Filler treatments in multiple places on the face: Get them all at once or spread them out?

Hi, Dr. Irwin - I recently attended two consultations (different doctors) for filler in the cheeks and chin, for mid-face volume loss & sagging. The first office proposed doing only the cheeks first (visit one) and then following up with the chin at a later date. The second office suggested doing it all in one visit. Is there any advantage to having the treatments done in phases vs. all at once? (For example, would I look strange if only doing cheeks, then filling indents in chin later?). I suspect the first approach is so that the filler has a chance to settle and the injector can see how the chin has been affected before proceeding. But it seems like a real hassle having to wait. Can I trust that someone doing it all in one visit would (should) already have the expertise to predict the outcome enough to be able to fill the chin without anything looking weird or wonky? Before I decide on a practitioner, I really wanted to get your perspective on this. Many thanks in advance for taking time to read and (hopefully) respond. :-)

So here’s our approach on this! It’s better, in general, to break the filler treatments up and this creates better long term results. Pragmatically, this might mean something like this:

HA fillers are better with no more than 2-3 syringes per visit, in my opinion. Your cheeks and chin could be done at the same visit, if you don’t exceed the # of syringes. Sculptra and HA fillers may be combined if used in different areas of the face. Again, doctors may differ on this as you noticed.
Secondly, Botox/Dysport can easily be combined with HA fillers and sometimes, but not always, with Sculptra.
Some laser and RF treatments are better done a different day than fillers. Too complicated for a web discussion! Please ask your doctor about specific combinations, because certain combinations could cause problems.

Here’s why you should break up filler treatments!

We all have some natural asymmetries. Making sure your doctor/nurse/mid-level can see those and adjust to them is important.
Starting with less will build confidence in you and trust in your provider.
It takes fillers and Botox about a week to sort of “mature” in your face. After that, they are what they are. In 1-2 weeks any bruises will be gone. The swelling around bruises changes the look of the filler temporarily. If the work is staged, your providers eyes can see where to go next better.
Your provider is less likely to overfill (or over Botox) you if the work is staged over a few months. We’ve all seen friends or Hollywood stars who actually look scary. Why does this happen? Many reasons, but one is that the provider hasn’t spend enough time, or doesn’t have the skills, to truly perceive YOUR face and what YOU want. It’s a more generic, cookie cutter approach occurs then.

Exceptions!

If you have not worked with this provider before, consider starting with LESS. Start SMALL. If his/her skills are NOT good. Find that out with something small. It difficult to live with a botched face for months which is what it can take to correct things.
If you have a very important event that has just crept up on you, and you know your provider well, it’s fine to exceed some of the limits and cautions. 🙂

Hope this helps,

Dr. I

For more information on fillers see my blogs here.