Here’s a screenshot of my piece in today’s Times about my major facial ‘refresh’ done by the brilliant Dr Tapan Patel. Which is all great – except that I look exactly the same in the before-and-after photos. I can see that’s a good thing, because it shows you can have a major treatment and still look like yourself. But it doesn’t show the huge improvements in my face. So here are my clinical before-and-after pictures, which DO show this. The ones on the left were taken immediately before the treatment in March, the ones on the right, two weeks later.
Why did I step up for this treatment?
Dr Patel has been doing my fillers (and Botox) for the past few years and one of the reasons I love his work is because it tends of be on the understated side, which suits me very well – I much prefer to look normal, rather than ‘done’. He has tended to use very little filler, one or two millilitres, at strategic points in my face – but recently, the thinking behind the use of fillers has changed.
Why is he using so much filler?
The new filler paradigm is that to create balance and harmony in the face, you may need quite a lot of the stuff – perhaps up to 20ml of it. Alongside his role as medical director of the Phi Clinic in Harley Street, Dr Patel is one of the top global trainers for Allergan, the pharma giant that makes Juvederm, the leading brand of facial fillers, so I had an early chance to try out the new look for myself.
What did he use?
Dr Patel used Juvederm Voluma, a sturdy gel that’s good for support and structure, in my temples (0.7ml each side), my cheeks (1ml on the right, 1.6ml on the left, to even them up), my chin (2ml), my pre-jowl area (1ml, at the bottom of the chin), and my jaw (1ml along the angle of the jaw on each side), and because my lips needed hydration rather than volume, he used 1ml of super-runny Juvederm Volite in there.
And yes, I’m very happy with the results!
What was the experience like?
Here’s my original draft of the piece for the Times.
Would you let this man put 10 syringes of filler into your face?
‘Small scratch…’ murmurs Dr Tapan Patel, as he nips the first needle into my right cheek and we’re off on a filler-marathon, a mega session of stealthy facial readjustment.
I have to admit, I’m a tad nervous. Not about the injections per se – I’ve been having injections of fillers to pad out my cheeks and lips for around 15 years – but about the quantity that is on the menu.
When using facial fillers, all cosmetic doctors have agreed that less is more and that the art of refreshing the face was to use the minimum quantities possible, a millilitre or two at most. That way, patients ended up looking subtly refreshed, rather than hamster-cheeked and slug-lipped.
But now, the aesthetic gurus who set the trends and establish the protocols in how fillers are used – principally the Brazilian plastic surgeon Dr Mauricio de Maio, the rock god of the genre – have come up with a new approach. What you really need for the natural-looking result which is the ultimate goal for all injectors, is more product, not less.
‘Originally, fillers were used to fill lines,’ explains Dr Patel. ‘But over time, as practitioners developed a better understanding of the ageing process, it was clear that volume loss was a major factor, so we started using fillers to address volume loss. Because doctors and patients were used to treatments comprising one or two 1ml syringes, we were trying to use the same quantity to restore volume.’
‘We now know that volume loss isn’t limited to one area. In any one patient, we may need to treat the temple, cheekbone, mouth region, chin and jawline – so we need more product. It is now not unusual for us to use up to 16 syringes of product in one treatment plan.’
There’s a Tony-Hancock-type joke in there somewhere, about 16 syringes being nearly a whole cheekful, but now might not be the time to crack it.
It’s peaceful in the all-white treatment room and so quiet, I can hear the slight hiss as the syringe slowly empties but apart from that tiny scratch, all I can feel is a strange kind of pressure as the filler gel eases its way into my face. There’s no pain – I had a dab of ice to chill my skin before the needle slipped in – and the filler, a thick, sturdy gel called Voluma – contains local anaesthetic, so it numbs as it goes.
Besides, I’m pretty relaxed. Dr P, as his staff call him, is medical director of the elite Phi Clinic in Harley Street, and such an expert in the artistic deployment of fillers that he spends half his time travelling around the world, teaching the latest filler techniques to other cosmetic practitioners.
I have been pestering him for opinions on aesthetic medicine – lasers, Botox, fillers and all the rest – for over a decade and for the past couple of years have put my face in his hands. I love his work because he tends to under-correct rather than over-correct, which means I still look normal, rather than some plastic facsimile of myself. All this means I trust him, even on this new add-more-filler paradigm.
When I say this, he laughs. ‘If I’d suggested doing this even a year ago…’ he muses.
‘Yes,’ I chip in, ‘I’d have run for the hills.’
Why? Because we all know what it looks like when fillers go wrong, when ageing celebs have too much put in and end up with a bad case of pillow-face. No one wants to look like that, which is why most people are terrified of the very idea of fillers. They think if you have filler, you automatically end up looking like that.
I can’t quite believe I won’t end up looking strange, hence the flutter of nerves, but I know he wouldn’t do that to me. Besides, I’ve seen some of the recent transformations he has carried out with this technique, all giving lovely, soft, natural-looking results. And 10ml of filler is only a couple of teaspoons, after all, and it’s going all over my face, not just into one spot. This sort of treatment doesn’t come cheap, either. 10ml of filler is £4k, give or take a fiver. That’s halfway to face-lift prices. But it’s instant and painless.
Also, I’m ready for this. For the best part of a year, I have been popping in see Dr P and saying ‘Look!’, pointing out the hollowing under my eyes and in my mid cheeks, the nose-to-mouth grooves and the way the skin puckers around my chin especially when I’m looking down. Usually, he just says, ‘Hmm, excessive muscle movement,’ and quietens the overactive muscles that pleat my brow, scrunch up my eyes and pull down the corners of my mouth with a few shots of Botox, and I leave him be for a few months. And then in the autumn, the new approach landed. ‘Come back in March,’ he said, ‘And book out 90 minutes. We’ll do fillers.’
So here we are, doing fillers. If you’re one of the many who think that Botox and fillers are interchangeable and do the same thing, well, they aren’t and don’t. Botox is injected into muscles, to reduce their ability to contract. Filler adds physical volume to the face. It comes in different densities and can be injected deep onto the bone to add structure, or into the deep fat pads of the face, to make them bigger, or beneath the skin and the muscle, to give soft volume.
Most fillers are made from hyaluronic acid, a polysaccharide (a kind of sugar, not a stinging sort of acid) that holds many times its own weight in water, and ‘cross-linked’ so it stays stable. Voluma comes from a well-accredited brand called Juvederm, so it’s as safe as they come, and should last for a couple of years before it dissolves (after which, no, my face won’t collapse like an overdone soufflé, it will just go back to looking how it did before).
The safety aspect is vital, because of the dire lack of regulation in the aesthetics market in the UK. There are around 200 injectable fillers available in the UK, very few of which are backed by the sort of safety and efficacy data demanded, for example, by the Food and Drug Administration (FDA) in the USA before it will approve a filler for use by doctors (Juvederm is one of the few brands of filler approved by the FDA)
Also, in most other countries, injectable fillers are classed as prescription medicines, which means they are carefully controlled and only doctors can prescribe their use. In the UK, they’re merely classed as ‘medical devices’. Anyone can get hold of them, take a weekend course in how to use them and can, perfectly legally, set themselves up in business to inject other people with them. Anyone. You or I could do it. Yes, that’s terrifying. Add in the fact that things can and do go wrong with filler; the product can go lumpy if the body puts a protective ‘encapsulation’ around it, and if filler is accidentally injected into a blood vessel, it can kill the surrounding tissue, or, near the eye, can cause blindness. That’s why the Keogh report, way back in 2013, described injectable fillers as a ‘crisis waiting to happen’, and that’s why if you’re thinking about having fillers, it is so vital to go to an experienced practitioner who uses decent products, and who preferably has an artistic aesthetic eye.
Cheeks done, Dr P moves on to my temples, adding Voluma to alleviate the sagging of the eyebrow tails that happens as the fat pads in the temples start to shrink.
Next, my chin is marked out in white pencil with two long rectangles below my lower lip, and three round spots along the jawline. The long patches are treated with a cannula, a type of blunt needle that sounds like a terrible idea, but in fact it can nose its way along between the layers of the skin, pushing out of the way fibrous bands, or blood vessels, which a needle could just stab through, so it is gentler on the skin tissues.
My lips get the cannula treatment too. Dr P floods them, just below the skin, with Volite, a super-runny type of Juvederm filler, which will hydrate them, rather than add volume. ‘Like having moisturising gloss on the inside,’ he says. Astonishingly – given that lips are so sensitive, and back in the old days I used to want a dental block anaesthetic before having anyone take a needle anywhere near them – it doesn’t hurt.
He keeps sitting me up to check how it’s looking (and to check that I’m not zoning out from needle fatigue – it happens, and he wouldn’t normally do this much work on one session), and decides my left cheek needs a bit more volume, to make it more in keeping with my right cheek. A couple of stripes of filler along the corner of my jawline, and we’re done. Wow.
My brain feels scrambled from all the injections, but my face looks – great. There isn’t a single bruise – icing before injecting helps there- nor even any puffiness. My lips swell up overnight, but quieten down after 24 hours, and my left jawline swells for a couple of days, before settling. But that’s it. I massage my new face carefully every night, to help the product integrate with the skin tissues. After a week, I can barely feel it in my cheeks, though my chin feels as if it has an internal implant. But I’m thrilled with the results. My face looks more balanced, my brows are less droopy, my chin and jawline firmer.
More filler? Bring it on.