The Skinny Confidential Him & Her Podcast - Dr. Samantha Ellis On Skin Health, All Things Filler, & How To Maintain Youth In Your Skin

Episode Date: August 24, 2023

#602: Today we're sitting down with Dr. Samantha Ellis to talk about all things facial filler. Dr. Ellis represents Galderma Restylane & she joins us today to answer all of your questions about cosmetic filler. We discuss who's a good candidate to get filler, how facial structure affects what filler will look like & how much you need, and she gives advice about everything people should know before going under the needle. She also dives into the different types of filler, and what purpose each type serves for different aesthetic goals.   To connect with Galderma Restylane click HERE To connect with Lauryn Bosstick click HERE To connect with Michael Bosstick click HERE Read More on The Skinny Confidential HERE To subscribe to our YouTube Page click HERE For Detailed Show Notes visit TSCPODCAST.COM To Call the Him & Her Hotline call: 1-833-SKINNYS (754-6697) This episode is brought to you by The Skinny Confidential This episode is brought to you by Galderma Restylane Visit aspirerewards.com/skinny and you can save $80 off any restylane treatment, offer terms and conditions apply. The Restylane family of products are indicated for people over 21 years. The most commonly observed side effects are swelling, redness, pain, bruising, headache, tenderness, lump formation, itching at the injection site, and impaired hand function. To learn more about the serious but rare side effects and full important safety information, visit www.RestylaneUSA.com

The following podcast is a Dear Media production. This episode is brought to you by Restylane. She's a lifestyle blogger extraordinaire. Fantastic. And he's a serial entrepreneur. A very smart cookie. And now Lauren Everts and Michael Bostic are bringing you along for the ride. Get ready for some major realness.

Welcome to The Skinny Confidential, him and her. Aha! illness. Welcome to the skinny confidential him and her. This is medical. And this is like also an aesthetic thing. Like this is not the place to skimp. Even if I have a patient who comes in, who has a budget, like we can work within a budget, but sometimes I'll say, Hey, if one syringe is all you can afford right now. And I truly feel like you need two syringes in the mid face to make a meaningful difference, save up and come back in six months or seven months or whatever when you can do both because it's not worth doing just a little bit. In this case, it's not going to be right for you. And I think a lot of injectors

might be like, oh yeah, just do what you can. But I think for some people, you really have to find that balance. Something that is not discussed enough is the intricacies of filler. So on this episode, we're going deep. We're going to talk about filler fatigue, pillow face, filler face, and all the things with one of the top board-certified medical and cosmetic dermatologists. Her name is Dr. Samantha Ellis, and she is an expert on all things skincare. We talk in this episode tips, tricks, advice on skin aging, being preventative, filler, how to get a natural look. We talk about small tweaks, not drastic changes. We break down what is in filler. I left this episode feeling so educated in all things injectables, and I know you will too. We're going to learn all the tips from Dr. Samantha Ellis. On that note,

let's welcome the beauty expert, Dr. Samantha Ellis, to the Him and Her Show. This is the skinny confidential, Him and Her. In your childhood, can you remember, this is a weird question, but like looking at people's faces from an aesthetic standpoint, like did you always know that this is something that you would get into? I think I was always aware of how people look, but I don't think I was ever looking at them through the same lens that I do now as a cosmetic professional. So I think only once I went through all of my training and now that something I do every single day in my job, now I look at people that way more, although mostly in the office all the

time. My friends are like, are you just like looking at my face and judging what you would want to do to it? And honestly, I really am not unless someone asks me to do that for them and then we can break it down. So where does Michael need filler? Don't you dare look at me. You're looking good. You got it. No filler. Oh, I'm good Lauren, see? I think so. I think I'd have to get up like really close and like touch your tissues and kind of see, but I think you're doing well. It's one of those things where I fear that if I started going, I would like look at, it would like throw, it would just throw me out of whack. Well, I think if you have a good injector and they're using the right things,

they shouldn't do that. And I also think how you would inject a male face if they are looking to keep their masculinity in those proportions is very different than how you would inject a woman's face or someone who wants more feminine proportions. And so just making sure your injector understands that is the most important thing because you don't want to feminize the face if that's not what they're trying to achieve. You have so much background and experience in this. What makes a good injector? What should someone look for? It's tricky because experience is one part of it. But as you can kind of imagine, experience isn't everything. You can have someone who's an amazing artist when they're five years old and you can

have someone who's been drawing their whole life and can't draw a stick figure. So part of it is experience, but part of it, I think, is also some bit of natural talent. I think you want to look at their credentials, like what is their educational background, who has certified them. I'm a board certified dermatologist, so there's very rigorous training that I go through to understand the skin and understand facial proportions and understand aesthetics. And it doesn't mean that people who are not board certified physicians can't inject. There certainly are amazing injectors who are nurses or physician's assistants. But I think looking at how they've learned, what criteria they've

sort of gone through, what classes and courses they've taken is really important. And then I think sometimes, too, it's nice to see their work, like if they share before and afters and things like that. But I always tell my patients you need to take before and afters with a grain of salt because people are only showing their best stuff. And also now in the era of like Photoshop, unfortunately, that can tweak things also. Have you seen Photoshop from doctors that's blatant? Oh, yeah, all the time. And it's it's kind of shocking, honestly. Well, one, because it's to me unethical to Photoshop your before and afters. But two, it's like, do you think people can't notice like that? This is the thing. The doctors are doing it or the patients are doing it. Well, I don't think the patient well, patients could do it, too. But I

think if you're like posting on your professional platform, for example, yeah, on your website or whatever, I think there are plenty. I think most people are not doing that. But I also think when you're taking before and afters, there's a lot of things that have to line up. The lighting has to be consistent. The patient's pose has to be consistent. And I think little tweaks with Photoshop are done to sort of help with that consistency between the photos. But then I also think that sometimes the results also get photoshopped in a way where they're maybe not as authentic to what's actually happening. That's wild, man. Yeah, it's tough. And I think, too, that's the hard part about injectors is like finding a

perfect one is sometimes you need to meet with them in person. I always tell people who aren't like I get a lot of DMs like, how do I find a good injector? I'm not in California. I can't come see you. And I always tell them, like, go to the practice, meet the person. Also, look at all the staff in the practice because oftentimes we inject our staff. And so just looking around and just seeing, like, what am I seeing? Does it match my personal aesthetic? Do these people look natural? Is it what I want? And that, I think, can also just inform you about, like, the way they inject and what their outcomes are. You mentioned the tissue. And I thought that was really smart. Can you tell us what you mean by that? You have to feel the tissue. What does that mean?

So I think when you're looking at someone, you can tell a lot about their face, their bone structure. But for me, I like to feel because there's many layers that go into the face. There's your bones, there's your muscle, there's your fat pads, there's the deeper layers of your skin and the more superficial layers. And sometimes someone can look like they have a lot of good support structure and then you go to touch their face and you're like oh that fat pad isn't very supported or their skin feels very stretchy and that can help me understand when I put a particular filler in how their tissue might respond it just gives me a better sense of like how I can predict how they'll respond because sometimes you can guess like if I put this here, based on my experience,

this outcome is expected. But sometimes you touch someone's tissue, like, oh, they have like really distensible or stretchy tissue. I might need more products to achieve the same result. Or I'm worried that this might fall if I don't use something more robust here.

So it can help inform like what products you're using and maybe your injection technique as well. Is there anything we can do at home to have great tissue? I think as a dermatologist, I'd be remiss if I didn't say sun protection, but honestly, UV radiation is probably the most damaging thing to your skin and even your deeper structures. I think other than that, genetics is a huge part of it. There's also a study that just came out that weightlifting improves your skin quality. So I was like, you know, you might lift

some weights. That's really interesting that you say that because we have a really good friend, Kim Kelly. Kim Kelly Fit, if you're in San Diego, she's an incredible trainer. And every time I see her, she just looks more and more amazing. And it's because she's constantly building muscle. And even when I see her, I'll see her in her 40s and she's like, it's amazing how the skin is so tight to her muscle. And I bet you that has to do with her tissue. It makes sense if you think about it in any area of the body, if you have muscle to hold the skin against.

Right. It's structural support. Yeah. A hundred percent. There's also this gum that we've just got. Oh my God. Tell her about the gum. Oh, please. Okay. So a lot of people are talking about mouth taping, like breathing through. Yeah. A hundred percent. There's also this gum that we've just got. Oh my God. Tell her about the gum. Oh, please.

Okay. So a lot of people are talking about mouth taping. Yeah. Like breathing through the nose. I love it. I've been trying to get my husband to mouth tape for years. I have some tips up my sleeve. Okay. Please, please. I think the big takeaway there, because sometimes when we talk about mouth taping, and many people are talking about it now, they freak out like, oh, you taped your mouth.

It's just retraining your body to breathe the way it's supposed to, which is through the nose. But there's this gum. What's it called? Guar gum? Yeah. Guar gum. And it's from this like tree root or tree sap or something like that. And basically you chew on it to make the structure of your jaw stronger. So a lot of people are, I know, using stuff to get that effect.

Yeah. But also just like building the muscle in the face because it's an area that we neglect, right? Like you work your body, but people don't think about this, especially maybe if you don't have a meat-based diet. Right. And you're eating softer foods, like your jaw just gets weaker and weaker. Completely. And it's so interesting that you say that because a lot of people too

naturally will have a very strong jaw with a lot of muscle bulk there. And they will use neuromodulator injections to actually slim that muscle or weaken it because it's too strong or they're having TMJ pain or something like that too. So it's so interesting like what people need or want. Are there areas with everything you've seen that you believe maybe maybe they've been a trend or maybe the people have just you know areas that you think people overfill or maybe you should stay away from filling or or are you seeing yeah because I because I we see all these kind of trends and they kind of come and go and it's interesting for me to look at especially as as I get older, to see like what's in vogue and then what goes out.

And I'm like, I think with this stuff, you know, what people are doing. It's interesting because to me, aesthetics, there are certainly things that really do come in and out of fashion. But there are certain things that are like timeless. Like if you look at like Cleopatra all the way to now, we've always valued like a long neck or like we were talking about trap talks earlier, that sort of like nice descent there. But I do think lips are an area where for probably maybe like five years ago, it became like so popular to have like really, really big lips, beyond sort of maybe what I would perceive as natural. And I think now people are like shifting

back towards a more natural aesthetic. But I do think people kind of overdid it initially with lips. Not everyone, of course, but I think a lot of people were asking for that. A lot of people wanted to achieve that, but not everyone's anatomy can support a ton of product in the lip in that if you're not kind of working within someone's unique anatomy, you're just trying to give them some cosmetic enhancement that they're asking for. You might not always be able to achieve like something that looks really good. Yeah. I think the thing that I feel about filler is you shouldn't be able to tell someone has it. Yes. It should enhance features slightly, but you shouldn't look at it and be like, oh, that person has filler. What I've noticed as I've watched sort of the trends evolve that when I'm looking at someone and something feels artificial or off, you can tell that they've had something done. So you don't want the brain to

sort of subconsciously feel that you're looking at something artificial. Absolutely. We always say, or at least I do, that the best injectable is undetectable. You should not see someone's work. It should just work within their natural anatomy to what you said, enhance, beautify, balance. But it really shouldn't. You shouldn't see the product. You should just see the balance of that person's face. five years ago to have huge lips and you continue to have huge lips, you can tell how old you are based on the trend. So if you think back, when Pam Anderson, Baywatch was all the rage, everyone got those bolt-on boobs. But if you have those bolt-on boobs now, you look like you're in your 60s or 70s because that's what was popular when you were younger. Completely. So you have to be really careful of the trend that you're holding on to

because it can actually do the opposite of what you're trying to achieve. Completely. You have to change with the times. And I've talked about this before on my own social platforms that if you don't adapt and change, then your filler can age you instead of not age you. There's so many great ways to make it beautiful and so seamless with yourself, but you have to kind of stick with what's current. It's like if I showed up with frosted hair and spike tips. Yeah. I don't know. You could rock that.

You're like, that's from the 90s, right? This guy must be getting up there. Totally. Maybe I would rock that. Carson, what do you think? Maybe I'll do that. When you say that there's little tips and tricks that you can do as an injector, what are those? So I think there's lots of things. I think working with the idea of less is more to start can be really helpful. I think sometimes people come in and they're ready to rock and roll and they want to do a whole bunch in one session. And sometimes you can do a lot of filler in one session and it looks beautiful. It's so natural. And sometimes actually using more product makes someone look more natural because you can balance the face

as a whole. Sometimes people come in and they're like, I just want lips. I just want chin. I just want under eye. But the reality is if they're struggling with their under eye, that often means that maybe they're lacking some support in the middle of their face or their chin might be a little bit out of balance. And so my biggest tip for injectors is don't look at the feature, look at the face. And really, like, even if the patient is asking for something specific, you have to use your own expertise and your own judgment to really look at what they need in total. And sometimes if someone's coming in and they want under eyes, you need to start with other areas of the face first and explain and educate your patient

why starting there might not be the best step. So that's one thing is just, treating the face more globally. And I think the other thing is like, don't be afraid to like have someone come back in two months and add a little bit more or tweak something like you always need to see your own work back because that's a way that you grow as an injector too is like seeing that's feedback that teaches you how did this settle after two months, after six months, after two years? So you can constantly evolve your practice. Isn't there something that's really going on right now too, where really high quality injectors are saying, Hey, like you just said, come back and we can then fill a little bit more. Like you go slower rather than just pump it all in on the first session.

Absolutely. I think working in stages is so helpful. And I also think, for example, if someone has more petite lips, their lip anatomy can only accommodate so much product. And so you don't want to push it beyond that because it's going to one, look unnatural, but two, then you might run into other issues like the migration things that we hear about. And so by just working in small steps, it makes it look much more natural. And also for people, if you've looked at your face looking one way for so many years, and then all of a sudden you have a massive adjustment, it can affect you psychologically. That happened to me. Did it? Yes. That happened to me so gnarly. I had a full identity crisis.

Yeah. Because you're looking back at someone that you don't fully recognize. Because of your jaw surgery? I had jaw surgery. I had double jaw surgery oh wow i wasn't prepared for to look in the mirror like you just said and see a such a drastic change and i for like a year maybe a year and a half was like it was i couldn't even look in the mirror it was horrible and i was googling like you know i didn't know what it was i didn't have the words to articulate what I was experiencing. Right.

Looking back, it was maybe like a little bit of a depression. But it was because of the drastic change in my face to look in the mirror, not recognize yourself is a fucking trip. It's like being on mushrooms or something. It's a trip. Well, yeah, it's like having that disconnect, especially because no one is more familiar with your own face than you are. And you look at it through a very particular lens. And so even if your injector looks at it and goes, oh, this is balanced, this looks great. Like if you if it's too much of a swing from what you're used to

seeing, even if mentally you think that's what you want, it can be like emotionally traumatic for some people. And so I think that's another reason why I always recommend working in stages. A lot of times patients will come in. They're like, I've been waiting for six months to get in here. Like, let's do it. Like, let's go all in. But I really caution against that just for that exact reason is it can feel like such a mind shift. Oh, it was horrible. Yeah. I should have gone to you. The golden ratio. Yeah. So we had Anastasia of Beverly Hills on the podcast and she's obsessed with the golden ratio and she explained it and like drew it out to us. And I thought it was super interesting. I would love to hear from a doctor's perspective what it means, how you can achieve it, maybe with makeup, how you can achieve it with injectables, how we all can get the golden

ratio. Sure. So the golden ratio, also known as phi, is basically this. It's essentially looking at the face and keeping things in proportion, keeping certain distances between the eyes and the cheeks and the lip height and the chin height and looking at proportions in a way that keeps someone super balanced. Now, I always caution a little bit against the phi ratio because it or the golden ratio because it looks at one type of face. And obviously, when you have different ethnicities and people at different ages, the phi ratio because it, or the golden ratio, because it looks at one type of face. And obviously when you have different ethnicities and people at different ages, the phi ratio shifts a little bit or the golden ratio changes. But ultimately it really is about like keeping proportions in balance. And again, that's another reason why when you're coming in and seeing a

patient in consultation, you're really looking at the balance of their face. Sometimes people just want to have symmetry, which is part of the golden ratio. We look at symmetrical things as more aesthetically pleasing, but it's also about having the right projection of the chin to the lip, to the nose, to the right distance between the forehead, the mid face and the lower face. Like those are all, all things need to be in balance. And it's basically about facial harmony. That makes so much sense. Facial harmony. And it was Da Vinci who put this out there? I believe so. I believe it's Da Vinci. Yeah. You know what's funny is I was listening to this podcast and you probably even know this better than anyone. They said a millimeter in the face can make such a difference.

Huge. Yeah. Even half a millimeter. You know, we talk about... If you move your nose a millimeter, you know. Right. It's huge. It's such a big difference. And that's the other thing is with fillers, you can do very small tweaks and make a really impactful change in the face that, that doesn't totally shift how someone looks or appreciates their own face, but balances them in a way that now they feel like things are sitting the right way. I'm going to butcher this, but I think Andrew Huberman was talking, maybe not about the golden ratio, but about basically facial recognition in the human species and basically what we find attractive because of the way we've evolved with these symmetries. So if someone, you know, like I know there's a trend where people are like

cutting off their eyebrows or like shit, like it throws the symmetry of the face off and it's not that we just think it's ugly, but the, I'm not saying people that do that are ugly. It's just, we've evolved to recognize eyebrows and that symmetry. And so when you take that off the human faces or the human eyes, like what's going on here? Same thing when people like tattoo their faces, it throws the symmetry and it takes a while for the human eye to recognize that distinction and find it attractive. Completely. There are certain facial landmarks like the eyebrows, for example, like the middle of the nose, the height of the lips that people just look at and then they understand a face. And that's the interesting thing is every single person, whether they're trained in aesthetics or not, can look at someone and say, this person is attractive.

And of course, we say beauty is in the eye of the beholder. But if you take two people side by side, 99 out of 100 people are going to say one person's more attractive than the other consistently, even if they're not trained in that, because the human mind just understands beauty. What are some things that you look at in a person's face that indicate aging? For instance, like, you know, I mean, this is a random one, but temples. Yes. Like I was literally going to say that. Tell us about temples. Let's talk about temples. Temples need better PR. They do. They really do. It's one of those things. Yeah. It's one of those things where no one comes into my office saying,

hey, my temples look sunken or hollow. But if you start to look at people as they age, almost universally, you will see the temples start to thin out and become a little bit more hollow. And so that's a huge sign of aging is things becoming more hollow, essentially in the temples, under the cheekbones, around the eyes. So we get a little bit of bone resorption. Our bone actually gets smaller as we get older, and that includes within our face. And so you can see the orbit around the eye getting wider. You can see the temples kind of shrinking in. You can see the cheeks becoming flatter, the jawline becoming more recessed or just not as well-defined. And so all of those changes make us recognize someone

as looking older, even though we might not going, oh yeah, it's because they have bone resorption. Another thing that's really common is the upper lip gets longer. So the distance between the base of the nose and the top of your upper lip, it's called like your philtral distance. This distance? Yes. Not the lip itself. Not the lip itself. It's called the what?

It's, well, that's your philtrum. Philtrum. Yeah. So your philtral column and the distance between the low, the bottom of your nose, top of your lip. If you start looking at people who are older, like if you just walk around the supermarket, for example, you'll just say, oh, every single person who's older has a long upper lip. It's why those old dudes can grow those fabulous mustaches. Yeah. They got a lot of real estate. They got the room. That's my move. If it gets too long. So what do we do about that? I mean, that's tricky. That tends to be more of a surgical fix if your upper lip is getting longer. Although, if you do enhance the lips, you can shorten somewhat that distance between

those two areas. The problem that I have with a lip lift is it's a very hard procedure, I think, because it goes wrong a lot. I've seen a lot of lip lifts that you can tell when you're talking to the person that something doesn't feel right. Something's pulling incorrectly. Yeah. A hundred percent. Yeah. Or you can see their scar or whatever. It's hard. It's right in the middle of the face. So if it doesn't go well, it's a big risk. Yeah. They call it like a bullhorn lip lift because you get a little bullhorn incision under the nose. And for many

people, you can't see it. But when you can, there's not a lot you can do about it. As a dermatologist, we think about scar resurfacing and things like that to help. I think my plastics colleagues in the area really like that I'm in the area because we can make their scars look really good. But yes, if it doesn't go right, there's not a great alternative. Besides a killer mustache. Oh, yeah, exactly. And I think a lot of us ladies are going to struggle with that. This is a question that I think 95% of people who have gotten filler have not asked, including myself. Okay. What exactly is filler? Like what is in the needle? So yeah, in the syringe there. So it's essentially hyaluronic acid. So hyaluronic

acid is a molecule that already exists in human tissues, but the hyaluronic acid in a filler has been processed in a way where it's more durable. It essentially is like a clear gel and different fillers have different thicknesses. They support tissues in different ways. They have different amounts of flexibility. And so it is essentially hyaluronic acid linked in a way where it has staying properties in the tissue because we're turning over our own hyaluronic acid in our skin pretty much on a daily basis. Obviously, if that was the case for filler and that hyaluronic acid, that wouldn't work so well. But it is essentially taking the molecule that we already have in our skin and in our joints and in our eyes. Hyaluronic acid exists throughout

the body and structuring it in a way where you can actually create changes in the face that hold longer than 24 hours. What should we not do after we get filler? You know, I think it depends on where you get it and how much you get. I always tell my patients no vigorous exercise. Anything that's going to increase blood flow or circulation can increase the chances of things like swelling and bruising. I think I prefer my patients don't put makeup on for about 24 hours after they get filler. If they have to, you have to, but most people don't have to put makeup right afterward only because you've made small microscopic holes in their face. It's just something that out of like an abundance of caution. We also don't have people to usually

get dental procedures for about two weeks after they get filler only because it can, when you get a dental procedure, it mobilizes the bacteria in your mouth. And I think of a filler as sort of like a temporary implant. You really don't want to do anything that's going to increase the risk of that implant becoming infected or having problems. And even though that's exceedingly rare, I just try to take every precaution with the patient to reduce that risk. What filler is your favorite and what filler do you inject with and why? I think my favorite is like the Restylane category of fillers. For me, I find them to be just so natural in the face.

They have a really wide portfolio of different products that you can use in different parts of the face. And I think what's nice is they have kind of two versions. They have like a thicker filler uses something called their Nasha technology, which essentially is meant for like projection and things like that structure. And then they have a more flexible filler that uses what they call expression technology which makes sense you use it in areas of expression it's more flexible and just a little bit more bouncy it's what i have in my own like lips for example i used rustling in my lips to do the lining of my lips. And I loved it. It was just the lining. And it was

such a like little pout. Thank you. Really, I was going to ask you if I need more filler. No, it's been a while. Totally. Even if it's been a while, I think filler lasts for a different amount of time in different people. And once you haven't had filler for a little while, you're like, oh, do I need it? But I think that's also the point of having a good injector. They can kind of like be very clear with you about what you need. But I love Restylane for like, yeah, lining the lips, for example, just giving like a little bit of plumpness, a little bit of zhuzh. Sometimes you're not trying to really like increase the height of the lip or the fullness. You're just trying to make it look more hydrated and a little bit more supple and just sort of restore the lip to maybe what it was five years

ago or 10 years ago, because we start losing lip volume when we're 14. I mean, how depressing. What do you think the most common mistakes people make or maybe some of the most common things where people come for you to fix something that's happened? I think overfilling, which is not that common anymore. But I think for a while, people were getting overfilled. And I think that really stemmed from people relying on filler to do every part of anti-aging for them. But in reality, anti-aging procedures are such a variety. It's laser resurfacing. It's increasing the quality of the skin. Maybe it's surgical for some people. Maybe it's relaxing things with neuromodulators.

And I think people relying on filler to do it all. And so sometimes people will be overfilled or I feel like their filler maybe wasn't placed in the right way if I wasn't the one who injected them. And so just doing small corrections before we go in and add more, because I think it's so important that I always tell my patients like we're building a house and we want to build it on solid foundation. So if you come to me with foundation where I don't know how it was laid, then there's just always going to be this question in my mind of like how it's going to it's less predictable. And I am I'm just I want predictability in my procedures. Like I want to be able to straight up tell the patient it's going this procedure is going to do this, this procedure is going to do this

or this procedure is going to do that. And I think when you're working on a foundation that you're not familiar with, you just don't have that guarantee. We don't want to be the three little pigs. Yes, exactly. We're not building a house of straw over here. We're building brick.

Built to last. Yes. The Goldilocks of filler. Exactly. Goldilocks of filler. What do you do if someone does overfill? Is it just a waiting game for the body to metabolize it? A lot of people think they have to wait, and the body will metabolize it and break it down over time. But you can also dissolve it,

which I think is really helpful. It's also what makes filler so safe because if it were to be injected in a place or in a way where it was not ideal for the patient, you could go in and dissolve it and that increases the safety of something like this. It's a lot less, it's not permanent, which is nice. Talk to me too about how some fillers can actually make you inflamed and hold water. I think one of the things that I like about Restylane is it, and you told me this too off air, is it doesn't give you that extra water. I don't want water in my face. It's like we want volume to an extent, but we won't don't want to be over volumized. And so hyaluronic acid, which is what all fillers are, all hyaluronic acid based fillers are made of holds water naturally, but you can process it in a way

where it holds more or less water. And the reason I like Restylane so much is because it doesn't tend to hold on to as much water in the tissue. And so you really can avoid things like looking boggy or overfilled or puffy. So many people come in and like, I don't want to look puffy. And I'm like, there's lots of ways to not look puffy, but product selection and placement is certainly part of that. When you go in, do you always use a full syringe? How does that work? That's a really good question. So to me, like one ml, which is what a syringe is, is kind of an arbitrary amount of product. So to assume that every person needs one syringe in their lips or one syringe under their eye or one syringe in their cheek is kind of arbitrary. I find that most of my patients when they're coming in,

they're doing more than one syringe at a time because we're sort of addressing the whole face. But I think if someone's doing their lips only, for example, oftentimes I won't use an entire syringe. And the patient's like, oh, I don't want to waste it. I'm like, it's not a waste. We're doing the amount that you need. It's sort of like if you're getting your hair colored and someone mixes up a bunch of dye for you and they don't end up using the whole bowl of dye, you're not paying for the dye. You're paying for the ultimate outcome. So whether you use half a syringe or 80% of syringe or full syringe, to me, that's not what you're really in there for. You're in for the ultimate outcome. Is there any body parts that people are getting filler in besides their face? I think hyaluronic acid filler is less so, but yes, I would say in my own practice,

I do not use it off the face. I've also seen people use it to fill their hands. Yes. Oh, thank you. Of course the hands. Yes. That is one place that is off the face that you could use it. And I do do that actually not infrequently. A lot of people, their hands age, and it's one of those things where like, we don't think about it until one day we look down and we're like, oh, do I have like Crypt Keeper hands? And part of that is volume loss in the back of the hands. And so for example, like Rustle and Lift hands? And part of that is volume loss in the back of the hands. And so, for example, like Restylane Lift, for example, FDA approved for the use in the back of the hands.

And that is a great way to rejuvenate the back of the hands because it kind of hides some of like the spindly tendons that you can start to see or the vessels that you start to see. And it just sort of camouflages that and re-volumizes that area. The great thing about this show is I can just sit back and eat popcorn and have someone like Dr. Sam come on and just educate my husband. Love it. So he's going to be looking

at his hand. The only problem with this though is now he's looking at my hands. Oh, totally. Well, now you know there's something you can do about it. And again, I wear driving gloves, so don't fuck with me. Oh, I love it. I love it. I was going to ask if there's other maybe non-aesthetic reasons that people would use this or think like is I heard one time like for headaches or something. Is there other reasons outside of aesthetics that people are using this stuff or is it mostly just aesthetics? For filler?

No, because that's what we're really using to like shift proportions or to kind of like lift or restructure. I would say the neuromodulators. This port too is great if you just for me, I got number 11. I just it gives you a little lift. Yes. It just kind of opens things up. Yeah, exactly. And that's, I also tell people, I know this is mostly about filler, but with like neuromodulator injections, you can use them to make someone look younger to help with wrinkles, but you can also use it to just beautify someone

by changing the arch on their eyebrow or opening their eyes up a little bit. And that's huge too. Skin, I heard, is 50% of the way we perceive age, like the texture of your skin. Completely. As a dermatologist, are there things besides staying out of the sun that we can be doing on a daily basis? Maybe a product that we could be implementing. Are there things that you have like that are non-negotiables because you have beautiful skin. And if you guys want to see your skin, you can go to YouTube. We have a YouTube app. Your skin is beautiful. It's glowy. It's beautiful texture. You can tell you really take care of it. I try to. I think as a dermatologist, you really have to practice what you preach. And part of that is skincare. So staying out of the

sun, wearing sunscreen every single day to me is an absolute non-negotiable unless you're in like the Arctic, for example. I really like some type of topical retinoid in someone's routine, whether that's something that you could get at a drugstore or a Sephora, for example, like a retinol type of product, or you have prescription retinoids like tretinoin, also known as Retin-A. These are topicals that really help you build new collagen. They stop the breakdown of collagen, which is really helpful. They help even out your skin tone. They sort of do it all, the jack of trades in terms of like skin care. And then, yeah, like lasers are huge. Chemical peels, super helpful, like in office procedures, definitely do more. To me, it's like seeing a

personal trainer like you can do a lot more with a personal trainer. I just got a VIP. So you're it's approved by a hundred percent. I think that, you know, getting appeal in the office is so helpful because they can take it a little bit further, a little more deep, a little more aggressive than maybe what you would ever feel comfortable doing at home. And you can certainly make more improvements sometimes when you lean more aggressive in your procedures. Of course, that changes the risk profile as well. And some people are not willing to take those risks. And I always think it's important to discuss those with our patients. But yeah, you're not going to necessarily achieve the same skin improvements with just at-home skincare. If you incorporate things in

the office, it's very helpful. What lasers do you like? Oh, so many. I think resurfacing-wise, the two I use probably the most in my practice just for evening tone is one called Clear and Brilliant. It's sort of like a very gentle resurfacing laser. I like it because someone could get it and then go out in the world the very next day and no one would say, hey, did you have a procedure? So it's not as impactful if you just do one. Usually people are doing a series of those. I also do a lot of Fraxel laser in my practice, which is a more aggressive resurfacing laser that really helps lift some of the brown spots off of the skin, but also goes in and helps with pore refinement and smoothing texture and collagen stimulation. So those two are probably like the workhorses in my practice.

And then we also have things that like get rid of brown spots. So I use a peek away laser in my practice to sort of like get specific brown spots off. And then I use something called a V-beam laser to help with redness. And it's all about just evening things. Do you like IPL? I do like IPL. I have two IPL devices in our practice and I think it's in the right patient. It's so good. Like I feel like you can make a huge impactful change. I also think it's one of the most dangerous cosmetic devices that's out there because if it's not done well or not done by someone who's experienced, you can cause really serious harm. Like you could burn someone with it. And I think unfortunately on like TikTok and things like that, I've seen some really sad complications of IPL done by people who

maybe don't have experience with using that device in the way that it should be. But in good hands, it can have killer results. In that lane, people that are new to this stuff, they're going to see someone like yourself or an injector or someone that is doing facials. What are red flags that people should look for or things that people should avoid? And I think about this in the lane. I know it sounds strange with like tattoo artists. Obviously I have tattoos and you don't just like pop in anywhere and just do your research. Yeah. Like if some guy comes out with a stick and a thing, you're like, okay, maybe you gotta, you gotta, you gotta do a little research. And in that world, obviously there's

certain things you avoid, which we don't have to get into here, but in your world, like what would you caution people against? I think there's lots of red flags you could look for. I think one is looking at the other people in the office. What do they look like? If it doesn't match your aesthetic, that could be a problem. Looking at your injector specifically, what does their face look like? What does their skin look like? And obviously, if you have an injector who's in their 60s or 70s, you cannot expect them to have the skin of a 20-year-old. They're still a human being. But just looking like, are they balanced? Are they overfilled? Those kinds of things can be really helpful. And if they feel out of balance, to me, that is a red

flag. Also, look at the clinic as a whole. Does it look clean? Does it look sanitary? I think these have become very commonplace procedures and people are quite comfortable with them. But they are still medical procedures at the end of the day and really need to be taken very seriously. And so if I go to a clinic and it's in someone's backyard, it's in like a barber shop, it doesn't look clean, there's dirt on the floor, like all these little things to me are just they speak about how the practices run overall. And I think that can be very helpful. And then also like what's your interaction with that practice on the phone when you call them, when you do your follow up appointments, all of that because injections don't just happen just

once cosmetic procedures aren't just once like you need to be able to have follow-up and you need to make sure that you feel like taking care of as a whole as a patient because if you were to have a problem which is rare but you should feel like you're gonna be able to get to talk to your doctor or you're going to be able to reach who you need to reach in a timely fashion yeah no and i think i know sometimes people are concerned about budget, but like, again, going back to tattoos, like you would never walk and be like, give me the cheapest one in here. You know, I think there is, especially if you're doing these kinds of things and touching your face, like it may be, you may have to spend a little more to find that quality person. But again, like you're touching your face and some of this stuff has very lasting effect. Absolutely.

I think when it's like heavily discounted or whatever, you kind of have to ask yourself why. So I feel like the other thing is like, do they have a wait list? Are people wanting to see them? Have you had a friend recommend them? Because I also think seeing how people look in person is so much more telling than just a photograph. So I feel like I get a lot of my patients through word of mouth because they're like, I saw my friend. She looks so good. I asked what she did. And then I ended up in your office. And so just being able to see those things in person, I'm sure it's the same for tattoos, like seeing the work in person, seeing the artwork, like really speaks about it. Yeah. I mean, you just don't, you just, I mean, like anything, I always find it strange in areas of aesthetics or where you're

changing something on your body when people are trying to kind of maybe like save that. I mean, there's other areas in life maybe you can save on. Yeah. Like this is medical and this is like also an aesthetic thing. Like don't, this is not the place to skimp. Even if I have a patient who comes in who has a budget, like we can work within a budget, but sometimes I'll say, Hey, if one syringe is all you can afford right now. And I truly feel like you need two syringes in the mid face to make a meaningful difference, save up and come back in six months or seven months or whatever when you can do both because it's not worth doing just a little bit. In this case, it's not going to be right for you. And I think a lot of injectors might be like, oh, yeah,

just do what you can. But I think for some people, you really have to find that balance. I'm sure some people are screaming, you know, like Lauren calls them the privileged police. But I think like in this area, again, like if I was speaking to a close friend of mine, this is an area I would tell them like, hey, maybe skip that night out and save up a little more to go to the right person. Yeah. If you can't do it right, to me, you shouldn't do it at all. And totally, aesthetics is a privilege. It's a luxury. And the problem is if we try to make it accessible by, you know, not charging what it needs to be charged to do it safely and properly, like that's not OK either. And so it's just something that is worth saving for it if you want to do it.

And it means a lot to you. What do you think about people removing their buckle fat? I wish they wouldn't. I mean, I get it. And I think in certain people, if they like have a ton of buckle fat, it can be beneficial. But facial volume is something that keeps you looking young. And so as I speak to this as someone who does not have a lot of buckle fat genetically, and it's frustrating, I wish I had buckle fat. And so I think if someone has buckle

fat, they should they should hold on to it because they might not like it when they're 20, but they will love it when they're 40 or 50. And it will keep them looking very youthful. And you can't get that back, right? Once it's. Yeah, you can, I mean, you could, but through some like very extensive procedures, or for example, if you're trying to use filler to replace what someone has lost with buckle fat, it is a lot of product. That is a huge investment. Well, and again, I think a lot of people are making this decision in their youth when they have a ton of volume in their face and they're not understanding what happens when you pass the age of 40 per se. Totally. And I get that. I've lived in the moment for that. But I also think like- We're waking up next to a skeletor and you're like-

So many celebrities have their buccal fat removed. It's crazy. It'll be interesting to see how that does age, but so many of them have their buccal fat removed. So many. And I think maybe for a celebrity who has the means to potentially replace that in some ways, they get older, they don't think of the consequences the same way. But I think for your average person out there, that's not something that they can do. And that's something I'm also very upfront with my patients about when they're in for a cosmetic consultation is like everything we do now has to age with you and it has to benefit you in the future. I don't want to just know what your aesthetic goals are now, but like, what are they five years

from now, 10 years from now, 20 years? Would you ever consider a facelift at this point in your life or in 15 years? Because knowing what their sort of aesthetic trajectory is and what their goals are really helps inform me on what I think I should offer them in the moment. You know what you can do if you want to remove your buckle fat? This is my tip. Yeah, I got to hear it. My tip is for six months, when you take a photo, do what I do and say prune. When you say prune in a photo, I say it all the time. I'll be like prune. And when you say prune, it sucks your buckles in and you can see what you will look like with your buckles removed in photos for six months. Yeah. So for me, I just like use my prune tip when I want to like look like,

I don't know, like a little snatch. Like I just will say prune. I don't, I can tell though, after like looking at myself in photos like that, I wouldn't want it removed permanently. I will just say prune. Yeah. By the way, that's prune.

That's not my word. Mary-Kate and Ashley made that up. They said when on an interview and they were like 20, they said they said, they say prune on the red carpet. So try saying prune for six months in photos. And if you love the way it looks, okay, maybe.

But if you're starting to see, ah, it does kind of make me look a little bit older. Just say prune when you want and then don't say prune if you don't. This is something you can kind of change. I love that tip. I'm going to have to tell my patients that. I also think too, people understand makeup more

and like contouring and using lights and shadows to sort of balance the face. And I think if you contour in a certain way, you can also sort of achieve what looks like less buckle fat. And so just understanding makeup techniques to do that can be very helpful too. Everyone who has their notebooks out right now

is writing, okay, write it prune. Yeah, it's like in capital letters at the top of their phone. Just look in the mirror and like suck your cheeks in and like see what it looks like. Totally. And I, whenever I do that, I'm like, oh, it does like in capital letters at the top of their phone. Just look in the mirror and like suck your cheeks in and see what it looks like. Totally. And I, whenever I do that, I'm like, oh, it does. You can tell it makes you look a little bit older.

It's weird. I kind of categorize my patients as they age into like sinkers and saggers. Like some people just get hollow and everything sort of like withers away. Their temples, their cheek fat, et cetera. And then some people are really sinkers where they get really jowly and everything just gets kind of heavy at the bottom of the face. And depending on how they age, the cosmetic interventions that you might offer them might be different. A lot of people are getting facelifts, huh?

Yeah. At young. And younger. Yeah. That's what I was going to say. A lot younger. And I think also the facelift techniques, even speaking as a not as a plastic surgeon, have really evolved over the years and have gotten better. If someone is listening to this episode and they decide that they're going to go get filler, how do they come in as a really researched, smart person when it comes to what the injector is injecting? So what are the questions that they

should ask? Should they ask the brand? Should they ask the kind? Because I know Restylane has all different kinds. There's a kiss. There's a contour. Like, how do we know which is the right thing that people are feeling? There's an eye light. Right. There's lots of different kind of products within the Restylane portfolio. And they're all amazing when used in the right locations.

I think it's tricky because as a patient, you don't necessarily know what the right thing is. Like, for example, Restylane Kiss is used for the lips. And people might ask, what are you going to use in my lips? And if they said Restylane Kiss, you might be like, oh, that tracks. In some ways, you should trust your injector to pick the right fillers for you and put them in the right location. So sometimes if I have a patient who feels like they're being like hypervigilant, like what product are you using? Where are you putting it? What's this? Like to me, that's like a form of like the patient being anxious. Like I don't take it personally,

like they're interviewing me or like accusing me of anything. But I also feel like that usually means there's some underlying anxiety with the patient that I want to address before we do any type of actual intervention on them. Wow. I just learned everything I need to know. I mean, really all anyone needs to do before they're getting a filler or I mean, any kind of facial procedure is listen to this episode. I mean, the problem is, is that to you, this is probably like information that is served to you on a daily basis. But to someone who is going in and getting whatever they're getting, it's it's like I mean, they need it. Totally. I think it's so helpful. And I also think it's it's OK to ask your injector why. Like

why do you feel like I need to fill my cheeks before I do my tear troughs? Why do you feel like I need to increase my chin projection before I do my lips? And I think a good injector won't get defensive about that. They should feel very happy to just educate you about why. I love having those conversations when a patient is interested in sort of like the why. Of course, I can't like teach them 10 years of cosmetic, you know, experience in one session. But I think it also, I like't teach them 10 years of cosmetic experience in one session, but I think it also, I like when patients are kind of invested in that as well. I would say if a patient does come in and they want to get filler, the most important

thing is to come in with clean skin, coming in with the understanding that there's going to be some healing afterward that needs to happen. I think a lot of people think, oh, filler, non-invasive procedure. I can just get up and go the next day and look 100%. But it's a medical procedure. You need time to recover from it also. My last question. Yeah. After you get Restylane, do you recommend ice? I do. Okay. I was going to ask you. Yeah. We can't take the ice roller and roll over it. But when I got it done, I just held the ice roller to my lip. Totally. It's like you don't want to be distorting the tissue

or you're not trying to do pressure to move anything in the face. But certainly something like ice or even the roller that allows you to sort of like slowly and softly go over an area, I think is great. You don't want to hold the ice necessarily too long in one area.

But I actually think the roller is kind of genius for that because you can kind of move it slowly over the tissues and get all the areas that you want. And that's really going to help with things like bruising and swelling. Like those will happen almost no matter what, no matter what kind of filler you get, but how you take care of your filler afterward and how you prep beforehand for your injections can really make a big difference in the recovery. Because we just talked about the roller, I'm going to give away the Skinny Confidential Ice

Roller to one person. They can use it during their Restylane appointment, after their Restylane appointment. Excuse me. Don't roll it. Just press it. All you have to do is tell us your favorite part of this episode on my latest Instagram at Lauren Bostic. Dr. Sam, thank you for coming on. Where can everyone find you? So I am on YouTube, Dr. Sam Ellis, and then my TikTok and Instagram are at Dr. Samantha Ellis. The Restylane family of products are indicated for people over 21 years. The most commonly observed side effects are swelling, redness, pain, bruising, headache, tenderness, lump formation, itching at the injection site, and impaired hand function. To learn more about the serious but rare side effects and full

important safety information, visit www.restylaneusa.com. Dr. Sam, thanks so much for coming on. Maybe I'll come to you when I'm in Northern California. I would be honored. I would love to come in. It's been a pleasure. Thank you.