Who Should I See for Injectable Fillers?

I'm a healthy and active 35 year old female with under eye hollows and puffiness. I'm apprehensive about surgery, so I'm considering either Juvederm or Restylane injections. In order to get the best results, should I see a plastic surgeon or a dermatologist?

Doctor Answers 21

Who is the best doctor for injectable #dermalfillers in Manhattan, NYC, or anywhere?

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 where
10) 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 creams
11) know how to use cannulas in certain areas to prevent bruising and other side effects
12) 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 lumps
14) take their time, inject small volumes and slowly, without rushing you through the procedure
15) have a manner and approach that makes you feel comfortable and that you find trustworthy

Once 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


New York Dermatologist
5.0 out of 5 stars 7 reviews

Who Should I See for Injectable Fillers?

In order to obtain the best results ether a board certified plastic surgeon or dermatologist should be able to help  you.  You need to check however, to ensure that  they have had experience working with fillers in this area.  

The real question here is determining exactly what the problem and how is it best treated.  Since this may mean surgery I would suggest that you see a plastic surgeon. 

Donald M. Brown, MD
San Francisco Plastic Surgeon
5.0 out of 5 stars 8 reviews

Doctor for injectable fillers

Hi!

I know you have heard that who does the injecting is much more important than what is being injected. Both dermatologists and plastic surgeons should be expert with fillers. But it is the individual that matters. Try to find a doctor who does a lot of fillers. Ask to see before and after pictures.

My web site has links to the societies, where you can get names near you.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Juvaderm / Restylane / HA fillers for undereye hollows: Pick a quality professional

Joonbug37:

We're glad you understand the importance of picking the right person to do your facial HA fillers, especially the area around the eye.

Your answer is not as simple as my recommending a Derm or Plastic Surgeon (even though I am a plastic surgeon). Some practices don't do hardly any cosmetic or aesthetic work - they're mostly reconstructive. You want one that does mainly aesthetic work. Some practices do plenty of fillers, but don't often do the lower eyelid hollows - you want experience. Some practices produce results you would be pleased with - and some produce results you might not like. See photos or talk to patients

You may need to interview a few physicians in your area in order to make an informed decision. Just like with Botox, it is the technique and placement that matter in the final result, not the number of units or cc's. Particularly not the lowest price per cc of filler. Pick a quality professional.

Sutton Graham II, MD
Greenville Plastic Surgeon
4.8 out of 5 stars 5 reviews

Either Dermatologists or Plastic Surgeons can do well for you

This is one area that you should be careful selecting your doctor who has done these procedures a lot.

Lumpiness and bruising is common in this area however it is easy to correct should it happen.

Good luck!

Nissan Pilest, MD
Irvine Dermatologic Surgeon
4.7 out of 5 stars 15 reviews

Restylane or Juvederm for correcting wrinkles

You can see either a plastic surgeon or a dermatologist for both of these fillers. Just be sure you are comfortable with who you see and ask to look at before and after pictures. Price is important, but don't settle! Board certification is an important quality to consider as well. Shop around and see what fits you! Good luck!

Pick based on qualifications, not price

As everyone mentioned, there are many different good injectors. The most important thing is to pick someone based on qualifications, not price. Injection in the area around the eyes does require more technique than some other areas such as the nasolabial folds. The nice thing about restylane or juvederm is that if you don't like the results, you can always have it dissolved with hyaluronidase.

D.J. Verret, MD
Dallas Facial Plastic Surgeon
3.8 out of 5 stars 13 reviews

You have many options

As the other providers have mentioned, there are many qualified medical practioners that can inject fillers safely and effectively. It is true that the eyelid area is much more unforgiving then the lips or nasolabial folds. You really want someone who has done a lot of these injections. The nice thing about injections is that if you don't like your result you can generally use hyaluronidase to get rid of the filler. The bad part of course is that it is temporary. Based on your age (35 being young), I'm guessing that you do not have a lot of redundant skin nor severe cheek fat pad ptosis, but are plagued with "bags" under your eyes. In this situation with a normal cheek fat pad position, while fillers can camoflauge these "bags" a simple transconjunctival blepharoplasty (inside the eyelid), maybe a permanent solution. It all depends on your individual situation. Good luck to you

Samson Lee, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Skin filler - Juvederm - Restylane - where to go?

Hello,

The real answer is to go to the doctor that will provide you the best result. If you set the "cost" as your determining factor, you may win or you may loose. Take a look at the listings about unhappy patients. Why do patients have "bad" results at least in their minds. A lot of possibilities.

For your treatment - Plastic surgeon... dermatologist... facial plastic surgeon...... ophthalmologist... gynecologist.... family doctor... clinic with a nurse providing the treatment... All can be very good or very bad as it relates to injecting a filler.

These products can be sold to many. You have to make the decision. In many ways,there is no wrong or guaranteed positive result with anything.

If your considering surgery vs an injectable filler to correct this problem, that limits the above options. The real answer to this question is not going through a web site but by spending time with the possible doctors that will be recommending the treatment options for you.

Spend the time / cost up front so that you feel confident about your decision.

Michael Kulick, MD
San Francisco Plastic Surgeon
2.3 out of 5 stars 4 reviews

Lower eyelid bags and 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

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 70 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.