Getting My Fill
There’s always one woman in my favorite uptown New York City lunch spot. It’s sort of a fancy restaurant, so I suppose I shouldn’t be surprised to walk in and be almost immediately confronted with the results of an overzealous plastic surgery job. There she’ll sit, her eyes bearing the appearance of perpetual surprise, her cheeks so taut that their fleshy apples are gone, and her lips no longer her own, seemingly added on top like a cherry or a new deck. I can’t help but stare, albeit quickly because longer would be rude. Moreover, having never seen the woman before, maybe she does look better now. Who am I to judge?
But I do. Having reached my sixth decade, a territory where many women are already considering entering facelift land, I prefer to maintain my aging face in a gentler way. I’m not ready for a facelift (even great ones require a huge commitment and then there’s that downtime), but lately I’ve been feeling—no, not feeling, looking—old. Or, old-er, and I’ve been thinking more and more about what can be done about it as I stare into my bathroom mirror. Occasionally stopping between makeup steps, I lay my fingers gently onto my cheekbones and then, every so slightly, lift up. Oh, happier.
When did everything start sinking in?
“As we age, we resorb bone,” explains Manhattan dermatologist Dr. Dendy Engelman. “Calcium comes out of the bone and it shrinks, so the whole scaffolding of our face also shrinks, and, in turn, the canvas wrinkles. By adding back to that structure, it kind of pulls back the canvas and allows the framework to be more robust.”
Yeah. I would like my framework to be more robust.
A few years ago, as I veered toward 50, I started leaning in and looking more closely at my peers as they discreetly shared what their dermatologists were doing. Despite my age, I still felt like I was 30. But while my physique continued to clock in 30-mile bike rides and double-diamond ski runs, my face was no longer cooperating at playing youthful, and injectable facial wrinkle reducers could only do so much, even during the temporary time when they work. Sure, they softened the appearance of my crow’s feet, and diminished the crevasse between my eyebrows, but those eyebrows were also now starting to ask for a raise, so to speak. Could I meet their demands without going under the knife?
Upon discovering that a number of my natural looking friends were the recipients of facial fillers, I sat back and thought, “Well, that would explain her perfectly sculpted cheeks and her supple lips.” It was my friend Marie, in particular, who, despite being born the same year as I, possessed what can best be described as ethereal beauty. All that was missing was a crown of daisies atop her hair and a Coachella crowd in the background.
“I always was not happy with my cheeks,” says Marie (she has asked me not to use her real name), who was a patient of the late Fredric Brandt, a famous New York dermatologist. “I asked Dr. Brandt what could be done about them, and the answer was filler. I wasn’t nervous — I super trusted him.’”
“I could see the difference right away,” remembers Marie. “I felt like myself but at the same time was exactly how I wanted to look.”
My reason for scheduling an appointment with Engelman was my sunken cheeks. For the first time, I had more than injectable wrinkle reducers on my mind, but I was wary. Did accepting filler in one’s life (or, in this case, face), mean finally waving that white flag of aging surrender? Was this the beginning of a slippery slope? Would my filler look too obvious, pushing me that much closer to looking like that woman in my favorite restaurant? Or…perhaps might a little bit of filler be my way of holding out my proverbial hand and firmly warning, “Not so fast, gravity.”
“People get worried about filler, and rightly so, because we’ve all seen bad work. We’re in this Real Housewives era where there’s tons and tons of syringes used,” says Engelman. “But I’m going to use one syringe to take care of both sides of your face. That’s one milliliter, which is one-fifth of a teaspoon of product, so that is not a lot of volume. The ones who start looking like an avatar are the ones who have several syringes on each side.”
“Do you blame the doctor or the patient?” I ask, recalling that First Wives Club scene when Goldie Hawn’s character demands more filler in her super-inflated lips.
“The doctor,” says Engelman, unequivocally. “I’ve had patients ask for more, then get upset when I say no. Some patients eventually stop seeing themselves for how they actually look, but I never do.”
She holds a hand mirror in front of me and my tired face glares back, as if to say, “Look who waited too long! Well, now it’s too late and you’re stuck with me.”
“Have I waited too long?” I hear myself ask, and her smile is a relief.
“There are multiple reasons for mid-face augmentation,” she explains. “One, we lose this fat pad medially, then it migrates inwardly and down. That accentuates the naso-labial folds more, making them look more pronounced. The loss of volume in the cheek pulls the line of tension downward, resulting in the cheeks looking more jowly.”
Given that I often compare my cheeks to a squirrel storing a few acorns, I think we’re heading in the right direction. She decides on a plan for filler customized to my face. After the area is numbed with a mixture of benzocaine, lidocaine and tetrocaine for about 30 minutes, it is finally time.
Engelman’s moves are subtle, quick and drama-free. She makes little “Hmm hmm…” sounds, with a rise on the second syllable that equally translates to “Almost done” and “This looks good.” Before moving to my second cheek, she takes a step back and compares. With a smile, she holds the mirror up. I see only a pinprick of red, but mostly I see a more chiseled cheekbone smiling back at me. Wow. I want to ask for more, but I hold my tongue. No one wants to be a cliche…Nevertheless, I apparently am the classic filler virgin.
“My patients are always apprehensive before the first injection,” explains Engelman. “They worry I’m going to inject too much and it’ll show. Then I do it, and they like it, and then they want more. If a little is great, how could more not be better? But it’s not.”
My subtly modified cheekbones and I are ready to head back to work, but I have one last question: Is there anything one should refrain from doing for the next day or two?
“I’d love you to stay away from getting a facial massage for the next 48 hours,” says the doctor, adding, “Actually, any massage that would require putting your head face-down in one of those face cradles isn’t good. We don’t want the filler to move for the next two days. Not even yoga, because your face is in those downward positions, like the crow pose.”
No problem. I’m an outlier when it comes to yoga, so I have no idea what crow pose is, but I give her a thumbs-up.
Filler injections can result in redness around the injection site, swelling, or slight bruising (among other temporary side effects), so the dermatologist should have ice packs at the ready. Mine did, and I had no bruising. There might also be a little pain or tenderness, but nothing one Aleve can’t temper (though everyone is unique – talk to your doctor about what’s right for you!).
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Would I consider getting filler again? Absolutely. The great thing is filler can last up to two years in the mid-face, so my cheeks are set. That said, I would like to explore where else it might help. But all in moderation, I know.
“There’s a very fine line you don’t want to cross, where the filler starts to look done and unnatural,” says Engelman. “I say to my patients, ‘We’re a team.’ I will tell them what they need, but I will also tell them when they don’t need something they think they do.”
Curious to see what she’ll say when I point to my laugh lines during that follow-up visit. marion