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

With the availability of noninvasive procedures that use injectable fillers to do the work surgery once monopolized, more people than ever before are seeking the elixir of youth that comes now at the end of a needle rather than a knife.

For the physicians who wield this needle, communicating the risks of injectable fillers is critical, both to inform the patient of any potential negative outcomes and to modulate the patient’s expectation of what fillers can and cannot do about what nature has either eroded or neglected to give.

Along with educating patients about the number of products available and safely administering the product, Jonathan Sykes, MD, professor and director of facial plastic and reconstructive surgery at the University of California (UC) Davis Medical Center in Sacramento, Calif., and president-elect of the American Academy of Facial Plastic and Reconstructive Surgery, emphasized that his job also involves talking about limitations. “There are some patients who want something that won’t work, or it may take more than one injection” he said. “My job is to provide two-way communication to find out what the patient wants.”

What the Patient Wants

Finding out what the patient wants is the first step in discussing the potential risks of fillers, because not fulfilling patient expectations is one of the risks.

“The first thing I try to do with patients is to get a concept of what they want to accomplish and what timeline they want to accomplish that in,” Dr. Sykes said.

Knowing the overall goals of each patient provides the foundation on which to discuss which fillers may or may not be appropriate and the potential risks of various fillers based on the agent used as well as their longevity (See “Complications of Injectble Fillers,” page 21).

“I listen to what concerns the patient, and if a filler is appropriate, I explain both the risks and the benefits,” said Hayes Gladstone, MD, associate professor and director of dermatologic surgery at the Stanford University School of Medicine in Stanford, Calif. For example, he said, if the patient wants lip augmentation, filler with hyluronic acid or collagen may be appropriate, while calcium hydroxylapatite could lead to lumpiness.

After selecting the appropriate filler and procedure, Dr. Gladstone then discusses with the patient the risks and benefits and provides a handout detailing these as well as the procedure itself. Included in the handout is a description of the most common fillers used and what they are best used for (see “Patient Education,” p. 21). When the patient comes in for the procedure, Dr. Gladstone again discusses the risks and benefits.