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Plastic Surgeon Or Dermatologist For Filler Treatments?

Posted: 12:00 p.m. Sunday, July 15, 2018

By Anita Mandal, M.D.
Question: I don’t want surgery but am interested in fillers for my hollow eyelids and deep smile lines. Since these treatments are non-surgical, would I get the best results by going to a dermatologist who treats skin aging instead of a plastic surgeon?

Answer: There are significant differences between what dermatologists and plastic surgeons do even though there is some overlap in a few cosmetic procedures. Typically, dermatologists, as experts in skin, focus on skin diseases such as acne, rosacea, rashes, and skin cancer. However, when, for example, a skin cancer is deep or extensive requiring more than a simple repair, dermatologists often refer to plastic surgeons for treatment that is beyond the superficial skin level and outside of their area of expertise.

Facial Plastic Surgeons are comprehensively trained in the 3 dimensional structural and functional anatomy of the normal and aging face, including deeper structures requiring surgery. These structures include the deep skin layers, facial fat, muscle and bone. Facial aging is not restricted to the skin but also occurs beneath the skin in deeper structures that are intertwined with many facial nerves and blood vessels. A surgeon who understands the complex facial anatomy of aging, beyond the skin, can effectively address your aging concerns.

Many factors, in addition to specialty, must be taken into consideration. With so many injectable fillers on the market, a knowledgeable injector understands the benefits of one filler over another in any given facial area. A skilled injector also knows when a patient requires multiple different fillers, layered one on top of the other, for optimal results. A skilled injector especially understands the limitations of both surgery and fillers, knowing when an aging concern requires surgery compared to when fillers will provide a result superior to surgery.

The duration of a filler is also important. Less experienced injectors are more likely to use short-acting fillers such as Restylane or Juvederm which go away quickly, a property that is beneficial in case of injector error. When it comes to long-term fillers such as fat grafts, stem cell fillers and Bellafill – The 5 Year Filler, higher injector skill is required since the duration of the results may be long-lasting, as with surgery.
A few dermatologists have come to better understand the deeper facial anatomy to become suitable injectors. Also, many plastic surgeons who focus mainly on surgery have not developed the necessary injector skills to give optimal results from fillers. These are all important factors to consider when selecting an injector. In the end, what matters most is not only your doctor’s specialty, but also how skilled your injector is in treating the particular areas of concern that you have with the most suitable filler for both natural and youthful results.

Your concerns, particularly the lower lid hollows, can be tricky areas to inject properly. A Facial Plastic Surgeon who specializes in the face, has a thorough understanding of the complex facial anatomy and is an expert injector with a high-volume injectable practice across a broad range of fillers may be the best of all worlds when it comes to providing you with the most optimal results.


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