast that dropped yesterday about TouchMD and my TouchMD app. We have a lot of before and afters on our website, but there's also before and afters when you come to consult. Sometimes more people will allow their before and after to be shown in a consultation kind of in our family photo album instead of on the web for everybody to see. So there's a lot that you'll be able to show when they're in that consultation. Here's some examples, and they can see your screen and see what are some examples of maybe filler in the cheeks or filler in the lips, or this product in particular. So I think that's really nice to know too, so that if you don't see a picture on the website in the gallery, it doesn't mean there's not more, we have a lot more pictures. A lot of our patients are very happy to share with other patients who are in the consultation. So that's kind of nice. And you, Julia, your Instagram. Oh my gosh. So you have to, she's so good, everybody. I got to tell you, I am just blown away. I am such an addicted watcher of the, so tell us, Julia, what is your Instagram handle? Because your stories and your reels are really, really informative and I think people can learn a ton from you. 

Julia Jowett (44:08):
Thank you. 

Monique Ramsey (44:09):
It's great.

Julia Jowett (44:10):
It's been so fun. So my handle is San Diego injector. I try to just keep it simple and I try to use it as an educational platform because I do think so much of this information that I think everyone walks around knowing I'll post this and then my patients or my friends or whoever I'm conversing with is going to be like, I had no idea X, Y, Z when you posted that. And I'm like, really? I thought everyone knew. And you get in your own little bubble of what you do in the world that you work in. So it's been really fun just playing around with things and yeah, come check it out and follow along.

Monique Ramsey (44:38):
Yeah. Yeah. So we'll put that link in the show notes as well. And for everybody listening today, we have a special favor if you love our podcast and maybe you learn something today. I hope so. I hope you had fun at least. And if it helped make your decision, please tell your friends, share it, subscribe, turn on the notifications. Every Tuesday we have a new episode. We kind of bounce around with our plastic surgeons and talk about surgery topics. We talk about med spa and injectable non-surgical topics, and we talk to patients. We talk to a lot of people. So we have a lot of fun. We've done, I don't know, 115 episodes now, almost over two years. So there's a lot of good stuff in there. So we want to hear from you on what you want to hear about. If you'll write us a review, we'd love it. So if you're listening today, you have questions about anything, check the show notes for links you'll see before and after in there as well. And you'll see information about Julia and her Instagram. So thanks again, Julia, for being with us. 

Julia Jowett (45:38):
Thank you for having me. This was so fun.

Monique Ramsey (45:40):
I know it was fun. I never see, I'm not working in the office. I never see anybody, so it's wonderful. When I have a podcast, I get to see you all and catch up. So great to see you, and we'll see all of you our viewers next time on the next podcast. Thanks.

Julia Jowett (45:56):
Thank you.

Speaker 1 (46:01):
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 lj csc.com or follow the team on Instagram at lj csc. The La Jolla Cosmetic Podcast is a production of The Axis, t h e a x i s.io.