Realistic expectations in aesthetics.

A common thing I hear during consultations with new patients is 'I would like a treatment but I don’t want dermal filler'.  This is completely understandable as a lot of what people see online about filler can feel worrying - overfilled faces, unnatural results, and the idea that filler always means adding lots of volume to completely change how you look. Because of this, many patients rule it out before they have even had the chance to understand what it can actually do.  

The reality is that dermal filler is often one of the most effective (and sometimes the only) way to address concerns such as volume loss, facial hollowing, reduced support, and lower face heaviness. When used appropriately, dermal filler is not about making somebody look “done” or changing their face. Very often, it is about replacing what has naturally been lost over time and restoring balance in a subtle, natural way. Yes, dermal filler can and is used in many circumstances to add volume - such as contouring the cheekbones, defining the chin, or enhancing lip shape or size. However, in many cases it can also be used to replace what has been lost due to ageing, treating the cause and not just the symptom. No other non-surgical aesthetic treatment can do this in the same way that filler can.

For many people, the goal is not to look different. It is to look fresher, less tired, and more supported, while still looking like themselves. Dermal filler is often misunderstood. It can sound intimidating, but in the right hands it can be an incredibly versatile treatment. It is not always about adding volume for the sake of it. In many cases, it is about restoring structure and support where the face has changed with time. 

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As we age, we lose volume in different areas of the face. The skin changes, support reduces, and this can contribute to sagging, heaviness, jowls, deepening folds, and a more tired appearance. Sometimes patients focus on the area that bothers them most, for example the lower face, but the real cause can be loss of support higher up in the face.

This is why a full assessment is so important.

I like to explain it like this - The upper/mid-face is the foundation. If the foundation doesn't have structure, it will be unable to support the other areas. For example, if you would like tear trough filler for hollow under eyes it is important to assess the medial cheeks to ensure there is enough foundation there to support the filler being placed into the troughs. Without this, the results will be affected and other issues such as migration can occur. This is the same when assessing the lower face - If there is no foundation in the mid-face, then treating the lower face only can make things worse, and lead to a poorer outcome and undesired results. 

Carefully placed dermal filler can help to restore support, soften shadows and folds, and improve facial harmony without looking obvious. The best filler treatments are often the ones nobody notices. People may simply say you look well, rested or fresher, without being able to tell why.  Treatment can also be approached gradually, building over time where needed, rather than trying to do too much at once.

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Why it is important to choose the right treatment and not follow trends. 

There has been a huge rise in interest and marketing around regenerative treatments, and a lot of this comes from social media. Treatments such as polynucleotides are fantastic for improving skin quality, hydration, tissue repair and overall skin health. They are a real game changer in aesthetics and can form an important part of a long-term treatment plan. However, regenerative treatments are often misunderstood too. Although they can improve the quality and condition of the skin, they do not replace lost volume in the same way dermal filler can. They are not designed to provide the same structure, support or lift where facial volume has been lost. This is where expectations matter. If somebody is concerned about crepey skin, poor skin quality, dullness, or delicate under-eye skin, regenerative treatments may be a brilliant option but if the main concern is facial hollowing, lower face heaviness, loss of definition or reduced support, then regenerative treatments alone will not achieve the result that person is hoping for.

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Quite often people read the words 'lifting' or 'tightening' used to describe the results from skin boosters such as Profhilo, or Polynucleotides and will think that this will physically lift their face to treat concerns such as jowls. This is absolutely not the case and what it actually means is they can help to  improve skin texture, collagen or elasticity, which can essentially 'tighten' the skin.  The number one reason we begin to notice jowls, sagging or a flatter appearance our faces is due to volume loss. These treatments cannot replace this and dermal filler would generally be the best option for this. 

Dermal filler and regenerative treatments can work together beautifully, but are not interchangeable,  Each has its place, and the key is choosing the right treatment for the right concern.

 

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Social media trends do not tell the whole story.

Social media has made aesthetic treatments more visible than ever. In some ways that is helpful, because patients are more aware of what is available, but it has also created a lot of confusion. Trends come and go. One month a treatment is being praised as the answer to everything, and the next month people are being told to avoid it entirely. The truth is usually much more balanced than that. 

Having realistic expectations is very important, as what works for one person may not work for another. A treatment that looks amazing on somebody online may not be appropriate for your face, your anatomy, your skin quality, or your concerns. Two people can have the same treatment and get completely different results because their starting point is different.

This is why it is so important not to base treatment decisions purely on what you see online. Aesthetic medicine should never be about chasing trends. It should be about understanding what is actually causing your concern, and choosing the treatment that is most appropriate, safe and effective for you as an individual.

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Something that is discussed a lot in clinic are dynamic lines - the lines which appear upon animation, making expressions, such as frown lines, forehead lines or around the eyes. Some patients can be hesitant about botulinum toxin (Botox) treatment and ask for alternative treatments like skin boosters instead, as they have seen a photo online of somebody's lines improving with skin boosters. It is important to know that skin boosters are excellent for improving skin hydration, fine superficial or static lines (which are present when your face is at rest). However they do not address dynamic lines, which are caused by the underlying muscle movement. Ultimately, the only treatment able to treat dynamic lines, and 'prevent' (or slow down) them becoming worse or turning into static lines, is a treatment that will reduce the movement of the muscle, such as Botox. Skin boosters can complement these treatments by improving the overall skin quality, but they cannot replace the action of muscle relaxation. 

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Understanding the anatomy and physiology, along with the mechanism of action (MOA) of the product or drug being injected is important in determining the best treatment to address the concern. Making an informed, educated choice about your treatments will help you achieve the best outcomes and ensure you are not spending time or money on a procedure that isn't addressing your concerns. This is why choosing the right practitioner is so important - someone with the experience and knowledge to guide you toward the treatments that will truly address your concerns, rather than offering procedures for a quick profit or agreeing to something they know won't benefit you. 

 

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The best treatment plan is a personalised one.

Many patients come to clinic already convinced of the treatment they do or do not want. Sometimes that aligns perfectly with what will help them. However, in many cases, after a full consultation, they realise there may be a more suitable option than the one they initially had in mind. That is not about “selling” a treatment. It is about education, honesty, and choosing the most appropriate plan. In fact, over the years I have had many conversations 'under-selling' treatment such as Polynucleotides,  and ensuring that my patients really understand the treatments and have realistic expectations of what they can achieve. This does not mean to say these treatments will not provide amazing results. They definitely have an important place in aesthetics, but they will not achieve the same outcome that dermal filler or muscle relaxing injections can. 

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A good consultation should look at the bigger picture- your concerns, goals, anatomy, history, and expectations. From there, the right treatment plan can be created for you. That may involve dermal filler. It may involve regenerative treatments such as polynucleotides. It may involve skin treatments, skincare muscle relaxing treatment, or sometimes a combination approach. Often the best results come from understanding that different treatments do different jobs.

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A holistic, balanced approach to aesthetic medicine.

My approach is always to focus on results that look natural, balanced and in keeping with you. Having a plan and building slowly, to achieve outcomes that will still look good later down the line. Aesthetic treatments do not need to be about changing your face entirely or following what is trending online. They should be about helping you feel more confident, refreshed and comfortable in yourself, with a treatment plan tailored to your individual needs.

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Sometimes that means explaining why a treatment you feel nervous about may actually be the best option for the result you want. Sometimes it means being honest that a popular treatment may not give you what you are hoping for.

The goal is not to do what is most fashionable. The goal is to do what is right for you and your anatomy, using evidence-based knowledge and the physiology of the ageing face. 

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