Fill 'er up
June 26, 2016 6:06 PM   Subscribe

Can you tell me about your experience with dermal fillers like Juvederm?

About a year ago I posted about some face droopage after recovering from jaw surgery that rearranged my face. Not much has changed in regards to the issue. I still look like that. In the meantime, I found a great example to illustrate the sort of fullness and droopiness around the nose-to-mouth area that I'm I talking about (who I hate to use for this, because I think she is talented and beautiful): Neko Case in her current photo on Wikipedia. See this photo for a front view. I was hoping to come out of surgery looking more like younger Neko Case, given that I'm ten years younger than her.

I talked to my dermatologist about this, and she thinks it had nothing to do with my surgery but that it's just aging. Maybe because my face was such a different shape I didn't see it? Anyway, she recommended Juvederm, a dermal filler.

The price was over 1K, a bit higher than I'd seen online (but then again, I am seeing a dermatologist in Midtown Manhattan). She said that it was supposed to last 4-6 months, but that for some people it lasted two years. For me, that price would be doable if it did last two years, but if it only lasts four months, that would be out of my budget to continue. I looked at some pictures online and some people looked amazing afterward - but some people looked about the same.

So some questions:
- Should I shop around some more for a better price? (But this is my face, so lowest price is not the biggest factor, for sure!) Or even just for a second opinion on what filler to use?
- Any recommendations for people in NYC?
- So how does this work for you, do you just get these things in perpetuity? Does this become a maintenance thing because you get used to having it done?
- How long did it last for you? I read online that if you get it done repeatedly it lasts longer. True?
- Did you notice big changes? Did you think it was worth it?
- When poking around on RealSelf, I saw some references to fat grafting for a more permanent solution. Does anyone have any experience with that?
- What questions should I ask any derm I see?

Feel free to MeMail me if you prefer not to have your answer public. Thanks for your perspectives.
posted by unannihilated to Health & Fitness (4 answers total) 7 users marked this as a favorite
Not a direct answer to any of your questions, but that price sounds high to me. You should call around and consider traveling to nearby states. I'd be willing to bet you could get it done for less, without compromising quality.
posted by Ursula Hitler at 11:00 PM on June 26, 2016 [1 favorite]

According to this article: "The cost of fillers is substantial. One syringe of Juvéderm Voluma, a product now commonly used on the cheeks, runs $700 to $1,200 in New York, with price variations depending on neighborhood and the doctor’s experience. A mild case of laugh lines can be corrected with one or two syringes. Severe volume loss could require four or more."

I think it also touches on the specific issue you raise: “One woman came to me with jowls,” Dr. Swift said. “I explained I’d start injecting the cheek area to correct the sagging in the lower face. She stopped me: ‘Whoa, why are you injecting up there when the problem’s down at my jawline?’ I asked, ‘How did you look when the last surgeon injected you with five syringes of product in your lower face?’ She answered, ‘Like a bulldog.’”

But what would give me pause, were I you, is this section further down the article: “In my experience, using filler to correct drooping skin in somebody who already has prominent cheekbones is reasonable for about a year and a half or two years,” said Dr. Michelle Yagoda, a plastic surgeon in Manhattan. “After that, the pocket where the filler was placed stretches. Then to achieve the same look, doctors will inject more product. You start seeing cheeks that are very prominent compared to the lower face.”

I've also seen this phenomenon at work. Folks get fillers done, and look great. Then the filler starts to fade. So they get it done again. The second time they don't end up looking quite as "right" as the first. The second batch fade, and then they do it a third time: By then, the incremental effects of filler over faded filler means that the insertions are no longer mimicking the natural planes of the face, but are instead distorting the original essence of the face (regardless of age or surgery), with layer upon demi-layer of filler, so the person just doesn't look like themselves anymore.... It makes me wonder if it isn't possible to measure, or make a mask of the face, beforehand, so it's always understood what the baseline was. Though, if you do it for long enough, you'll also have to account for aging and weight fluctuations too....

If it were me, and I wanted some sort of dermatological procedure, I'd research doctors outside of New York and Kings County, ideally in an academic environment, and maybe also ideally, with rehabilitative experience, which means their emphasis isn't on a rejuvenating "spa" experience. I'd strongly reckon doctors in a place like NYC not only overcharge, but often take advantage of a monied clientele or a clientele that makes money on their faces (models, actors). You'd be better off with a doctor who takes the process seriously--and tests you for allergies before using fillers--because they also work with patients who due to accident or incident need to mimic "real-life." Judging from the many derms I've seen in the media and the results on many of their clients (e.g. see Madonna, Nicole Kidman, the list is long), lots of derms don't have any aesthetic sense, or sense of what human beings, regardless of age, really look like.

In a related vein, in DC it's heavily rumored that most politicians, including HRC (and Chelsea) have had plastic surgery. By and large, they do a far better job there than elsewhere because it's so critical that politicians (the VP and Nancy Pelosi aside) not looked "worked on."

I'm not a big fan of what Paula Begoun has done to her own face over the years. Like a lot of high-profile derms, she is, no doubt, under pressure to look youthful, and instead just ended up looking rather ... alien. Having said that, she is extremely knowledgeable about what OTC and prescription products and lasers can do to restore elasticity and collagen. It might be worth a long afternoon reading through her voluminous writing and answers to questions on this issue, and then maybe writing her directly, too.

It's also worth considering whether you suffer from water retention, food or environmental allergies, even constipation. All of the above, and likely lots of other conditions, too, can cause droopage in the jaw that can be long-term temporary, but is not permanent.

Finally, I'd be remiss if I didn't wonder whether you are somehow seeing the ghost of your own jawline troubles in your current face. I say that not to disrespect your feelings, but because I've seen you in person several times, and each time I noted how you're not just good-looking, you're actually strikingly good-looking. If you spent a lifetime worrying about your jawline ... maybe you don't quite see it? I don't know. But it's something to consider too....
posted by Violet Blue at 12:57 AM on June 27, 2016 [4 favorites]

I used Juvederm Voluma two years ago last April. I was told that it should last two years and it has lasted longer. I think that I paid about $800. I recently had an appointment to check in and see if I might get a touch up, I was happy to be told that they didn't think that I needed anything additional fillers yet.
I've been very happy with the results. I only had one syringe. I opted to go to a medical spa instead of a dermatologist. I did do a little bit of Botox and some of the fillers that don't last as long and have not gone back to do them again. I didn't want to get caught up in vicious cycle searching for the fountain of youth in a syringe. I will most definitely go back for Voluma when I see the need.
posted by jennstra at 3:54 PM on June 27, 2016

Wow. And this is why I come to Ask Metafilter. I've put this off for the moment, because of the stretching issue that Violet Blue highlighted, which scared the bejesus out of me. Thanks!
posted by unannihilated at 5:58 PM on August 26, 2016

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