Who Should I See for Injectable Fillers?

You truly need to see a plastic surgeon, but this is the reason. One, we are the experts in this field. Two, if you see a dermatologist, you will get the injection because that is all he or she could do. What I mean is that if you see a plastic surgeon you will be analyzed and given an honest opinion what fillers would do for you vs. surgery. The plastic surgeon may also tell you that what you are looking for is not achievable with fillers and that you may need surgery instead. You will not hear this from physician who dont offer surgery. Just my 0.02

Hi Joonbug37, this is a great question. Choosing a practitioner, especially one qualified to inject in such a delicate area, can be a daunting task. It’s important to be treated by a board certified facial plastic or plastic surgeon when dealing with the under eye area. I’ve seen many patients go to an injector who is either a nurse or a non-core physician and end up worse than when they started. There are times when dermal fillers can help mask the puffiness under the eye, but there are some cases where filler will not help and surgery is the better option.   

Best of luck!

Thomas E. Kaniff, MD

Dear Joonbug37:This is a very important question that many people ask and I would like to help you and others who will read the answer to this question for a long time to come.  The best doctor for you will meet the following criteria.She or he will: 1) be board-certified in dermatology or plastic surgery  2) have years of experience in dermal fillers and other aesthetic procedures 3) have been trained at a medical school and hospitals with excellent reputations 4) perhaps even have had some experience post-residency training working at an academic institution, or doing research, which is not essential but even better 5) spend a considerable portion of their day or week performing aesthetic procedures 6) have available a variety of fillers as there are ideal indications for at least 5 of the many available fillers 7) have a solid understanding of facial anatomy, which you can determine in part by asking about where the filler is to be placed for you and why, and what specific structures are to be avoided, and what facial proportions (such as the golden ratio, phi, and other measurable proportions) should be attained or maintained by dermal fillers and other procedures. In the case of undereye injections, they should be able to explain how they are going to prevent the Tyndall effect (that blue hue that can but should not occur in this area)   8) have an understanding of what happens to bone, fat and fat pads, muscle and skin as we age 9) understand the rheologic characteristics of the various fillers they inject (ask!), very important factors in determining what should be injected where10) ask you about medications and supplements that make bruising more likely, give instructions in how to prevent or treat a bruise with postprocedural icing and supplements such as arnica, bromelain and vitamin K and prescriptions such as Biafine, and offer free laser treatment of a bruise in the following days, and instructions regarding how to cover up a bruise with certain colors of camouflage creams11) know how to use cannulas in certain areas to prevent bruising and other side effects12) cleanse your skin thoroughly with something that will remove all bacteria from the skin and maintain clean technique during the injections 13) know how to minimize but be prepared to deal with the rare and unlikely side effects of infection or intravascular injection or lumps14) take their time, inject small volumes and slowly, without rushing you through the procedure15) have a manner and approach that makes you feel comfortable and that you find trustworthyOnce you limit the list to those that meet criteria 1 and 2, in my experience the prices are very much in the same ballpark in the same area of the country, so this is one of those purchases where it does not benefit you to price-shop. The answers to the first 4 should be available on a doctor's website and to the others from your interactions with the doctor and his or her staff. Perhaps it's time for your annual complete skin exam or you have some other skin issue, and then you can begin to ask some of these questions at that appointment, or you can make an appointment for a cosmetic consultation.I do hope this is useful to you and others who want to know the answer to this excellent question.All the best, Dr. Clark