This Dermatologist Breaks Down the Myths Around Filler

Welcome to Under the Surface,

where we explore aesthetics and the trend-shaping

beauty culture.

I'm your host, Dianna Singh, Allure's Features Director.

Today, we're tackling the myths around filler.

The internet is full of half-truths,

clickbait, and conflicting advice.

So who better to guide us than Dr. Ellen Marmur,

a board-certified dermatologist and injectables expert

known for her preservation aging technique

and years of clinical experience

helping patients achieve natural, safe results.

Dr. Marmur, thank you for joining us.

I'm so happy to be here. Thanks.

Let's get into it. Great.

[upbeat music]

So, Dr. Marmur,

when you think about the biggest misconceptions

that people have about filler, what comes to mind?

Like a waterfall of things, so many.

Forever lasting filler, filler forever.

My husband or partner will kill me if he knows I did it.

Meanwhile, he comes and does it too.

Oh, ooh. Yes.

If I do it, it's gonna expand my skin

and then when it goes away, it'll be all floppy.

Everything should be convenient,

so somebody should just come to my house and do it for me.

Those are the ones.

Let's unpack, let's unpack some of those.

Let's start with filler migration.

Does filler move?

Filler does not dance across your face.

And anatomically, your skin is like,

think of a mattress and it's got coils and foam.

So you've got like muscle and collagen

and all these proteins.

So it's not like a waterbed,

where you just have this like empty space

and you inject filler and it just kind of goes anywhere.

So I did a deeper dive on this in the literature,

so let's get science-based. Yeah.

There's one study published out of Brazil

that looked at the databases for about 10 years.

So millions of injections have been done.

There were only 28 cases that fit the definition

of migration. Okay.

Of those, most of them were not done

with modern hyaluronic acid fillers.

They were done with permanent fillers

often done in Europe many years ago,

Like a silicone sort of thing?

Like silicone, acrylates they're called.

So things that like sound like glue.

People used to put paraben in their skin.

So things that last forever,

probably not the thing to go for.

But modern hyaluronic acids mostly don't migrate.

When people think about migration,

really, I think they think of like parasites or something.

Like they think something's gonna like get up and move

like five years later.

Really, again, the way the skin is put together,

it's like a very complex, you know, home.

You've got compartments in your face,

you've got different types of soft tissue,

and as you age, those muscles move, those compartments move,

and the filler that was put there might move with it

and show up a bit later. Okay.

There's anatomic variations in our skin.

There's different types of viscosities

or like textures of fillers,

so if you put a very lightweight filler

in a very high motion area, like around your lips,

maybe that'll sort of spread a little bit,

but we're talking like a millimeter.

So typically it's misplacement,

or diffusion like very locally,

but usually it's not migration.

Is it more diffusive in the hours after placement, then?

'Cause I know I've had filler before

and I've been told, You know, don't, you know,

sleep on your stomach that night, for example.

Honestly, probably not.

That's really more of the neuromodulators.

So Botox is like a micro droplet liquid,

so you're not smush your face.

But filler is a molecule.

Think of like a little mini sponge.

Hyaluronic acid is a little molecule

that we already have in our bodies.

Every plant, every animal, it just hydrates. It's a sponge.

And it's in a little gel, so think of hair gel.

So when you inject it,

that gel is interpolating into those little

things I told you about.

So it's now where you put it,

and then your body water comes to it and fills.

That gel goes away, it's just a carrier.

So within two weeks that gel is gone,

and now it's just your body water

on that natural molecule that you already have in there.

So for the first two weeks, things are settling in,

but you really can't ruin it by sleeping in a funny way.

That's good to know.

I do millions of dollars of filler a year on people

and I've been doing it since my fellowship in 2003,

so a long time,

and I've never once had a case of filler migration.

So it did make me feel a bit better

looking at the literature and being like,

Okay, all right, I'm not crazy.

There really aren't very many cases,

less than 0.1% of cases.

Migration or it lasting- Or lasting forever.

Years and years and years.

So how do you set a patient straight

who has seen some of this clickbait,

has, you know, asked ChatGPT for

Where would you put filler on my face?

How do you kind of toe the line of respecting the patient,

but also, Here's the deal.

It's actually really hard,

because people are gonna wanna think what they wanna think.

And they're going to think,

if they don't know you already,

they're gonna think you're trying to sell them something.

So I just back off and I'm like,

All right, just so you know, I just wanna educate you.

From what I know, it doesn't last forever

if we use a small amount.

You know, if we use 27 syringes, maybe, you know.

It doesn't migrate.

This is the way anatomy works

and modern HA fillers are reversible and refinable.

So you're not married to it.

Like, you can try a tiny little bit.

Why don't we try, like if you ever wanna try it,

a teeny weeny bit, like 0.1 CC.

We'll just put it there and you'll be like-

A little sprinkle. Oh, gosh.

Okay, that's not that big of a deal.

So it's a big decision to do filler,

it's an elective procedure.

It's not like you broke your arm and have to get it set.

Like it is a thing,

and it should be done in a clean environment

in a doctor's office.

Spend the extra 20% if you have to.

Save your money elsewhere.

And never be ambivalent when you're

doing an elective procedure.

Like, just ask all your questions, you know,

go bye-bye, come back, do it when you're ready.

Yeah. Yeah.

And take what you see online with a grain of salt,

it sounds like. Yeah.

Yeah, and think about who's the messenger.

When I hear fear-based messages, it makes me scared.

And then I'm like, Wait, who's telling me that?

Why are you doing that? Like, think about it.

And then you don't agree with everybody in any room, anyway,

so get your own information, bring back your own authority.

So we've talked about what happens when things

perhaps go wrong.

When things go right, what should a patient expect

in terms of results and longevity of filler?

And 99.9% of the time, things go right.

Filler is so popular because it is now refined

and it works well, with restraint, with knowledge,

with clinical studies that have cost millions of dollars

on many thousands of patients worldwide.

Different skin types, different ethnicities,

different ages, different genders, everything.

So what you should feel is that you actually

look more natural.

But most of us, as we age,

we actually feel disconcerted when looking in the mirror,

because we don't look as natural as we want to.

So aging makes you feel like you look unnatural to yourself.

So sometimes restoring that youthfulness a little bit

brings you back to who you think you are.

So the mirror matches- Yes.

With the outside.

And that's what I hope for people.

I hope that when they try a little filler, they're like,

Oh yay, I don't have that like indent anymore

or Oh, that's just a little bit better.

But I can't feel it, I smile the same.

Everything else is the same.

Nobody noticed, you know, yeah.

And does that vary in different areas of the face?

And I know you mentioned the lips,

where you might be talking a little more.

Are there differences in anatomy?

Yes.

So hypermobile places, like around the eyes

and around the mouth tend to last less long.

But you're also choosing a filler

there that is finer and more serumy,

and so those may not last as long.

Thicker fillers that are used for like bone structure,

straightening the nose, lifting the cheeks,

lifting back here, even lifting the brow,

those might last a year or maybe two.

So it sounds like you've got a lot of tools in the toolbox

then, even as narrowly as filler, specifically.

100%.

Like actually more tools in the filler toolbox

than maybe any other toolbox.

Asking like, Okay, which one are you gonna use?

How much is it? We make a master plan for people.

So we have an androgynous face

and I listen to the person,

I'm taking notes about what they're interested in.

And then I write out what exact filler,

how much it costs, how many syringes,

how long I think it'll last, where I think it should go.

And then if they select,

then my nurse will go over it with them

if they want to do it.

They're always in charge. Yep.

We get it set up and we always ask,

Have you been taking any aspirin or Advil

or any blood thinners?

Did you drink a lot of alcohol last night?

Did you fly on an airplane yesterday?

All these things I think can create bruising.

And that's a bigger side effect

than all those myths that we talked about.

Thank God it's temporary.

But always knowing also if your provider

has hyaluronidase in the office,

that's your like emergency kit.

So if something bad happens, it usually happens right away.

You can tell, like it bruises or blanches.

Then you immediately can inject this hyaluronidase

and then it's totally fine.

Is that actually breaking down the HA in the filler then?

Yeah. Yeah.

It breaks down like the whole gel complex,

so it makes it just turn into water.

So like anything else in that soft tissue, it's just water.

Got it. Got it. Very cool.

Are there other sort of red flags,

things you should look out for

if your provider is not giving you answers,

what raises alarm bells for you?

You should see the box that the filler comes in,

open to this like clean package is opened in front of you.

The filler and its little syringe and needle right there,

like it should all be in front of you.

Almost like an open kitchen at a restaurant.

Like you see how they're doing things

behind the scenes is right with you.

If you can't know what it is,

how much is being used and all that jazz,

you probably should be like, You know what, I don't know.

I'm gonna.. Yeah.

I got a call I have to make, I'll be back.

Ooh, yeah. Make an exit.

Yeah. [laughs] Time.

Totally. Totally, that makes sense.

And are there ways of, you know,

avoiding even getting to that point

in terms of vetting your providers?

And are there resources for someone

who couldn't come see you in New York?

Yeah, ASDS and AAD are two organizations.

American Society of Dermatologic Surgeons

and the American Academy of Dermatology

have providers listed.

Those are board certified dermatologists.

To get that training

means that you're not just getting a weekend course.

Yeah, absolutely.

Dr. Marmur, thank you so much for this conversation

and for sharing your time and your expertise.

We're so grateful. Thank you.

I think this is so important.

It is really important to redirect misinformation.

And I think this trend is gonna double any,

I mean, fillers, the use of fillers is gonna double

in the next couple of years.

So understanding what they are and who should be doing it

and for whom is so important.

So thank you, Allure. Thank you.

And thank you for watching.