• #1-2. Filler Procedure Areas and Technical Development Process


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    Nose is the most common site for filler injection. Complaints may occur when the injected filler is pushed away when the patient was trying to squeeze the sebum out, or due to side effects, including necrosis. Doctors should keep in mind that, despite easy access, the nose is also the most commonly complained site. The key point in the nose is to create a concept of a beautiful nose. Simply elevating the nose is not the solution. Doctors should understand the shape of a beautiful nose in the eye of both the patient and doctor. Without that, patients are more likely to request a repeat procedure. This is also the reason for the high reoperation rate of nose surgery.

    It is also necessary to weigh between bolus vs. separate injection. Some cases may benefit from the former, others from the latter. There is no improvement in filler procedure without understanding them. Again, patients should be informed of the possibility of the filler showing through thin skin and the risk of filler movement due to the patient’s habit.


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    Front jaw

    Larger amount of filler injection would yield a better outcome, but cost effectiveness should be also taken into account, considering financial burden on the patients’ part. Front jaw is also the area where the operator’s aesthetic concept, especially that of the profile including the front jaw, nose, forehead and mouth, is important. The hardness of the filler and the importance of maintaining the shape should be also taken into account. Continuity of the shape is essential, because the shape may become collapsed with time.


    Before and after filler injection to the front jaw


    Nasolabial Folds

    Filler injection for nasolabial folds is an often encountered but not a very easy procedure. Mastering filler injection to nasolabial folds is almost like laying the foundation for becoming an expert in filler injection. Doctors should keep in mind that the aim is to smooth the nasolabial folds, not completely remove them. With this recognition in mind, doctors can let go of the obsession to accomplish everything with one injection, because filler can be combined with laser, thread and others.

    Doctors need to find their own way of lifting folded space. This is also a good opportunity to master using the left hand (when the right hand is dominant), until the left hand could feel the movement of filler. It is also necessary to become accustomed to the theory and method of lifting depressed area and multi-layer injection technique. Of course, a technique to maintain the continuity of the shape is also necessary.


    Indian folds

    Indian folds are relatively easily treatable with filler injection. As with nasolabial folds, doctors need to consider the theory of lifting depressed area and to master the multi-layer injection technique as well as the technique for maintaining the continuity.


    Before and after filler injection to Indian folds



    Cheeks are another relatively easy site. The biggest complaint is sagging cheeks. It is most important, therefore, to make a smooth and lifted appearance. The filler should be injected continuously, with the consideration of the large area as a whole, and the influence of gravity should be taken into account when determining the location for filler injection.

    Doctors need to be aware of the problem arising from injecting filler to the surface of the cheeks. The biggest problem among novices is that the skin looks full after injecting a small amount of filler and they are satisfied with that. Eventually, they may end up injecting filler to the superficial layer, which ultimately makes the area further depressed. Filler should be injected as if piling up the filler from the bottom, or filling up soft spots.


    Before and after filler injection to the cheeks



    The key point in filler injection in the lips is to have an idea of a beautiful lips. Doctors can learn how to make an intended shape with a minimum amount of filler.


    Before and after filler injection to the lips


    Steps for Filler Procedure


    Range of procedures available with filler injection

    The spectrum of areas treatable with filler depends on the capacity of operator. Below is what I think of the steps for filler procedure:

    1. Master nasolabial folds, with full training on how to lift depressed area.

    2. Think about a beautiful shape of the nose. This is a good opportunity to experience side effects at least once. Try to resolve the side effect alone, without asking for other’s help. After this experience, you will feel more confident about filler injection.

    3. Next challenge is the forehead. Accumulate as much knowledge as possible about filler injection to a large area.

    4. Aegyo-sal and lips are perfect areas to see how accurate your technique is. Make yourself fully familiarized with minute corrections.

    5. Try performing dark circle correction for the last step.


    As I said earlier, the most important thing in filler injection is determining indication. It is also important to master relatively easier areas first before stepping to the next level. If you can become proficient in procedures for each site and can handle side effects and complaints well, you can really become an expert in filler injection. Thank you for listening.


    -The End-


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