How a Puffy Face from Fillers can be Avoided, and Reversed

For more on Structural Volumizing, please go to: prasadcosmetics...
For more about Dr. Prasad's background and training, please go to:
prasadcosmetics...
New York facial cosmetic surgeon Amiya Prasad, M.D. talks about why some people end up looking pillowy and doughy after facial filler treatment, how it can be reversed, and a deeper filler placement technique to avoid it, with natural-looking results:
0:21 - Introduction to facial volume loss
1:02 - Dr. Prasad details his background training in cosmetic oculofacial plastic and reconstructive surgery, as well as his experience as a facial rejuvenation specialist
1:29 - Dr. Prasad discusses why patients sometimes look doughy or pillowy after filler treatment
2:03 - The limitations of conventional placement of facial fillers
2:35 - How some practitioners intentionally place a large volume of filler to fully fill the face
3:05 - Dr. Prasad talks about his experience working with facial bone anatomy
3:26 - How most volume loss occurs at the bone level
4:04 - The advantage of placing long-lasting fillers at the bone level
4:58 - Unsatisfactory filler treatment results can be reversed with hyaluronidase
5:41 - How it is a doctor’s skill that determines the outcome of a procedure
6:02 - Conclusion
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[@wem-c9f]

Thanks for this video. I dont want to get into the group where i have to dissolve fillers. Thats would be so upsetting. Arming myself with knowledge is the key. Thank you Dr.

[@AmiyaPrasadMD]

You're welcome!

[@sassydryad9016]

Love the positivity of the video! Please tell what i need to make sure to choose a good doctor in my country? I should show him or her pics of how i wanna look like after chin filler? It's possible to make the chin wider a bit too? Not just forward growth?

[@AmiyaPrasadMD]

Hi sassy dryad, You can look at the before and after pictures of your prospective doctors, so you can find an aesthetic style that resonates with you. It is possible to make the chin wider, but I can't say for sure without examining your face, and seeing what fits with your natural anatomy. I hope this clarifies things for you.

[@mstssweeties2007]

Those before and afters are amazing!!!

[@AmiyaPrasadMD]

Thank you, Ms T's Sweeties! And it only takes minutes to do, without surgery.

[@jennyquezada9644]

Can I sleep on my side after having cheek filler or will it cause it to migrate?

[@AmiyaPrasadMD]

Hi Jenny Quezada, It depends on the level where the cheek filler was placed, and the amount of pressure placed on the treated area. Generally, this isn't a common problem because the amount of filler material used isn't that much. I suggest you discuss this with the doctor performing the treatment for you as they would know the details specific to your treatment. I hope this helps you.

[@DrAdnan]

If I have a wide face now, does that mean my face will look narrower/better with age?

[@AmiyaPrasadMD]

Hi Adnan A, While aging does make your face more angular due to volume loss, especially bone loss, your metabolism also slows with age, so you can gain weight in the face. However, bone does not grow back in the face, but fat cells can get bigger. I hope this clarifies things for you.

[@maggotmeatballz2692]

@@AmiyaPrasadMD can bone grow back in other parts of the body?

[@AmiyaPrasadMD]

​Hi@@maggotmeatballz2692, Extracellular matrix has been used to grow back fingertips that were cut, including the bone, but this can't be applied to the skull for normal facial aging. I hope this clarifies things for you.

[@annpringle8219]

Thank you for educating us.

[@AmiyaPrasadMD]

You're welcome, Ann Pringle. I'm glad you found the video informative.

[@lisaboxell670]

Hello Dr Prasad. I'm messaging in hopes you can help me with a bit of info. Last year when I turned 40 my cheeks were naturally high and I didn't have much jowling. This year my face dropped so a dermatologist suggested voluma in my cheeks and masseter botox. I did it last month and now my face looks older and puffy with a tiny jawline as i already have a weak chin. I dont recognize myself and I look older and less attractive. How do I get my face back to how it was before the filler and masseter botox? I'll take the aging over this distorted look. They used 22units of botox on each side masseters and 0.7 ml of voluma in total on cheeks, so less than a syringe but they still look odd. Will my face look even worse if I dissolve cheeks since my jaw is slimmed and fat is falling forward towards my mouth? Will the masseter botox wear off and when since I only had it once? Thank you so much if you read this. I live in Indiana and can't find anyone that knows what to do.

[@AmiyaPrasadMD]

Hi Lisa Boxell, Sorry to hear about your problems. The effects of Botox usually start gradually fading after about 4 months, but there is no way to speed up the process. Thicker hyaluronic acid fillers like Voluma can last up to two years before being safely and fully metabolized by the body, but can be dissolved with the injectable enzyme hyaluronidase if you'd like to have it resolved sooner. You can refer to this new video about it - kzbin.info/www/bejne/hmPEY2aAfteZbNk

[@wem-c9f]

Hi Dr Prasad, do hyaluronic acid fillers go away under patients' skin as time goes?

[@AmiyaPrasadMD]

Hi, Hyaluronic acid fillers are safely metabolized with time, and thicker fillers take longer to be metabolized. This is also why permanent and semi-permanent fillers are not recommended because they don't metabolize, and the body can recognize the filler as a foreign body, causing injection, and these types of fillers can migrate to other areas where they can't be surgically removed. I hope this clarifies things for you.

[@wem-c9f]

@@AmiyaPrasadMD Thanks. What are some permanent and semi permanent fillers, Dr? Silicone?

[@AmiyaPrasadMD]

Hi, I don't perform or recommend semi-permanent, or permanent filler treatments, but they include: silicone, polyacrylamide, polyalkylimide, and polymethyl-methacrylate. You can refer to this video about their effects and risks- kzbin.info/www/bejne/eYutYWion8apadU

[@wem-c9f]

@@AmiyaPrasadMD Thank you Dr, will watch the video, as usual :)

[@AmiyaPrasadMD]

You're welcome!

[@jasse145]

Hi I got revolax and another filler in my cheeks two times and also midface. Today I feel I’m puffy and I think it has migrated. how do I no where it has migrated?

[@AmiyaPrasadMD]

Hi A, Sorry to hear about your problem. I suggest you see your doctor who performed the treatment for follow up. Filler can be located through ultrasound if needed. I hope this helps you.

[@jasse145]

@@AmiyaPrasadMD thank you I’ll check that up. Also I want to know if it’s possible to inject Botox to the muscle tissue on the corners of my lips and around mouth. The muscle are veeery tight and thick.

[@tinydancer6699]

I’m 28 and got cheek filler i would like to get it dissolved as I look very puffy if I got it removed would I look like my old self or would the skin be stretched? I’m worried I’ve ruined my face please help!

[@AmiyaPrasadMD]

Hi Tiny Dance, Filler will not stretch your skin if you have it dissolved. I made a video about it, for your reference - kzbin.info/www/bejne/nqmYZWOneauVqNU

[@tinydancer6699]

@@AmiyaPrasadMD thank you so much 💖

[@AmiyaPrasadMD]

You're welcome, @@tinydancer6699!

[@violetta6280]

I need someone in Melbourne Australia that does this procedure. A google search came up with nothing.

[@AmiyaPrasadMD]

Hi Violetta, You can look up the Y Lift network of doctors as Structural Volumizing is what I call it, but I'm unaware if there are trained practitioners in Australia. I hope this helps you.

[@david-qp6mk]

i have had filler in my cheeks, jaw, nose, lips and chin. if i have all of these dissolved will it reverse the pillow look? i feel like it has come from the cheek filler

[@AmiyaPrasadMD]

Hi david, Yes, dissolving hyaluronic acid filler should reverse the look as fillers don't stretch the skin. Pillowy or bloated results are usually caused by superficial placement of cheek filler. You can refer to these videos about how hyaluronic acid filler can be dissolved, and why the filler doesn't stretch the skin: kzbin.info/www/bejne/l2S8mpavedSHkLc kzbin.info/www/bejne/nqmYZWOneauVqNU

[@maybelliner7824]

Wow your are amazing. I would love to come see you. Do you have any videos about the marionette lines? And can fillers help in this area? Thank you .😀

[@AmiyaPrasadMD]

Hi Maybelline R, Thank you for kind words! And yes, I do have videos for marionette lines, and fillers can definitely help. You can refer to these videos about it: kzbin.info/www/bejne/pn7bmpiDZZqepck kzbin.info/www/bejne/qHTNpoh3pMt4fLc kzbin.info/www/bejne/p3erl4yOqbuAq9k

[@a.evansrn107]

Love your channel!

[@AmiyaPrasadMD]

Thank you, A. Evans RN! I'm glad you find the videos helpful. Thanks for watching!

[@wem-c9f]

Hi Dr Prasad, for a patient who has had fillers used over a few years and now needs a face lift, does she have to have all the remaining fillers dissolved first? Thanks.

[@AmiyaPrasadMD]

Hi, Not necessarily, as a facelift treats sagging skin, muscle, and tissue, while fillers treat volumetric loss due to aging. I hope this clarifies things for you.

[@wem-c9f]

@@AmiyaPrasadMD Thank you. So a person who has existing fillers can still do face lift? Will there be additional risks or complications to do face lift with existing fillers? Asking cos I am sure there will come a time when fillers no longer works and skin will probably do best with a surgery lift. Thanks.

[@AmiyaPrasadMD]

Hi, The situation with the existing fillers needs to be examined before surgery to determine any additional risks or complications, but generally a facelift can be done with existing fillers present. I hope this clarifies things for you.

[@wem-c9f]

@@AmiyaPrasadMD This makes sense. Thank you.

[@AmiyaPrasadMD]

You're welcome!

[@jacqueline369]

Hello Doctor, how do i find a doctor like you to know how to apply the filler. I would love to show you a picture of my puffy face and would love to get your thoughts. I’m in California but originally from New York. And maybe consider you but because of Covid id like to take care of it now locally. Your thoughts

[@AmiyaPrasadMD]

Hi MakeItCount, Doctors trained in the Y Lift technique of filler placement can place filler at the bone level, but we all have our different aesthetic styles when it comes to procedures. I suggest you look for Y Lift-trained doctors, and look at their before and after pictures to view their aesthetic style, and see which style resonates with you. I hope this helps you.

[@corgiskittens6095]

For a person who has significant volume loss to various parts of the face, fillers are extremely costly to use. Would you recommend biostimulators such as Sculptra? Is it true that not everybody will get good results with Sculptra? Do you use Sculptra to nasolabial areas or the neck for your patients? Thanks. :))

[@AmiyaPrasadMD]

Hi Corgis & Kittens, If you want precise and predicable results, I don't recommend Sculptra/ poly-L-lactic acid because you don't know how your body will react to create volume. Long-lasting hyaluronic acid fillers such as those featured in the video are more precise, and when placed at the bone level, and held in place by the muscle layer, are prevented from migrating. I hope this clarifies things for you.

[@corgiskittens6095]

@@AmiyaPrasadMD It makes sense regarding the unpredictability of our body's reaction. And the long-lasting hyaluronic acid filler you talk about can be placed at bone level even for the nasolabial and marionette areas? Thanks Doctor Prasad.

[@corgiskittens6095]

@@AmiyaPrasadMD Oh Doctor, I understand that the fillers injected around the peri-oral areas usually dont last very long due to the constant movements. :( That was why I am thinking of Sculptra.

[@AmiyaPrasadMD]

Hi@@corgiskittens6095, Filler can't be placed at the bone level for marionette lines, and nasolabial folds because these areas don't have bone behind them. I still don't recommend Sculptra for these areas, but a combination of hyaluronic fillers with different viscosities can be used. While longer lasting fillers are ideal, their thicker viscosities tend to not work well in areas with more facial movement. I hope this clarifies things for you.

[@corgiskittens6095]

@@AmiyaPrasadMD Thanks Doctor. I have seen doctors place filler in the nasolabial and marionette areas but I am guessing it must be superficially done, rather than on bone level. I agree with you that the longer lasting ones won't work for high movement areas but the lower viscosities ones metabolise very quickly.

[@471annika]

Please help! Restylane filler was injected on the sides of my mouth (I asked for only my top lip, nurse decided to inject my face as well). One year and 2 months later I have built up collagen or scar tissue deposits on the sides of my mouth. It feels like pockets of trapped material. I've tried hyaluronidase at least 8 times and kenalog twice. Doctor has told me to massage the area daily. How do I get rid of it! It's very uncomfortable, noticeable (to me), and makes my mouth appear much wider. Help! What should I do!

[@AmiyaPrasadMD]

Hi Annika Lewis, Sorry to hear about your problem. A physical exam is needed to determine the cause of your issue, whether it's scar tissue, filler encapulation, an infection like biofilm, etc. If you can't make it here for a physical exam, I suggest you get another opinion at a different clinic, as massage may not be enough to deal with this problem. I hope this helps you.

[@sucra87]

I need to know your location for a consultation dr thank you

[@AmiyaPrasadMD]

Hi sara c, Our offices are located in Manhattan, New York City which you can call at [phone], Garden City, Long Island at [phone], or Vienna, Virginia at [phone]. You can also reach us through www.prasadcosmeticsurgery.com, www.eyelifts.com, or www.pufffyeyes.com by filling out a contact form, and we will get back to you. Formal consultations can also be arranged through Skype video conference. I hope to hear from you soon.

[@johne8389]

i know this is off topic but i’ve had the worst under eye bags and dark circles for about all my life, i’m only 16 and they don’t seem to be going away i’ve tried everything from sleeping at 8 to every cream out there but nothing seems to help it , do you know what causes this because it brings unwanted attention because of how bad it is

[@AmiyaPrasadMD]

Hi john e, Sorry to hear about your problem. For someone your age, treatment would only be done in extreme circumstances, but it is possible. Eye bags that are puffy all the time are due to fat normally around the eyeball pushing forward, and it can happen in young people. I have done eye bag surgery for someone as young as 14 because it was really affecting his self-esteem due to bullying. You can review these videos for more about the causes and treatments: kzbin.info/www/bejne/h3PZm52srbWnaMk kzbin.info/www/bejne/navHhZ9tgJugZ7c kzbin.info/www/bejne/r6TdoY2JhKp6pbM

[@Maxcap208]

Dr.Prasad can a laser treatment be done for under eye dark circles for someone with brown skin? One of the doctors told me that it can turn the lower eyelid skin pink color if done on brown skin. Thank you!

[@AmiyaPrasadMD]

Hi Sub Zero, Your doctor is describing hypopigmentation, which people with dark skin are at a higher risk or getting when using lasers. I would use PRP to help darker skinned patients with dark circles before using a laser. You can refer to these videos about it: kzbin.info/www/bejne/h3PZm52srbWnaMk kzbin.info/www/bejne/oIK4k2lth9WUd68

[@sherryhart519]

Will you please come to Atlanta and do my face

[@AmiyaPrasadMD]

Hi Sherry Hart, Sorry, I don't practice in Atlanta, but you can come see us in New York or Virginia as we do have out-of-state patients coming in every day. Our offices are located in Manhattan, New York City which you can call at [phone]; Garden City, Long Island at [phone]; or Vienna, Virginia at [phone]. You can also reach us through www.prasadcosmeticsurgery.com, www.eyelifts.com, or www.puffyeyes.com by filling out a contact form, and we will get back to you. I hope to hear from you soon.

[@sherryhart519]

@@AmiyaPrasadMD I would love to come, but it’s taking Off from work and the expense of travel. I know it would be worth it. I may see about next summer. You do amazing work. I’m 56 and would love a few years off

[@AmiyaPrasadMD]

I hope to meet you sometime,@@sherryhart519 !

[@sherryhart519]

@@AmiyaPrasadMD ❤️

[@tnt01]

What are your thoughts on Amalian filler for cheeks Dr.?

[@AmiyaPrasadMD]

Hi tnt, While Amalian is a hylauronic acid filler, and a filler brand I don't use, the brand of filler is not as important as the doctor's skill using it. It's like a house being built is not determined by the brand of concrete being used, but rather the skills of the architect and the builder determining the final result. You can refer to this video about it - kzbin.info/www/bejne/oaHOeqiFjdCfpas

[@tnt01]

@@AmiyaPrasadMD Thank you.

[@AmiyaPrasadMD]

You're welcome,@@tnt01!

[@znnzrrt4362]

Dr. Prasad can I ask you something. I had under eye fillers 3-4 months ago and I am really happy with the result but the problem is I use retin-a and sometimes get irritated red skin under the eye area and a few small pimples. Now I wonder if this irritation could harm my fillers. I dont want to give up retin-a but dont want my fillers degrade faster or change shape. Can you help my please :)

[@AmiyaPrasadMD]

Hi Mmn Nmm, Retin-a will not have an adverse effect on your filler as it is a topical treatment, and the filler is embedded at a deeper level. I hope this clarifies things for you.

[@znnzrrt4362]

@@AmiyaPrasadMD thank you so much for your answer. Can the pimples leave holes or eat out the filler in a way? Im a little worried :D

[@AmiyaPrasadMD]

Hi Mmn Nmm, That's highly unlikely as the filler should be underneath the eyelid skin. I hope this clarifies things for you.

[@znnzrrt4362]

@@AmiyaPrasadMD thank you so much :)

[@AmiyaPrasadMD]

You're welcome,@@znnzrrt4362!

[@aprilsteinmetz9582]

Can filler in your nasal folds over time get to your cheeks? My eyes are super small now

[@AmiyaPrasadMD]

Hi April Steinmetz, It is highly unlikely as fillers tend to migrate downward, not upward, and don't migrate far from the original location. An examination is needed to determine the problem with your eyes. Also, did you have hyaluronic acid filler treatment? These fillers are metabolized with time, so they won't go too far, but that's not the same case for permanent and semi-permanent fillers, which I don't recommend due to safety issues. I hope this helps you.

[@aparnasen9755]

I am from India ,so it is my bad luck that I couldn't ask for your opinion and treatment feeling so helpless

[@AmiyaPrasadMD]

Sorry, Aparna Sen. You can look up the Y Lift as the basis of this deeper filler placement technique, but I'm not sure if any doctors in India have been trained in it.

[@sherryhart519]

Yep

[@hijgghkgkgiy8226]

Yup now I know why I look different

[@AmiyaPrasadMD]

Sorry to hear about your problem, Hacker 12345, but I hope the video gave you the information to address and avoid an overdone look.