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“I am interested in getting injectables and would like advice about how to find a good place to go. My face just looks tired all the time and I would like to do something about it.” —Patricia, Toronto
Not to be glib, but I’d like to suggest “My face just looks tired all the time” as the working title for an oral history of the year we’ve had. It’s been an exhausting bile-inducing year to say the least. So since I know you’re a smart, sensible person, I’m going to assume that you have already given some consideration to the question that naturally arises before the question you just posed, which is: How tired are you, actually? Because yes, there is an amazingly comprehensive array of skincare science out there that can help refresh your appearance, but none of it replaces sleep or the daily machinations of caring for yourself in a basic and fundamental way. Layering treatments on top of stress and anxiety and nights spent staring at the ceiling isn’t going to give you the results you are after. I may not be about to count on much at this point, but I know that.
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Now, if you’re feeling good—if you’re eating real food and resting and getting outside and breathing from your belly and doing some of the vitally important things we often forget to do—but the appearance of your skin is still bothering you, then, sure, you can chat with a qualified pro to see what your options are. I called Dr. William McGillivray who founded noted dermatology clinic and medispa Project Skin MD in Vancouver for some shortcuts to help you find the best practitioner.
“The most important thing to do is to see somebody who’s very qualified because injecting Botox or fillers is a medical procedure,” he says. That may sound obvious to some, but it doesn’t to those who have willingly gotten injections at, say, pool parties. (While the pandemic has ushered in loss and isolation, I can only hope that it has at least put an end to get-togethers during which otherwise smart people get drunk and dabble in medical injections.) “Botox and fillers should only be administered in a controlled environment that is well-lit, where the patient can be properly assessed, where there is time to get all their questions answered,” says McGillivray, outlining the absolute baseline concerns. Any provider should be licensed and registered with their provincial college of medicine, and that license should be posted on the wall for anybody to see. “Patients should always get proper consent forms—and providers should give patients full knowledge of the risks and benefits of the procedure based on their specific medical background and any issues they may have.” Basically, if it seems like it might be an inappropriate setting, it likely is. “A new patient of mine told me she got her lips injected in a nail salon once,” says McGillivray. “The most important question is: If a complication arises, are you somewhere that can deal with it?” (Ask these two key questions: Are there materials on hand to dissolve filler, if necessary, and is there a physician present or on call?)
So if we are building a house of credentials, all that would form the basement. Once those concerns are satisfied, we can move onto the proverbial main floor by asking questions about the level of experience and training your provider has gotten. How often, for instance, is the doc in question actually injecting Botox? “Some physicians may just dabble in it, so their daily experience is not much—and it’s important to note that Botox in particular has to be reconstituted, so you don’t want it sitting in the fridge for a long time before using it, since the potency degrades,” explains McGillivray. Non-permanent hyaluronic acid dermal fillers like Juvederm are gels that can be safely stored until their expiration date. (There are also, of course, other semi-permanent and permanent filler products on the market, but McGillivray doesn’t work with those because, as he says, “permanent products can have permanent problems sometimes.”)
Experience is particularly important because your injector must absolutely understand the anatomy of the face. “It’s crucially important for safety for both Botox and dermal fillers because there are vascular structures that must be avoided,” says McGillivray. “Only experienced injectors should be working in the area under the eye, for example, because there are some vessels there that have a retinal branch so there can be a very bad outcome, like blindness, if the person does not know where those vessels are.”
Asking lots of questions during an initial consultation will allow you to gauge the doctor’s approach, as well, since injecting is as much an art as a science. “It’s the opposite of sculpting because we add instead of take away.” But thinking of the face as a sculpture is a handy way to realize that no two can be approached in quite the same way: Male and female faces have different typical structures, as do different ethnicities. “If an injector is treating everyone the same, then eventually everybody starts to look the same.”
In fact, there are different kinds of fillers that you might want to use for different areas, he explains. While the basic purpose of filler is to replenish the volume in certain areas that’s lost as we age, there are myriad details. “We can use a tiny amount to hydrate and redefine the lip line, so you have a more defined line when you put on lipstick,” says McGillivray. “Or if we correct the loss of volume in the middle of the face, we can help the area under the eyes, the folds around the mouth and also the jawline—with just that one treatment.”
A little volume in the temples helps combat the look of tired eyes and lifts the brow. Jawlines can be redefined, while bumps on noses can be smoothed. (The simplest shortcut to getting a doc who has lots of product knowledge is this: “Look for a doctor who might be involved in research. We have a research department in our clinic, so we have a big knowledge base of what’s going on out there.” And lots of pros will list what research projects they are involved in on their websites.)
The result of most fillers can last anywhere from around four to 18 months depending on where in the face they are used. The cost also varies widely depending how how much you’re getting. Project Skin MD charges about $500 to hydrate the lip, while a comprehensive facial rejuvenation could be as much as $4,000. And again, common sense always applies: If it’s super cheap, question why.
Importantly, expect a trustworthy professional to ask some hard questions of you, too. “The ability to talk patients out of things that might not be appropriate is essential,” says McGillivray. “I don’t have many dysmorphic patients in my practice, but it’s inevitable that you get some, and it’s our job to recognize those people and help them—not to ignore them and certainly not to enable them.”
Here are some tips for pre- and post-care
Avoid Aspirin, Advil and non-steroidal anti-inflammatory medications for up to a week before a procedure.
Avoid alcohol for a week before injections, since it may result in more bruising, as well as a host of other common foods and supplements like green tea, ginkgo biloba and oral antioxidants.
Don’t exercise vigorously.
Avoid liquid makeup for 24 hours.
Expect to see the full results only after a week or two.
Shop the advice
These products can help care for your skin after injections
$15 at well.ca
A cooling eye mask can help relieve pain and swelling after under-eye injections.
$42 at Sephora
Arnica has been shown to reduce bruising and swelling when applied topically.
$16 at well.ca
Stick to a gentle, fragrance-free moisturizer—no retinol or AHAs—while your skin is sensitive.
$32 at La Roche Posay
You can start using concealer after 24 hours, and DermaBlend is a good heavy-duty option for hiding bruises that is also suitable for use on sensitive skin.
$8 at Walmart
Acetaminophen—not ibuprofen or aspirin—is recommended for post-injection pain.