Bill Klaproth (host): This is OMS Voices, an AAOMS Podcast. I'm Bill Klaproth. And with me is Dr. Manolis Manolakakis, who is here to discuss factors to consider with fillers. Dr. Manolakakis, thank you so much for being here.

Manolis Manolakakis: Good morning, Bill. Thank you for having me.

Bill Klaproth (host): You bet. So, let's jump into this, what are injectable fillers?

Manolis Manolakakis: Injectable fillers is a cosmetic procedure that we use to enhance facial features, either deficiencies or areas that have been bothering patients for years and years.

Bill Klaproth (host): Somebody wants to change the look of their facial features, is that right?

Manolis Manolakakis: That is correct. So, injectable pharmacology or injectables are typically elective cosmetic procedures, non-surgical procedures.

Bill Klaproth (host): Right. So then, when we're talking about injectable fillers, what are the different types of fillers? And what are the differences between them?

Manolis Manolakakis: Yeah. You know, now it's kind of like going to the bar and saying, "Hey, you know what? I want alcohol." The bartender will look at you and say, "Well, what kind of alcohol do you want?" They have fillers for everything. They have big fillers, little fillers, fillers for the lips, fillers for the eyes, fillers that not only fill, but also stimulate. So, there's a lot of different types of fillers and it just depends on what the patient needs and what the desired outcome is.

Bill Klaproth (host): How long do these fillers generally last?

Manolis Manolakakis: So, the most common filler out there, the type of filler, is hyaluronic acid. Those typically lasts about anywhere from 12 months to 18 months. There are some studies show that they actually linger longer than wanting, but that's a whole 'nother topic.

Bill Klaproth (host): So, is this something then where someone would come in yearly or every 18 months they have this procedure done?

Manolis Manolakakis: Yeah. Typically, our filler patients are coming in roughly every year or so, depending on what their desired outcome is. They're not permanent, but sustaining a certain level with that is definitely something to be aware of.

Bill Klaproth (host): Right. So then, how does a patient determine which type of filler to use?

Manolis Manolakakis: Oh, man. There's so many different outlets at this point. There's social media. There's their friends that just went and had something done. But the reality of it is they definitely need to have that consultation. They have to have discussion with their surgeon or injecting doctor or PA or nurse, because it's out there now. But it is something that has to be discussed. And then, a plan is formulated and the best procedure is performed for that patient. So, it's not so easy like, "Hey, I'm coming in for a filler." There needs to be a consultation.

Bill Klaproth (host): Right. And the patient needs to know exactly what to expect during the procedure and the effects after.

Manolis Manolakakis: Absolutely.

Bill Klaproth (host): So, let's talk about how quickly a patient can expect results. Generally, what is that?

Manolis Manolakakis: So, for instance, if someone comes in and has their lips injected, there is the instantaneous result that they will see. They start at one spot. They look in the mirror afterwards and they have an immediate result. The problem is that there is an inflammatory response that happens, and that takes anywhere from about a week to 10 days for that to calm down, but they will see that immediate response. And that's what makes it so popular.

Bill Klaproth (host): Wow. That's great. So, is there any downtime that's needed at all?

Manolis Manolakakis: You know, what I consider downtime is different than what patients would consider downtime. So, for instance, if a woman comes in or a patient comes in and she says, “My husband can’t know that I got injected.” If I give her a tiny little bruise, that’s downtime. To me, a tiny little bruise is more of an acceptable thing that happens with a needle going into someone's face. But for the most part, they can work out. They can go do everything they normally do. There's no disturbance in their day. But there may be a slight little inflammatory response that makes them look like they had something done.

Bill Klaproth (host): So, Dr. Manolakakis, this is something you need an expert to do. I heard you talk about earlier, "Hey, you have to have a consultation to really do what's right for the patient." So, why is it important that someone choose an OMS to perform this procedure?

Manolis Manolakakis: Well, as minimally invasive as this appears, when it goes bad, it can go bad. It can go really bad. So, there are definitely some things that need to be considered. Obviously, you know, oral maxillofacial surgeons, we are the experts in facial anatomy from bone to soft tissue from reconstructive surgery that we've done to elective cosmetic surgery that we do. So, the anatomy, it plays a huge role. Specifically, the vasculature, the facial vasculature anatomy, it plays a huge role because if any one of these little fillers tends to get into those little blood vessels, you can either have a really serious problem or even blindness.

Bill Klaproth (host): Yeah. Okay. You don't want to mess with it. Well, this has really been fascinating and informative, Dr. Manolakakis. So, as we wrap up, any additional thoughts about factors to consider when someone is thinking about fillers?

Manolis Manolakakis: My main thing that I love to tell my patients is stop looking at social media and saying, "Hey, this is what I need to look like" or "This is what I want." My goal is to make you look the best that you can look. Forget about right and left, because you want your esthetic surgery to whisper, not scream.

Bill Klaproth (host): Just hearing you answer that question just makes me think about getting the proper consultation. You know what will work. Somebody says, "I want this." You can be like, "Hmm, I really can't give you that. You don't want me to do that for you.” Is that right?

Manolis Manolakakis: There's the technical stuff. And then, there's also the taste level. And I think taste level goes right hand in hand with the technical abilities.

Bill Klaproth (host): Absolutely. Well, this has been really informative and educational. Thank you.

Manolis Manolakakis: Bill. Thank you. I appreciate you.

Bill Klaproth (host): Yeah, this has been great. Once again, that's Dr. Manolis Manolakakis. And for more information and the full podcast library, please visit MyOMS.org. And if you found this podcast interesting, please share it on your social media and don't forget to subscribe. Thanks for listening.