Last Saturday, I attended Allergan’s workshop for fillers and botox. I was excited about the workshop because the speaker is Dr Mauricio De Maio from Sao Paolo, Brazil. With over 20 years of injector experience, he is really a world class guru when in comes to facial rejuvenation. I first met Dr De Maio in Singapore perhaps in 2010. During this time, the take home message that I learnt from him is anatomy, anatomy, anatomy. We spent the whole morning memorizing the muscles of the face before we learnt any injection techniques. I thought it was super. It made me study my anatomy more meticulously than before and I discovered, but understanding the anatomy of a person’s face, it made me into a better injector when it came to botulinum toxins or fillers. Dr De Maio is but 1 of the many world class injectors that I have crossed paths with, but his approach has always been systematic and unique. During this seminar, he was explaining the MD Codes for Eye area rejuvenation. It was a method he devised to assist younger injectors to create the same effect on patients, by creating a systematic way of assessing the patient and deciding how much product is really needed for the facial rejuvenation process. Yes people, filler and botulinum toxin injection is a real science where we are required to understand surgical anatomy (I repeat surgical anatomy) of the face and the effect of adding volume at certain key points. It takes not only studying but the experience to get the points correct and avoid complications. Hence why doctors are required to undergo continuous learning.
A lot has evolved in my 8 years being actively involved and studying injectable techniques. I remembered the early days when we were more on location based on length rather than muscle actions and how fillers used to be placed superficially just to treat a line. Nowadays, we have discovered many techniques to improve a person’s look naturally and enhance their expression to allow them to look more refreshed and younger. Instead of treating just a nose or a chin, we can actually fix a lot more problems by giving an overall overhaul of the face to recreate that youth look that we want and still appear natural. In fact,now most clinicians agree that there are some things better of fixed using injections rather than surgery, and with less downtime and complications, it gives a better satisfaction to patients on the whole. So before you decide to go under the knife for everything, maybe a quick chat with your aesthetic dermatologist would give you a better perspective.
One of the most interesting aspect of the seminar was how Dr De Maio approached his patients. Instead of just asking what they think need to be done, and what he thinks need to be done, he asked the patient as simple question by showing a simple chart of emotions. Instead of asking what do you want to fix, he asked the patient how would you like to feel? Less tired ? Less Saggy? Less Sad? Less angry? More youthful? More attractive? More feminine? Or More Masculine? It is a very objective approach of getting the patient close to what they really want. Often I am being asked by patients telling me they need fillers but in actual fact they do require some botulinum toxins rather. Others tell me they need a face lift or threads when in actual fact they have unaddressed volume loss that leads to sagging and can be easily fixed by using fillers.
But the most important aspect that patients need to understand is that, 1 syringe of fillers will not bring you anywhere close to what you need, and that a proper liquid facelift, or facial rejuvenation usually requires 5-6 syringes of hyaluronic acid fillers and perhaps half to 1 vial of botulinum toxin. Original A Brands fourth generation hyaluronic acid fillers (yes people, we are at the fourth generation already) are not cheap and can range between RM 2000 – RM 3000 per syringe depending on the brand, the attributes and specificity of the filler. Volume fillers tend to be more expensive compared to non volume fillers simply because one syringe of volume fillers is almost equal to 1 and a half syringe of normal fillers, with a more dense and elasticity involved. A Brands are basically fillers which already have a strong branding in the market such as Restylane, Juvederm, Teosyal, Belotero etc… Other brands tend to be slightly cheaper but still fare above RM 1000 per syringe. Mostly these are the less known brands, newer fillers in the market or Korean filler brands etc. So basically, if you are looking for a proper facial rejuvenation with fillers and botulinum toxins you will be spending around RM 12K -RM 20K per year. Anything less than that is really an incomplete job, so you can’t really complain.
Some patients ask me why is filler work so expensive? Well, there are a few components to it. First of all is the product that we use. The higher the quality, the more expensive it is, because of the new technology inbred into the filler to give a much nicer and natural look. Secondly, the training for the fillers usually requires sacrifice on the doctor’s part i.e. in terms of buying commitment or paying for exorbitant conference fees just to be better and thus, you are paying also for the professional service of the doctor to be able to inject you properly and safely, thirdly, the overhead cost to run the clinic practice since medical aesthetics is always a private entity. Fourthly, there is a standard charging rate per syringe as set by the supplier or principal for each location. Fifthly, the doctor’s responsibility towards the patient extends throughout the duration the filler is said to last inside the patient’s body. Which means that if the filler lasts 6 months, then the responsibility is 6 months, if the filler lasts a year then a year. This responsibility means any complications arising from the placement of the fillers i.e. infection, delayed hypersensitivity etc. These are known possible complications. However, it does not cover for inadequate fillers requiring more. That, unfortunately you will need to purchase the top up syringe. So you cannot argue and say fillers in Iran are cheaper than Malaysia just on price value, but you also need to compare apples with apples, and pears with pears and also look at the going market rate. By the way, Kuala Lumpur prices are a lot cheaper than Singapore and comparable to Bangkok if you were to compare brand to brand. This is also due to the weakening of the MYR, to the USD since most of the medical supplies imported are traded in USD.
There are a few reasons why people sell fillers too cheap in the market and before you get overly excited, here are the most common reasons:
- The doctor is still in training and not confident of his or her skill, so basically you are the guinea pig for him or her to practice. Some people do not mind being a test subject at a lower fee but sometimes the outcome may not be exactly what you wanted.
- The injector is not a licensed doctor or not properly trained in medical aesthetics – beauticians, nurses, medical assistants etc, there are so many aesthetic doctor wannabes in KL.
- The product has expired.
- The product is not licensed.
- The products are fake. You can get so many fake fillers from China imitating the original brands but with unknown source of hyaluronic acid (if it is hyaluronic acid).
The most horrifying part of going to an untrained injector is that they are not bounded by the same responsibilities as doctors and thus when complications arises they can just simply ignore you. Even if you try to sue them, the first thing the lawyer will ask you is 1. Is the injector a trained doctor certified to give the treatment? 2. Is the premise of treatment given a licensed premise? – If any of the answer is No, your case will definitely be thrown out of the door because you knowingly went to an uncertified practitioner. Scary huh? Perhaps, the other scary part is the weird un-human like alterations they do to your face with the fillers that they deem pretty but to the rest of the world looks like something that came out from a sci-fi movie. It is hilarious that some people have the cheek to tell me that their face is original and not done up with anything when clearly they look like they just came out from a different planet. But my mum always told me, if I have nothing nice to say, say nothing, so most of the time, I just smile and ignore the statement.
I remembered my training with another well known dermatologist, and he said, the best injectors in the world can inject a patient and make him or her beautiful without people realising that work has been done. The more subtle you are the more impact you create. If you are curious to know how fillers can help improve your outlook and how much it would cost, just drop me an email ideally with a video of yourself or front and side pictures. Or if you happen to be in Bukit Bintang area, make an appointment to see me and we can discuss further. In conjunction with Mother’s Day, I’m giving out free consultations (Worth RM 150) to the first 20 people who consults me in this month.
For more information or for appointments, do contact us at firstname.lastname@example.org or send a message to 0129660852 and we will contact you back shortly.