Over Filler or Just Over Filled?

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Welcome to another episode of
Park Avenue Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your co-host Doreen Wu.

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And I'm excited to be here with Dr.
Lawrence Bass Park Avenue plastic surgeon,

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educator, and technology innovator.

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The title of today's episode is
"Over Filler Or Just Overfilled"

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Dr. Bass, you're always
coming up with these titles,

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which provoke yet have a lot of meaning.

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Where did today's episode title
come from and what does it mean?

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I'll tell you the story
behind this title, Doreen.

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I saw an internet post on Instagram from

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someone who's a consultant or aesthetic

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advisor, uh, very well known
in the aesthetic industry.

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And this individual said
the patients that they are

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talking to are so over
filler they're done with

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it. They're sick of walking
around, looking all plump and

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swollen, and that was the
gist of the Instagram post.

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So when I saw that,

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it really gave me pause
because I feel like in

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honesty, that's completely out of
step with what's actually going on

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in dermatology, plastic surgery today,

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where we're using more filler than ever.

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There are a whole bunch
of filler indications and
creative things that are being

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done with filler and where
someone looks overfilled.

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That means the patient asked for too much

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filler or the provider pushed
too much filler on them,

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or the artistry of the
application was inadequate.

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And we've talked about this
before on this podcast,

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if you try to substitute filler

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inappropriately for something like a
surgical lift, it just doesn't work.

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You can't add enough volume to pump
someone up and take up the loose skin.

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And that's not really an
indictment of fillers.

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It's an indictment of the patient
and provider who are doing something

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inappropriate and not surprisingly,
that doesn't look right.

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Uh, so as we've said
again, on this podcast,

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the quality of the provider is
really important to give you

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worthwhile advice to ensure that what
you're doing of course is always safe.

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And that what you're doing
is artistically applied and

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not overdone. In fact,

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when we look at market data on fillers,

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and there was a recent
study by McKinsey & Company,

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looking at the future of aesthetics
injectables, and they projected

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an annual growth rate of
12 to 14% a year over the

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next five years. So that's
a double digit growth rate.

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So if anything is happening

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where getting more use of fillers, it's

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continuing for sure as
far as anyone can see.

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And we're definitely not over fillers,

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but I certainly understand
if people are unhappy,

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if they wind up overfilled.

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Let's talk more about that market
data. Where's this growth coming from,

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is that all existing patients doing
more filler or are new patients joining

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the pool of users?

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Well, that's a great question. And
in fact, it's some of both, uh,

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the numbers are growing because we have
more indications officially approved by

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the FDA, as well as creative
off-label uses of fillers. Uh,

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so there are more places we're thinking
where judicious amounts of filler

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can help us aesthetically,
but also very importantly,

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a lot of people who are not currently
consuming aesthetic treatments are

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projected to jump into the pool,

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probably starting with fillers,
uh, fillers and neuromodulators,

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Botox-like medicines is an
obvious place that people think

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of early in aging changes when they'd
like to work on their appearance.

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So these new patients could give an
even bigger growth rate than already

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projected.

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That makes a lot of sense.

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I think with Zoom and FaceTime and all
the time that we're spending on these

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platforms, we're seeing
ourselves more than ever.

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And so people wanna start with more
minimally invasive procedures and

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neuromodulators and fillers, like
you said, are good starting place.

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So what is the industry
doing to support this growth?

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Well, there are a number of
things, uh, for starters,

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big investment in research and
development, new filler technologies,

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so to speak, uh, in my opinion,

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and this is a forward looking statement
and we can never say specifically what

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FDA might or might not approve.
We need to see the data,

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but I think there's going to be a lot
of really interesting stuff coming.

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Uh,

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that's very satisfying to patients for all

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over the face,

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but also a variety of body
indications using injectable

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techniques. Uh,

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and I think there's going to be
huge expansion in body injection

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as, as there was that big wave
of expansion in facial injection.

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When we got the appropriate
filler materials,

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Restylane and Jeuveau that
led to the dawn of the modern

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age of injectable fillers.

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And currently, what are the indications
that are most popular for fillers?

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So there are a number of indications
that are really popular and that patients

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seem to like, um,

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for sure if you look in almost
any market, whether it's Europe,

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uh, Australia, Asian markets,
uh, south American markets,

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or for, for us here in North America,

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the number one is always lips.

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And this is a subject we talked
about previously on the podcast.

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And a lot of people are afraid of lips,

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but the message is very clear when
you see that that's number one

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worldwide in each individual market,

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it means that properly done that can
be very satisfying and very natural

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looking. And I do that for
a lot of my patients, uh,

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folks who have gotten a little older,

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which tends to create a
loss of volume in the lips

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and a loss of curviness of the lips.
So the lip gets thinner and straighter.

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And by adding filler,

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we just come back to the,

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the youthful volume that the patient had.

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We're not trying to create
crazy look or bee stung lips,

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unless that's really what
somebody is going for,

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but just something that makes
your lips look beautiful,

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but no one knows you did anything,

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give the curviness back and get back to
youthful volume. So that's number one.

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Uh, and after that, in most places,

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including North America, it's,

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it's lines around the nose and lips.

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So the nasolabial folds the marionette
lines, marionette lines in particular,

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you know, that's a fold that isn't
there when we're 20 years old.

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And we hate looking at that. So
everyone likes to get rid of that,

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but the area that's
really growing is cheek

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fill under the eyes,

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which just got an FDA
clearance and jawline

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fill, which, uh, got a
clearance, uh, end of 2021.

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So there's a lot of new
official FDA indications.

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And that really is following what
was happening off label in many

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providers practices restoring
volume to sagging cheeks

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sharpening and straightening the
appearance of the jawline or accenting it

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somewhat. And again,

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taking the tired look under the eyes
with the deepening of the tear trough

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at the lid/cheek Junction, and really
filling that in. So that looks smooth,

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giving everybody a little
bit more rested look.

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I'm curious, Dr. Bass, in your practice,

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are you seeing both men and women coming
in for fillers or is it predominantly,

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still a female population?

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Well, in

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filler utilization and in
plastic surgery across the board,

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there's still more women
patients than men patients. Uh,

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but filler is definitely
an area along with,

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with neuromodulators like Botox, Dysport,

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Jeuveau and Xeomin,

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definitely areas that men
participate actively in,

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in greater numbers than
they ever have before.

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So earlier we talked a little bit
about what the industry might be

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developing and new, exciting
developments that are in the pipeline.

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What else is new?

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One of the big pushes in neuromodulator
development and in filler

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development is to get longer duration.

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We don't necessarily really want a
permanent filler because you know

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our face is going to change
over the next five, 10 years,

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and we may not want or need volume in
a certain area where it was placed,

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but we would like more duration
than what we are currently

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getting, uh, patients.

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That's probably the number one request
that I hear in terms of fillers.

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Not that it's not correcting
them the way that they want,

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but that they wish it lasted longer
than the six months or the year

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duration depending which filler they're
working with that is currently a

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typical retreatment interval.

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So there's no question that looking
at different ways of crosslinking

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fillers or composing them,

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although still most of the fillers
are hyaluronic acid fillers. Uh,

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that's definitely a goal in
neuromodulate development.

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We know that there are efforts
underway to create longer duration,

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uh, treatments.

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So that's the number one focus
looking further out in time.

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Uh, there's all kinds of research to

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understand essentially how to
better do tissue replacement.

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When we put a filler in, as I said,

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most of those are hyaluronic acid
fillers and hyaluronic acid is the main

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ground substance material in
our skin and connective tissue.

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And we lose a lot of that as we age.
So we're sort of replacing what we

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lost and that kind of biological

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replacement is really at
the core of antiaging.

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There are more subtle things
also happening the pattern and

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structure exactly the
physical structure of the

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material, even if it's
chemically the same, uh,

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greatly affects how well
that material mimics,

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what it's being placed
to take the place of

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and how much the body
then follows after that,

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and is stimulated to
continue as tissue turns over

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to replace that material
in that structural pattern.

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So there's a lot of research
on this in the laboratory.

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That's starting to come into
the clinical development phase,

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uh, but those are the kind of products
that I project we'll see in tissue

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replacement, tissue rebuilding,

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and in biomodulation tricking
the body into behaving the way

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we want in a youthful fashion. Uh,

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and I think we'll be seeing more and
more of that over the next five to 10

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years.

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It sounds like there's a lot of exciting
things coming down the pipeline. So Dr.

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Bass, what is the bottom line?

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What is the role of fillers on the
aesthetic playing field today and for the

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foreseeable future?

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So again, to go back to
the title of this episode,

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fillers are not over
, they're so not over,

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they actually play a
central role in facial

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rejuvenation,

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whether you are at the 30 something
stage or the 60 something year

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old stage or anywhere in between,

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and even beyond into seventies and
eighties, fillers are still central

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to everyone's facial rejuvenation
plan if they want to look optimum,

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uh,

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of course this is always in proper amounts
so that it looks perfectly natural.

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And for the particular
features where it's suitable,

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where there's really no better
option for that feature, um,

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and not overdoing something
for the sake of trying to avoid

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an alternative proper treatment
for an aesthetic feature.

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Thank you, Dr.

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Bass for sharing your insight with us on
the role of fillers present and future.

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I know I learned a lot and I hope our
listeners enjoy learning more about the

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role of fillers and how it may
be involving in the coming years.

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If you think of other exciting
developments in plastic
surgery that you would

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like us to discuss in upcoming episodes,

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please reach out via email or
Instagram. We'll see you next time.

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This is Doreen Wu,

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thanking you for joining Dr. Bass and
me for this discussion of dermal fillers

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and its evolving use in aesthetic
medicine. Be sure to tune the next time.

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And don't forget to
subscribe to our podcast,

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to stay up to date with all of the
exciting content that is coming your way.

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Thank you for joining
us in this episode of,

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of the Park Avenue Plastic Surgery
Class podcast with Dr. Lawrence Bass

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Park Avenue plastic surgeon,
educator, and technology innovator.

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The commentary in this
podcast represents opinion.

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This podcast does not
present medical advice,

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but rather general information about
plastic surgery that does not necessarily

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relate to the specific conditions
of any individual patient.

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