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The Finesse of Fillers, The Subtle Art of Staving Off Surgery

April 4, 2014,


This man is 61 years old.

The first time I met board certified plastic surgeon Dr. Grant Stevens at a recent luncheon, my guess was he was late 40s early 50s. He shared with me he was 61 years-old, and that he, like many of us, was going to age on his terms. “I’m going down kicking and screaming,” said Dr. Stevens with a smile.

He then gave me a “tour” of what he had done to himself. Radiesse along his cheekbones, eyelid surgery, a facelift, and Zeltiq for his now non-existent love handles. Zeltiq of course is what the famous “freeze the fat” billboards are promoting for his Marina Del Rey medical spa and offices. Lifting his jacket, he showed off an enviable waistline for any man, let alone one of 60.

Doctors’ offices everywhere (even dentists) are full of brochures listing new nonsurgical procedures that promise to tighten skin, obliterate redness or brown spots and eliminate fat. Welcome to the new world of plastic surgery, where the frightful scene from Terry Gilliam’s film “Brazil” is no longer its poster child.

It gets better.

Grotesque people with exaggerated features are still out there, but they’re usually the resulting sum of the equation of a well-off mentally ill patient who finds an ethically challenged cosmetic surgeon ready to cater to their body and facial dysmorphic disorder.

Dr. Stevens tells me that the bulk of his practice is performing subtle, non-invasive and minimal procedures “that buys time” and even elongates a man or woman’s career, especially in this economy where retirement is pushed off even further and youth is prized.

But even when his patients come in for the works, a full facelift (rhytidectomy) he was adamant that they got “everything” including lasering and fillers if needed, to make it all jibe and look great. He said, “I did my mom’s facelift years ago and everything was great, except my brother asked me why does mom look younger but still have brown spots and wrinkles after the surgery…and it made me rethink how I approach facelifts.” He had amazing before and after pictures of his mother, now in her 80s, who looked dynamite. The brown spots and crinkly lines were history on a face that looked 20 years younger.

Slight subtle enhancements like facial fillers and neuromodulators (Botox, Xeomin) smooth and fill a face, spot “wide awake” liposuction and Zeltiq “fat freezing” can actually alter one’s psychology for the better. The argument being that this person’s improved confidence will bolster their commitment to a healthier lifestyle and overall sense of optimistic well-being.

This “happy” factor is one to really consider, especially when an office cosmetic procedure is successful in its goal. People start to eat cleaner, work out a little more diligently and begin to put all the pieces together of reversing cellular aging. The payoff being that they are happier and less stressed, even more well-rested with confidence levels restored.

It is a fact that older generations – people in their 40s and up – are trimmer and healthier than many teens to 30 somethings. This is the age of kids with adult onset Type 2 diabetes, and horrible, lazy eating habits and sedentary lives.

Dr. Stevens and anyone else who remembers the 1960s growing up had a more active life and a portion controlled wholesome diet. He is quick to point out that being a native Californian and surfing and being active was terrific in his youth, but the sun damage he weathered made him just as needful of lasers and other procedures to keep any possible skin cancers in check and to make the appearance of his skin reflect his own good health. Many people can relate to this when looking in a mirror, feeling strong and fit, but seeing a face that belies their inner vitality.

In short, looking great with minimal downtime for a natural appearance is where it’s at in this elective surgery world. Over 80% of all plastic surgery procedures are non-surgical, according to Dr. Stevens, citing facts from the American Society for Aesthetic Plastic Surgery. Having an understanding of what’s out there and what’s “for what” helps a patient have an intelligent conversation with their doctor, so that expectations are managed and met.

But with all this happy “we’re going to look great” news comes huge caveats.

Non-surgical procedures can have horrifying outcomes like ischemic events or vascular injuries if you go to non-board certified plastic surgeons. An injector with experience with facial anatomy is important, and facial plastic surgeons have that. There are other factors, such as gentle hands, slower injections, artistic skill and definitely years of experience that make for a positive experience.

All fillers will result in some swelling to them. Fillers like Radiesse which are thicker may see more swelling and bruising, but I have seen Radiesse injected with no marks because the doctor performing this was skilled and experienced.

Resist the urge to massage areas that were injected. Arnica gel and sublingual pills will help with swelling as does icing the areas. The Tyndall effect is a bluish discoloration that appears if hyaluronic acid fillers are injected too superficially into the skin. This can happen when medium weight dermal fillers like Restylane or Perlane are injected too close to the surface. The clear liquid gel reflects light so when light reflects through it through the skin it appears bluish. It can last for over a year and can be resolved with hyaluronidase.

For superficial fine lines, lightweight filler Belotero can be injected much more superficially, without the risk or causing a Tyndall Effect.

There are loads of unqualified cosmetic surgeons, dentists, spa owners, nurses and outright hacks out there injecting compromised, diluted or even counterfeit injectable fillers and neuromodulators. It’s a big business and it’s put a huge dent into traditional plastic surgery practices. Dr. Stevens was ahead of this curve and adjusted his own practice accordingly.

Bottom line: Do not have anything done until you have exhaustively researched your doctor, talked to his or her patients, and checked the medical boards for any lawsuits or issues with the physician. One area where this is completely out of control is silicone injections for gluteal sculpting. Back alley “Butt” injections are killing people and maiming them.

Dr. Stevens discussed some of the better fillers on the market, explaining their nuances and features.

Of note:

Belotero Balance

Lightweight. Dr. Steven’s likens this to a 5 weight motor oil, meant for small jobs and lines. Soft hyaluronic gel that brilliantly softens under eye hollows and vertical lines above the lip. Not meant for filling a lip, good in nasolabial folds that are not as pronounced.


FDA approved Radiesse is an architectural filler with a calcium base, meant to trace bone structure to “lift” contours and stay put. It’s the heavier filler that is never meant for soft folds or lips. It is also my favorite filler for seeing immediate results, unlike pricier Sculptra which is a two step total crapshoot in the wrong hands or even worse, fat as a facial filler, which is unpredictable at best and can actually distort facial features as your weight fluctuates.

Caveat: Radiesse cannot be dissolved like a HA (Juvederm). It can be dangerous when in the hands of an injector that does not know how to recognize an occluded or compressed facial artery. Make sure you have this done by a proper facial plastic surgeon. The results are immediate and impressive.

Xeomin (also known as Bocouture)

This is the alternative to Botox for people who do not fare well with that popular neuromodulator. FDA approved, meant for the frown lines. Slightly less expensive than Botox too.


This is the freeze the fat miracle with zero downtime. A device that contains a freezing unit that is used to freeze and kill fat cells without damage to the skin or internal organs. Also known as CoolSculpting. FDA-approved: 2010. Dr. Stevens says male patients love this machine. Cost: $700 to $1,500 per treatment

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