Tired eyes and face correction with fillers by Dr. Naderi

Thanks. All right, everybody, welcome. Happy. What is it today? Monday? Monday, yeah, Monday. It's a slow day, so we are injecting ourselves. That's what happens. The economy is slow, government's shut down, so patients are a little hesitant and they're staying home. So our staff are all doing stuff to each other today. Look at that. So what we're gonna do is a little bit of augmentation for our beautiful Ma's cheeks. I'm going to point out what we're going to do. So I actually pointed this out to her today. I was looking at it going, you know, this area is looking a little drawn down. If you look, you can see here is the eyelids, here is the tear trough. But then this cheek trough junction is kind of drawn down on both sides. And lighting can be better or worse. Maybe in certain lights it's not too bad. Certain lights it's worse. And then this cheek fat pad sells here. Now, if she was older, she's very young, I would say we need to get this to come up. We need to kind of lift everything. She's way too young for lifting. She needs volume. So the volume needs to go in this area. When you volumize this, the cheek looks higher, fuller, better. Now anytime you tell somebody I want to do cheek volume, the first thing to do is I don't want to look fat. This is the opposite of fat. It actually is going to make you look more contoured. Fat is down here. We're not putting anything down there. You should never put fillers down here. We're going up here. So we're going to suspend this basically like a cheek lift, just with fillers, though. Now, as you lift this up, the smile line starts to look better, the marionette starts to look better. We only brought a couple of syringes. We don't want to go crazy. She's here, she works here. I'm going to see her on a weekly, daily basis. So I may add a little bit later on. But if you're flying into town for this, if you're flying and we have a lot of patients that fly into town for this, you need a little bit more volume. You may need three or four syringes, maybe even a little bit more to kind of get the ultimate result. Because we're going to lift this up and potentially still add a couple drops to the smile line, still add a couple drops to the marionette. But today we're focusing on this cheek trough groove right here. So watch the technique. Don't stop videoing. You're going to see it happen now, Tiffany, I love the assistance. You're going to be on the other side. What we do is a little bit of icing, so a little bit of ice on her cheeks for distraction. Cheek down. You want to put your head in anatomic position. I've seen a lot of injectors inject patients completely flat. Well, guess what? When you're flat, all this stuff falls. Gravity falls. You don't see what's happening. I want her sitting perfectly upright. In fact, I want her head tilted down a little bit more like this, because that's when I get to really see this cheek trough. Okay, ready? So she did no numbing. Typically, we put a little bit of numbing for patients. She did do no numbing. Now look at the direction of my needle. Come in. Zoom in. Zoom into the direction of my needle. Do you see this? It is completely vertical down to the bone. Vertical down to the bone. I did no aspiration. I didn't aspirate. Why? Because I'm vertical down to the bone. There is no blood vessels on the bone. I need to aspirate. Look at people on Instagram. Look at all these videos. People are being taught the wrong thing. People are going to courses, paying 10, $15,000 and being taught the wrong thing. You're injecting the cheeks like this. That is the wrong thing. Do not inject the cheeks in this way. You can go intravascular. Don't worry, nothing's going to happen. You can go intravascular and at the worst case scenario. But best case scenario, you're weighing down the cheek. You're putting the filler in the wrong place. It's got to be on top of the bo. It's like a cheek implant. It goes on top of the bone, lifts and pushes everything up. If you go in this direction, I'll use my finger instead. If you go in this direction, you're actually not putting in the right plane. So super important point. Close your eyes. Let's keep going vertical. Look at this. Vertical down to the bone. I'm feeling the bone. I'm putting the material right on top of the bone. And I'm drawing out. As I come out, you can literally see it. Like, it's amazing that. What? One little. Here, hold on. I'm not done yet. I only did a third of this, but let me show you. Watch this. Take a look. Look at the right versus the left. Oh, wow. Right? It's really different. I mean, it's like really different. I barely did anything. I mean, it's just we're not even done yet. But it made such a difference. So that's not even half the syringe yet. We're going to keep going a little bit more. No, we're going to keep going. I'm just going to stay. Close your eyes. I'm walking the needle. Go a little bit more medial again. I'm down to the bone. I don't need to aspirate. I know exactly where I am. Take another look. Which side looks more rested? Yeah, correct. That side looks more rested. Now switch the equipment. Put the ice on that side. I mean, you can totally see the contour. Look at three quarter view. If you come around the camera, look at the three quarter view. Look at this contour. It's a nice smooth contour. This side falls in. This side was doing that, but now it's kind of doing this nice contour. And we only used half a syringe. Not 10 syringes, not 15 syringes. I'm not going crazy. Just half a syringe in the right place. All right, ice here for me. Cool. All right, keep going right down to the bone. Vertical, straight down. I'm feeling the bone. I'm not skiving it. This is not like these online courses, you see. And as I'm. I'm seeing it happen. Look, I'm watching. End result is I'm watching what I want to see. When I see the right result, I pull out right there. That's gone. That depression is gone. So what's my end result is what I'm seeing. I'm not distorting it. She's not laying down. I'm not moving her face around. It's just perfect anatomy. She's sitting right there exactly as she sees herself. The filler goes in exactly as I want it to be. Is my face missing? Okay, so that's how I want you to focus on. Small needle. No cannulas. No cannulas. Kian Karimi, I love you. He was my resident. He was my medical student 20 years ago. I love him to death, but I don't like cannulas. They're not precise. You don't know where they go. Cannulas go in the wrong direction. We use cannulas for fat because fat will not go through this. So when I do fat injections, it's going through cannula, not through this. But this is a 31 gauge needle. Extremely precise. It puts the filler exactly where I want it to go. All right, let's keep going. Go a little bit More here again, straight down, right to the bone. I'm feeling the bone right there. Periosteum. This is a supra periosteal injection. And I'm seeing the results. I'm not distorting it. I'm watching to see how much it plumps. Then I pull out. That's where I am. How painful is this? Is it terrible? You crying, little tears coming, but it's. You should have known. You didn't know. It really doesn't hurt. Okay, good. Perfect. So a little bit more. Close your eyes. When they close their eyes, things relax a little bit more. I'm gonna be right there in the bone. I'm looking for end result. End result is where I want to be happy. I don't want to poke her a million times. I want to get the right drop. Now you've heard of me. Talk about microdroplets. This is not microdroplets. When I do nose injections, it's microdroplets when I do lips, microdroplets. This is not micro. I want to have the least amount of injections, but in the right place at the right depth. So if I'm top of the bone, if it's going to act like an implant doesn't need to be microdroplet. It's actually a pretty large globule, but it's going in the right place. That's how we deal with this. Cool. Take a look. Very refreshed. That's it. Well, it looks very good. All right, cool. I have a little bit more left. Let me see. Let me see where I'm going to put it. Look straight up. Put your head back for me. Put your head back. Tilt your head down. Now there's your helicopter view. All right, you're really symmetric. You don't need this. Put your head back. I'm really happy with this. You know what? Smile lines. Let's use it in the smile line. Yep. Here, please. It's just not enough. But this side's deeper on her. So what I'm going to do, I'll wait for Tiffany to come around. Put a little ice there. So we're going to go to the piriform aperture right here. Again. Look at this one. Straight down. It's going straight down right there. Again, it's not microdroplet at this area because it doesn't need to be. There is no risk of vascular occlusion when you do that. Done. So one syringe, that's all it took. Sometimes it takes more, sometimes it takes less, but in the right place. No bruising. She did great. And again, we'll do this again. This is not going to last five years, but the stuff that we did there will be there probably up to two years, but every six to eight months, you want to do a little bit more to maintain it, to augment it, to add to it, to improve it. So that's what you're going to do, right? Cool. Awesome.