Over Filler or Just Over Filled?

Doreen Wu (00:00):
Welcome to another episode of Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host Doreen Wu. And I'm excited to be here with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The title of today's episode is "Over Filler Or Just Overfilled" Dr. Bass, you're always coming up with these titles, which provoke yet have a lot of meaning. Where did today's episode title come from and what does it mean?

Dr. Lawrence Bass (00:36):
I'll tell you the story behind this title, Doreen. I saw an internet post on Instagram from someone who's a consultant or aesthetic advisor very well known in the aesthetic industry. And this individual said the patients that they are talking to are so over filler they're done with it. They're sick of walking around, looking all plump and swollen, and that was the gist of the Instagram post. So when I saw that, it really gave me pause because I feel like in honesty, that's completely out of step with what's actually going on in dermatology, plastic surgery today, where we're using more filler than ever. There are a whole bunch of filler indications and creative things that are being done with filler and where someone looks overfilled. That means the patient asked for too much filler or the provider pushed too much filler on them, or the artistry of the application was inadequate.

Dr. Lawrence Bass (02:01):
And we've talked about this before on this podcast, if you try to substitute filler inappropriately for something like a surgical lift, it just doesn't work. You can't add enough volume to pump someone up and take up the loose skin. And that's not really an indictment of fillers. It's an indictment of the patient and provider who are doing something inappropriate and not surprisingly, that doesn't look right. Uh, so as we've said again, on this podcast, the quality of the provider is really important to give you worthwhile advice to ensure that what you're doing of course is always safe. And that what you're doing is artistically applied and not overdone. In fact, when we look at market data on fillers, and there was a recent study by McKinsey & Company, looking at the future of aesthetics injectables, and they projected an annual growth rate of 12 to 14% a year over the next five years. So that's a double digit growth rate. So if anything is happening where getting more use of fillers, it's continuing for sure as far as anyone can see. And we're definitely not over fillers, but I certainly understand if people are unhappy, if they wind up overfilled,

Doreen Wu (03:36):
Let's talk more about that market data. Where's this growth coming from, is that all existing patients doing more filler or are new patients joining the pool of users?

Dr. Lawrence Bass (03:48):
Well, that's a great question. And in fact, it's some of both the numbers are growing because we have more indications officially approved by the FDA, as well as creative off-label uses of fillers. So there are more places we're thinking where judicious amounts of filler can help us aesthetically, but also very importantly, a lot of people who are not currently consuming aesthetic treatments are projected to jump into the pool, probably starting with fillers fillers and neuromodulators, Botox-like medicines is an obvious place that people think of early in aging changes when they'd like to work on their appearance. So these new patients could give an even bigger growth rate than already projected.

Doreen Wu (04:43):
That makes a lot of sense. I think with Zoom and FaceTime and all the time that we're spending on these platforms, we're seeing ourselves more than ever. And so people wanna start with more minimally invasive procedures and neuromodulators and fillers, like you said, are good starting place. So what is the industry doing to support this growth?

Dr. Lawrence Bass (05:04):
Well, there are a number of things for starters, big investment in research and development, new filler technologies, so to speak in my opinion, and this is a forward looking statement and we can never say specifically what FDA might or might not approve. We need to see the data, but I think there's going to be a lot of really interesting stuff coming. That's very satisfying to patients for all over the face, but also a variety of body indications using injectable techniques. And I think there's going to be huge expansion in body injection as, as there was that big wave of expansion in facial injection. When we got the appropriate filler materials, Restylane and Jeuveau that led to the dawn of the modern age of injectable fillers

Doreen Wu (06:04):
And currently, what are the indications that are most popular for fillers?

Dr. Lawrence Bass (06:09):
So there are a number of indications that are really popular and that patients seem to like, um, for sure if you look in almost any market, whether it's Europe, uh, Australia, Asian markets, uh, south American markets, or for, for us here in North America, the number one is always lips. And this is a subject we talked about previously on the podcast. And a lot of people are afraid of lips, but the message is very clear when you see that that's number one worldwide in each individual market, it means that properly done that can be very satisfying and very natural looking. And I do that for a lot of my patients, uh, folks who have gotten a little older, which tends to create a loss of volume in the lips and a loss of curviness of the lips. So the lip gets thinner and straighter.

Dr. Lawrence Bass (07:11):
And by adding filler, we just come back to the, the youthful volume that the patient had. We're not trying to create crazy look or bee stung lips, unless that's really what somebody is going for, but just something that makes your lips look beautiful, but no one knows you did anything, give the curviness back and get back to youthful volume. So that's number one. And after that, in most places, including North America, it's, it's lines around the nose and lips. So the nasolabial folds the marionette lines, marionette lines in particular, you know, that's a fold that isn't there when we're 20 years old. And we hate looking at that. So everyone likes to get rid of that, but the area that's really growing is cheek fill under the eyes, which just got an FDA clearance and jawline fill, which got a clearance end of 2021. So there's a lot of new official FDA indications. And that really is following what was happening off label in many providers practices restoring volume to sagging cheeks sharpening and straightening the appearance of the jawline or accenting it somewhat. And again, taking the tired look under the eyes with the deepening of the tear trough at the lid/cheek Junction, and really filling that in. So that looks smooth, giving everybody a little bit more rested look.

Doreen Wu (08:57):
I'm curious, Dr. Bass, in your practice, are you seeing both men and women coming in for fillers or is it predominantly, still a female population?

Dr. Lawrence Bass (09:07):
Well, in filler utilization and in plastic surgery across the board, there's still more women patients than men patients. But filler is definitely an area along with, with neuromodulators like Botox, Dysport, Jeuveau and Xeomindefinitely areas that men participate actively in, in greater numbers than they ever have before.

Doreen Wu (09:36):
So earlier we talked a little bit about what the industry might be developing and new, exciting developments that are in the pipeline. What else is new?

Dr. Lawrence Bass (09:47):
One of the big pushes in neuromodulator development and in filler development is to get longer duration. We don't necessarily really want a permanent filler because you know our face is going to change over the next five, 10 years, and we may not want or need volume in a certain area where it was placed, but we would like more duration than what we are currently getting, uh, patients. That's probably the number one request that I hear in terms of fillers. Not that it's not correcting them the way that they want, but that they wish it lasted longer than the six months or the year duration depending which filler they're working with that is currently a typical retreatment interval. So there's no question that looking at different ways of crosslinking fillers or composing them, although still most of the fillers are hyaluronic acid fillers.

Dr. Lawrence Bass (10:55):
That's definitely a goal in neuromodulate development. We know that there are efforts underway to create longer duration treatments. So that's the number one focus looking further out in time. There's all kinds of research to understand essentially how to better do tissue replacement. When we put a filler in, as I said, most of those are hyaluronic acid fillers and hyaluronic acid is the main ground substance material in our skin and connective tissue. And we lose a lot of that as we age. So we're sort of replacing what we lost and that kind of biological replacement is really at the core of antiaging. There are more subtle things also happening the pattern and structure exactly the physical structure of the material, even if it's chemically the same greatly affects how well that material mimics, what it's being placed to take the place of and how much the body then follows after that, and is stimulated to continue as tissue turns over to replace that material in that structural pattern. So there's a lot of research on this in the laboratory. That's starting to come into the clinical development phase but those are the kind of products that I project we'll see in tissue replacement, tissue rebuilding, and in biomodulation tricking the body into behaving the way we want in a youthful fashion. And I think we'll be seeing more and more of that over the next five to 10 years.

Doreen Wu (12:54):
It sounds like there's a lot of exciting things coming down the pipeline. So Dr. Bass, what is the bottom line? What is the role of fillers on the aesthetic playing field today and for the foreseeable future?

Dr. Lawrence Bass (13:06):
So again, to go back to the title of this episode, fillers are not over , they're so not over, they actually play a central role in facial rejuvenation, whether you are at the 30 something stage or the 60 something year old stage or anywhere in between, and even beyond into seventies and eighties, fillers are still central to everyone's facial rejuvenation plan if they want to look optimum, uh, of course this is always in proper amounts so that it looks perfectly natural. And for the particular features where it's suitable, where there's really no better option for that feature, um, and not overdoing something for the sake of trying to avoid an alternative proper treatment for an aesthetic feature.

Doreen Wu (14:09):
Thank you, Dr. Bass for sharing your insight with us on the role of fillers present and future. I know I learned a lot and I hope our listeners enjoy learning more about the role of fillers and how it may be involving in the coming years. If you think of other exciting developments in plastic surgery that you would like us to discuss in upcoming episodes, please reach out via email or Instagram. We'll see you next time. This is Doreen Wu, thanking you for joining Dr. Bass and me for this discussion of dermal fillers and its evolving use in aesthetic medicine. Be sure to tune the next time. And don't forget to subscribe to our podcast, to stay up to date with all of the exciting content that is coming your way.

Speaker 3 (14:48):
Thank you for joining us in this episode of, of the Park Avenue Plastic Surgery Class podcast with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The commentary in this podcast represents opinion. This podcast does not present medical advice, but rather general information about plastic surgery that does not necessarily relate to the specific conditions of any individual patient. No doctor patient relationship is established by listening to or participating in this podcast, consult your physician to advise you about your individual healthcare. If you enjoyed this episode, please share it with your friends and be sure to subscribe to our podcast on Apple Podcasts, Google, Spotify, Stitcher, or wherever you listen to podcasts.