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There are a million techniques for anything anesthetic surgery or plastic surgery. Most doctors are using FDA prescribed or drug representative prescribed techniques which usually don’t yield good effect/results. If you look in the dermatology literature, there’s a described point of injection where you measure from the nose to the tragus and lateral canthus. This puts you about right here very low, and the reason this is described, I believe, is mostly based on anatomy.

The anatomy is complex around the eye and the lower lid. There are big nerves, there are lots of blood vessels, and there are risks for getting into trouble if you’re not well-trained. A practitioner that’s not particularly comfortable with facial anatomy is going to want to inject right here; there’s nothing here. You can inject here all day, you’re probably not going to bruise, you’re not going to get a nerve, and you don’t have problems. The problem is volume of youth does not exist down here; this is volume of age.

The reason all these celebrities and people of high society look so strange is they’re going to practitioners getting this prescribed point that they discussed in literature; drug reps will even tell you to inject there, and they get these kind of golf balls low in the face. It confuses the perceiver’s brain because when you look at this face, you think the skin’s tight; they should look young but the immediate perception of your brain is this is an old and ugly face.

Aesthetic judgments happen in 200 milliseconds before you have time to think, and it’s the patterns, the shadows, space and negative space of the face that generate this impression of your brain and your brain hands you the impression. Once you receive that impression, you’re stuck with it. You can look at the skin and say it’s tight all day long but your brain is going to be confused. It’s being told “Old, ugly and younger more beautiful”.

The trick to fillers really is understanding what makes a youthful face, understanding what makes a balanced face and understanding the diversity of human facial development. It’s more about balance. You have to understand not just the rules but when the rules should be broken. The fact of the matter is to do a filler intervention and make it look natural and beautiful. It takes a lot more volume than your average practitioner is comfortable with.

I commonly treat people for the first time handling the periorbital area – the area around the eyes. My minimum injection volume is 6 cc which is way more than the maximum that most practitioners would think of. The reason for that is I don’t treat a line, a teardrop or wrinkles; I restore a volumetrically sound aesthetic shape to the face. I wouldn’t feel good treating a patient making a wrinkle go away and not conveying aesthetic improvement. Everything I do is designed to convey aesthetic improvement, and it simply takes more volume.

You’ll be hard pressed to find another doc with my perspective but if you’re looking for a real rejuvenation, a real balancing and harmony in your face, and not just getting rid of wrinkle or tightening of skin, that’s really the way you have to go.

Does Injector Technique Matter with Fillers?

Dr. Rian Maercks discusses why injector technique matters with filler.

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