Managing Expectations: Facial plastic surgeons emphasize the limits of injectable fillers

He does caution patients, however, that there is a greater propensity for papule and nodule formation with this type of filler if it is injected too superficially. But this can be avoided if it is mixed correctly and injected more deeply than shorter-term fillers, he said.

Dr. Grunebaum also avoids permanent fillers; instead, she uses calcium hydroxylapatite (Radiesse) for facial remodeling. “In the right patient, I feel that it has the best consistency for lasting and reliable mid-face augmentation,” she said.

Overall, Dr. Gladstone emphasized that “the philosophy is to volumize the face, [which means] looking at the aging face as a whole rather than just filling specific lines.” He said short- or medium-term acting fillers may be better than long-term fillers to manage the face changes that occur because of aging.

Despite the low incidence of risk, however, all agree that it is critical to talk frankly to each patient about potential risks, including the risk of not meeting patient expectations.

“A patient’s happiness after a procedure is equal to the outcome minus their expectations,” said Dr. Johl, who recommends taking pictures prior to the procedure so that patients can compare these to the outcomes.