Ask Us Anything About… Dermal Fillers

Description – The video begins inside the Esteem Penn State Health Cosmetic Associates exam office. Two people are standing next to each other. Standing from left to right are Barbara Schindo and Dr. Jessyka Lighthall.

Barbara Schindo – Live from Esteem, Penn State Health Cosmetic Associates in Harrisburg, you’re watching Ask Us Anything About… Dermal Fillers. Now we called it dermal fillers on our Facebook page but that’s not really a very all-inclusive term, so from here on out we’re just going to be calling them fillers. My name is Barbara Schindo. So, as we age the skin muscles and fat in our faces can kind of change and show signs of aging, and fillers are a way to help decrease those signs. I’m joined today by a facial plastic surgeon, Dr. Jessyka Lighthall,. Thanks so much for joining us.

Jessyka Lighthall – You’re very welcome.

Barbara Schindo – She is here to talk to us about fillers, what can they do? Who should get them? As well as, show us, physically show us how they work by administering some fillers live on a patient we have with us named Anna. So, we welcome your questions for Dr. Lighthall whether you’re watching this here live on Facebook or if you’re watching on Playback. Just post your question in the comment section and we’ll get an answer for you about fillers.

Jessyka Lighthall – Okay.

Barbara Schindo – Dr. Lighthall, let’s start with kind of the basic —

Jessyka Lighthall – Sure.

Barbara Schindo – What is a filler?

Jessyka Lighthall – So, filler’s kind of a generic term, it talks about multiple different chemicals that we use, that we inject in the face or hands and other areas to add volume. I think that’s one important thing that a lot of people don’t realize is, fillers are very different from some of the toxins that we use to quit wrinkles from occurring, like in the forehead or the scowl lines around the eyes. Very different, and they’re often misconceived and not understood. So, fillers, we add volume to many different areas. So, common areas that we do is in these folds here, they start getting deeper with age as all the volume starts coming down. We can fill up the grooves but it doesn’t make them go away, but it can efface them and make it look a little softer. And we also add volume to the lips and forehead, the temple areas, under the eyes, and in the mid-face depending on what the needs are.

Barbara Schindo – Okay. So, who would be a good candidate for a filler? Or who might want to think about getting fillers?

Jessyka Lighthall – So, as we age, as you mentioned, we lose a lot of volume, both soft tissue volume, so fat, muscle, and things shrink and also move down a little bit as we all know, but also in the bone. So, everyone needs something different. If you’re considering whether or not you’re a good candidate for filler, I’d say talk to a physician who has good training and knows about this, and we can come up with a customized plan for you. I hear a lot of people come in saying, I want x filler here because my friend had it. And then you look at the friend and you look at them, and they are worlds apart, they need completely different things, so it’s not a one-size-fits-all.

Barbara Schindo – So, tell us a little bit about what fillers aren’t, what can’t they do? I know you were telling me before we started here that sometimes people confuse them with other procedures.

Jessyka Lighthall – Yeah. So, filler is not going to change the quality of the skin on the outside. So, if you have sun damage, fine lines, texture wrinkles, they don’t do as much for that. Some of the fine lines we can fill in, but really, they’re not the same as doing a good skin care regimen, sun protection, lasers, peels, things like that. They’re also not going to stop the wrinkles that you have when you’re moving your face. So, people say, ” Oh, I look angry, I have all these wrinkles in my forehead or between my eyebrows and around my eyes when I smile, my squint lines, my crow’s feet. I don’t like those.” Fillers won’t treat that movement. those we need to weaken with other types of treatments

Barbara Schindo – Okay. And so, you are going to not just tell us about fillers but also show us how the procedure works.

Jessyka Lighthall – That’s right.

Barbara Schindo – So, we’re going to go here. If you want, I don’t know if you want to put your gloves on or get ready —

Jessyka Lighthall – Yeah.

Barbara Schindo – I’m going to step away for one minute —

Jessyka Lighthall – Sure, and put my gloves on and they we’ll talk while we go to work.

Barbara Schindo – Okay, sounds good. So, while she is putting her gloves on, again, just to kind of remind you, you are watching Ask Us Anything About… Fillers, here at Esteem Penn State Health Cosmetic Associates, which is located in Harrisburg. They do fillers and a lot of other procedures here. So, we will put a link to the Esteem website in the comment field here below this post, so that if you are interested in any of these things you can find some more information on that. So, Dr. Lighthall, it looks like you may be ready to start here.

Jessyka Lighthall – All right.

Barbara Schindo – And I also just want to point out, ooh, we have Dr. Vijay Patel, who is a resident here, who will be kind of in the background assisting with the procedure. So, if you want to start and tell us —

Jessyka Lighthall – Wonderful. [inaudible]. — you know, how this work; what you’re going to do?

Barbara Schindo – All right. So, this is Anna.

Anna [Patient] – >> Hello.

Jessyka Lighthall – Anna, we’ve known for a while and we’ve talked several times about some of her concerns. For her, she’s very slim and fit and trim, which is great, but the problem is, when you lose a lot of volume in the face, it can create a little hollow look or a skeleton eyes look. And it just doesn’t look like you did when you were 20, so, our goal is to try to enhance that. You’re not going to take you back to when you were 20, but we’re going to try to rejuvenate, without making you look like you had a lot of work done or unnatural. I think that one that people are really afraid of with fillers is that the don’t want to look like x, y, z actress on TV who has you know, lips the size of Canada. They want to look refreshed and, but natural.

Barbara Schindo – Yes.

Jessyka Lighthall – And so, specifically for Anna, she’s you know, she’s very trim, but you can kind of see the outline of the bone. She’s getting some lines in many different areas that are deeper, so these are not lines when she’s moving her face, they’re just there when she’s at rest. These are ideal for fillers. And so, for her, we’re going to inject a little bit in her cheeks to try to just bring this out a little bit. And that will help the appearance of her eyes, as well in the mid-face. And then, once we do that, we’re going to inject a little bit into these lines here that bother her, and then maybe a little bit into the deep groove here. And then we’ll end with just a little bit of enhancement to the lips. For her, she’s got great volume in the lower lips and good shape. We’re going to enhance the groove and the line that creates a more youthful appearance for her, which is mild. And then, we’re going to put a little bit of volume in the middle where’s she’s lost volume; we’re not going to overdo it, okay? We’ve already cleaned her face and sterilized it, and she’s already had some topical numbing cream that we’ve cleaned off. Okay?

Barbara Schindo – All right. So, while you are doing this, so you’ll do the filler now. Will it take affect immediately? Or will, can they expect to see something immediate?

Jessyka Lighthall – Yeah. The beautiful thing about fillers is that you’ll be able to see the results immediately while we’re doing it. So, we can do one side and the cheek, and then you can compare both and we’ll go back and forth. And a lot of people are asymmetric in the face, so one side is flatter than the other. And so, we may not do things perfectly symmetrical. And you’re not going to take them all the way away, but you’ll get to be able to see an idea of what fillers look like. You ready, Anna?

Anna [Patient] – Mm-hmm.

Jessyka Lighthall – Okay. The other thing I want to note for fillers is, for each area that we inject, there’s multiple types of fillers that we could use. So, really important to talk to providers who have experience with multiple types of fillers and can customize the regimen for you.

Barbara Schindo – Mm-hmm. Now as you are getting the procedure done, is there anything that the person, the patient needs to be aware of? Any type of side effects or anything they should expect when they leave here and go home?

Jessyka Lighthall – Yeah. The first thing I want to say is, if you can avoid taking any blood thinners, so that includes aspirin, ibuprofen, Aleve, all of those types of medications. They will thin the blood and make the risk of bruising higher. So, if you can avoid those for a week prior to having injections, you will notice that you get a little bit of a better result and you have less chance of bruising.

Barbara Schindo – That’s interesting. I can already tell that it looks a little bit fuller on the left side of,oh, no, that’s the right side. I’m looking the other way. On the right side of Anna’s face here. And there, it looks like there’s; it seems like it’s a probably a normal procedure to have a little bit of blood during the filling.

Jessyka Lighthall – Yeah. That’s very, very common. This is a normal amount. She’s not getting any obvious bruising. And then, the thing you’ll notice once we start doing fillers, you’ll see the result, and then what’ you’ll notice is she’ll start to swell up in some of the areas. So, it is common to have a little bit of swelling after fillers, particularly in fillers under the eyes or around the lips. So, if you’re doing that, don’t do fillers we say within a few weeks of a really important event. So, don’t come in the week before you’re getting married for a filler. There’s a high chance you may still have a little bit of bruising or swelling.

Barbara Schindo – And about how long would any bruising or swelling last for somebody who’s getting filler?

Jessyka Lighthall – It’s pretty individualized. Some people it’ll only last a few days, other people if they get some bruising, it can linger for about a week. And again, if you can minimize the chance of getting bruising from not taking blood thinners, that will be very helpful for you.

Barbara Schindo – And one thing that I think it would be important to ask for anybody watching this, or anybody interested to know about is, if you are interested in getting filler or any cosmetic procedure, how can you be sure that you are working with a good, qualified cosmetic doctor?

Jessyka Lighthall – That’s a great question. These days, medical spas are very popular and not that they don’t do a lovely job, but sometimes when you go to various spas, you don’t know who’s injecting you. So, it may be a nurse injector whose never actually had training in aesthetics. So, it’s really important to say, what is your training and what is your experience with this type of filler? We’re going to come right down in here, okay, Anna. You doing okay?

Anna [Patient] – Yeah.

Barbara Schindo – Great. This is her first time getting injections and she’s doing lovely, so very brave for her first time coming in and doing this. And you know, often times you’ll find somebody who, for instance, says, “Oh, we do fillers,” but maybe they’re a dentist or a family practice doctor who has no formal training in it, but has started to do it. And I think that’s an important thing to ask about. What is your training? What is your certification? And then, what is your experience? Other people have experience with only one type of filler, and they won’t vary from that at all. Which is really not great, because as we talked about, not everybody needs the exact same treatment. But you can see as I’m doing this, she’s getting a little bit more volume in here. And the particular filler that I put in here will continue to pull a little bit of water in, so, she may see even some improved enhancement there for about four weeks. And you can see there’s the flattening of the fold compared to the other side from where we started.

Anna [Patient] – Mm-hmm!

Jessyka Lighthall – You okay? Great.

Barbara Schindo – Yeah. I’m not sure how good the view is on Facebook, but you can, I can see here that it already looks a little bit fuller on Anna’s face here, on the right side. Again, you are watching Ask Us Anything About Filler. We are at Esteem Penn State Health Cosmetic Associates in Harrisburg with Dr. Jessyka Lighthall, who’s a facial plastic surgeon. We welcome your questions for Dr. Lighthall, whether you’re watching now live. Feel free to type your question in the comment field below this post. Or if you’re watching on Playback and you still have a question, we can get an answer for you. So, go ahead and put your question on the comment post and we will get an answer from Dr. Lighthall about fillers or she may be able to help with some other — — she’s the medical director here at Esteem, so if there’s other questions about other cosmetic procedures you’re interested in, feel free to drop them in this post. Or, again, we’ll make sure that we have the website in one of the comment fields here.

Jessyka Lighthall – Okay. So, you can just see with one side we’ve just enhanced the result a little bit, added a little bit more filler. For her, we could probably add even a bit more in this area. But, as it’s her first time, we don’t want to go overboard at first, you can always add more filler if you need to. If you don’t like the result, you can always reverse it. We do have agents that reverse most of the fillers that we use these days, but if you don’t have to do that, most people don’t need that. They just get a nice enhanced result and they’re happy, they fill a little bit rejuvenated.

Barbara Schindo – How are you doing?

Anna [Patient] – I’m fine.

Barbara Schindo – Good. So, what is the, for a person who is getting any filler, what is the aftercare like? What do they have to do when they get home? Is there any certain things that they need to be doing or changing there?

Jessyka Lighthall – Sure. Let me switch sides —

Barbara Schindo – Sure absolutely. — and then we’ll chat about that a little bit more.

Jessyka Lighthall – [inaudible] over there.

Jessyka Lighthall – So, I think the most important thing is, when you get filler put in you want to make sure — — you may notice a little bit of lumps or irregularities at first, leave those alone. It’s very common to have those initially — — but they will smooth out.

Barbara Schindo – So, don’t be alarmed if you go home and it looks not perfectly smooth.

Jessyka Lighthall – Correct. And people may swell up more on one side or the other, so just, you have to be patient and let it do its thing. If you go two or three weeks and you still have irregularities or lumps, then I would let your provider know. Having prolonged nodules or lumps or any reaction are extremely uncommon, but they can happen. But often times we just need a touchup and make things a little more even, especially if you have a pretty asymmetric face. Now hers is pretty symmetric, so we’re going to do this very similar on this side to the contralateral side.

Barbara Schindo – And so, when Anna goes home or when anybody else who gets fillers goes home, do they, are they able to kind of resume normal operations like washing your face normally? Wearing makeup if you wear makeup, and you know, wearing sunscreen? Or is there any type of things that people need to be aware of or taking precautions?

Jessyka Lighthall – No. Just go back to your normal activities. Just don’t push too hard on your face, don’t massage. You know, again, the areas where we’ve injected heavily, try not to play with them too much. Other than that, go back to your normal activities.

Barbara Schindo – Okay. And are there any — — side effects or something that somebody should be looking for afterwards that may be, you know, call your doctor and go back?

Jessyka Lighthall – Yeah. There are very, very uncommon, extremely rare, but if you get an injection, a filler close a blood vessel or around a blood vessel, you can actually decrease some blood supply to the area and potentially have poor outcomes. If you notice extreme pain at the injections site, that’s not normal. If you’re noticing a lot of the skin is changing colors, it’s turning white or white with little purple lines through it, that’s a reason to call your provider urgently, not tomorrow, or be seen immediately. That would be the one thing to look out for. Again, that’s extremely uncommon, I have personally never seen that.

Barbara Schindo – Yeah.

Jessyka Lighthall – And I do a lot of fillers, but that is a good thing to look out for.

Barbara Schindo – Okay. And is there any… is it typical, can the patient expect there to be a little bit of pain during or after getting filler?

Jessyka Lighthall – Yeah. Doing filler, if you can notice, you notice she’s closing her eyes trying to breathe and relax. A lot of these have anesthetic in them and we’ve put topical, occasionally for people who are extremely sensitive we’ll do nerve blocks; most people do not require that. The most sensitive place is in the lips, usually after that, once the anesthetic wears off there’s no pain. It’s just during the initial injection point. And she’s actually doing really wonderful.

Barbara Schindo – Yes, Anna, you are doing a great job. You feeling okay?

Anna [Patient] – I guess. Yeah.

Barbara Schindo – You can talk.

Anna [Patient] – I’m feeling fine. It’s really minimal to no pain.

Barbara Schindo – Oh, good. So, Anna’s, so, reporting now, getting her filler live on Facebook that she is having minimal to no pain. And Dr. Lighthall’s been telling us kind of what to expect and what to expect after you leave and go home. And it looks like we have, we do have a question here. So, we have a question from Facebook which is, “How long do the results last for most fillers?” Like will they last for a very long time or do you typically need to get follow-up procedures?

Jessyka Lighthall – So, fillers, the majority of fillers that we use are temporary. They’re safer, they have fewer side effects, but that means they will wear off. and when they wear off depends on the location that we inject them, and the type of filler used. One question people always ask, “Well, why can’t you put a filler that lasts 12 to 18 months in my lips?” Well, it’s because of the type of filler. If you put that in your lips, you may have a lot of issues with swelling and nodules, or periodic swelling that comes in. And it can pull water into it, and so, it just may lead to an unnatural appearance. So, we put different filler types in different locations, and at different depths. So, the one that I just put in was really close to the bone, okay? When we get to the lips, we’re very close to the surface, I cannot use the same filler. So, around her mouth and in this area, most fillers will last about six months. In this area it may last 12 to 18 months.

Barbara Schindo – Okay. Now you are watching Ask Us Anything About — Fillers with Dr. Jessyka Lighthall at Esteem Penn State Health Cosmetics Associates in Harrisburg. Dr. Lighthall is doing a live procedure right now on a patient Anna, who’s getting some fillers in her face. Is there anything, Dr. Lighthall that I have not asked about fillers and the procedure that you think is important for viewers to know?

Jessyka Lighthall – I think it’s important to just talk to a provider about your concerns. You may not know exactly what you need, or you want, but just keep an open mind, go to a trained provider and say, hey, you know, these are the areas that are kind of bothering me or I just feel like I don’t look like myself. You can even bring pictures of your old self when you’re younger if you want. Our goal is to try to enhance what you have, and I think that’s very, very helpful.

Barbara Schindo – Okay. And you’ve been watching Ask Us Anything About Fillers with Dr. Jessyka Lighthall. And if you still have questions after this broadcast, you feel free to put them in the comment field below this post, and we will still get an answer. Dr. Lighthall, we’ll let you, you know, finish up here with Anna, but thank you so much for joining us today.