Bellafill® Dallas | Facebook Live | Dr. Robert Schwartz

Watch Dallas plastic surgeon, Dr. Robert Schwartz, give a patient Bellafill® injections during a recent Facebook Live demo!

Transcription

Happy Friday guys, we're here live at Robert Schwartz Plastic Surgery getting ready to do some Bellafill so I'm going to turn it over to Dr. Swartz.

So this is Tonya, a long time friend and we're going to do several things on her today. We've already assessed her before this, we've gotten her numb, we've done all these things already because, really, who wants to watch me do that? But, we're going to do a little bit of filling in the temples over here to soften the cheekbones a bit, a little bit of filling below the cheekbone also, again to soften it. She's got great cheekbones but this area looks just a little too hard, it looks a little too bony so we're going to soften that. We're going to build up the softness in the cheeks and upper area here to create a bit more of that. We're going to soften the folds, these are the nasal labial folds, we're going to soften the jowl line here by filling this area and we may, if we have enough syringes to do on her, firm up the jaw just a little bit there.

So, let's get started on the temples.

Tonya, are you excited?

Super excited. I've been dying to do this.

Okay, so we've number here lips already because we're going to do that later, so Tonya's going to have a little trouble talking for the rest of this video. And you may drool.

You did that on purpose.

Just give us a thumbs up or thumbs down. And Facebook friends, if y'all have any questions, feel free to post them and we'll try to answer those for you as they come, okay?

Okay, so let's get started. All right, we'll start at the top and work our way down. So we're going to start in the temple here and she has just a little bit of hollowing, it's probably not going to take a whole lot to smooth this out. Oh, a little theme music for this.

A little Lifetime.

Okay. That may be done right there. It doesn't take a whole lot. One of the things I like about Bellafill is you get a lot of correction for a little bit of product.

So what is it actually doing?

Well, right now it's mostly... Bellafill is tiny, basically plastic beads, and when I say beads, if you're thinking like picturing a visible bead, you're picturing the wrong thing; it's almost like tiny little grains of fine powder. Ultimately the grains of powder stimulate your body to form its own collagen. Erica, could you pass me another couple of alcohol wipes?

Sure.

So that's ultimately the way Bellafill works and because it's making your own collagen, it lasts for years which gives it a huge advantage over other fillers that last maybe a year or so. But right now the beads are in a base of collagen so what you're seeing doing the correction right now is actually the collagen going in. So it's nice, so we get immediate correction with the collagen and then we get the semi-permanent correction from your own collagen formation from the beads. This side is not quite as hollow as the other one, so it's probably going to take even a little bit less.

How many syringes on average do you do at one time?

It kind of depends on how many areas we're doing and how much correction the patient wants, but somewhere between three and five is fairly typical because it's not like other fillers where we're doing sort of a temporary fix, we're kind of doing this for the long haul. It's really very flexible so we can use it almost all areas of the face. The only place really where I don't inject it is into the lips. It does not work that well on lips.

Can you use it under the eyebrows to kind of...

You can use it in that whole area, too, yeah. You can do here, you can do almost anywhere in the face, really. Okay, so there, we've got that. Let's move on now and just soften this shadow underneath the cheekbone. You doing okay?

Mm-hmm (affirmative).

So we did a nerve block before we got started here but that gets sort of the central face numb, it's really not getting in here, but you know, Tonya's pretty tough.

That's what they say.

And Bellafill has lidocaine in it so as we start injecting, the area gets more and more numb, so it's sort of like the first injection in the area stings the most and then it kind of goes away after that.

Is there any down time after injections?

Well, there can be some bruising and there's usually a little bit of swelling, but I'll make a confession here... Last week I had ten syringes done on my face.

Wow.

You animal.

I thought you looked younger.

Oh, I'm easily 20 years younger now.

Kind of got that Channing Tatum.

No, but I mean the point is I went out that night after I had it done and, you know, I actually got carded of course.

We have a viewer that wants to know, can this fix smile lines?

Yes. It depends what we're talking about, you can do it into the upper lip. I wouldn't do it into the lip itself, but you can do it into the sort of smokers lines, so those creases that you can get up there. It's good for these lines here. It's real tough, sometimes people get sort of almost like parenthesis type lines over here, outside the mouth, it'll work on that and it works as well, or better than anything else, but really nothing works great on those. There we go.

Looking good.

Better already?

Oh, yeah. I just want to make sure we're symmetric.

And so results are pretty immediate?

Yeah, so results are immediate and it's interesting because it wouldn't necessarily have to work this way, but it really seems in most people that your new collagen forms at roughly the rate that the artificial collagen in here is going away. So you just maintain the same level of correction.

Looking good. Thank you guys for tuning in.

Okay, and I love doing this because you can basically watch the face transform in front of you as you do it. Okay. You can see now-

Getting a thumbs up.

You see how she still has great cheekbones, but now instead of it looking bony, it's looking nice and soft through here and that just looks younger.

You can see what a difference it's already made in the five minutes.

Yeah, it's pretty amazing to watch.

So I'm going to look just like her when we're done?

You guys are going to be twins.

You've got the younger version over here.

Show Kaitlin for a second. You're going to look like her younger sister.

Oh, awesome.

Yeah, definitely.

Hope you guys have fun plans for tonight.

Right? Now we need some.

Well, you've known me basically since I did look like that, so...

We were in preschool together.

We did pre-k together.

Okay. So, I mean look, we've gotten all this correction so far and I've used a little over a half of the first syringe.

That's it?

That's it?

That's it.

Wow.

That's crazy.

It doesn't hurt at all and I'm kind of bleeny sometimes so I'm proud.

She is.

I know I keep walking in front of the camera, but I like to go back and forth and make sure that we're balancing this out.

And he also loves the camera.

Yes, on the back of my neck. Make sure you get the good side of the back of my neck.

I will. I'm working on that.

Does it work equally well on all areas of the face is another question that just came in.

Yeah, I think it does. You know, you gotta use a different injection technique in different areas of the face in terms of and depending on what you're trying to accomplish, so if you've been watching closely you'll notice that sometimes I'm sort of laying in almost like a mound or a pilon of it to build up an area and sometimes, like right now, I'm going underneath and fanning it out in multiple layers. But using the right technique, I mean, it tends to do the same thing everywhere, it just builds up the volume in a very natural way.

Is there a certain age range that it works best for, is it for everyone?

Well, you know what, I've done from 20s to 70s and usually the only difference is as you get older, there can be more laxity in the skin and in the tissues underneath the skin and it tends to take a higher volume of Bellafill to get the look that you want. But that's not a problem because one, you can just do more, and two, with Bellafill because it's lasting so long, you can just build it up over time, so we don't have to do some huge amount the first day. You don't have to be a lunatic and get 10 syringes.

It was 11.

Was it 11?

I think the magic number was 11.

So, okay, maybe I got 11. You don't have to do that, though, and frankly most people I wouldn't. But you can do three to five at a setting and we could wait a couple of months and see how it looks and touch it up from there and just build it over time. Okay, still on the first syringe now.

That's insane.

Look at her.

I mean, just the temples alone.

I know.

I would've never even thought to do that.

Yeah.

That looks like it took 10 years off.

So how long, exactly does is last, we have a question on that one.

That's kind of a tough question to answer. So, manufacturer's saying expect about five years but if you think about... This is my answer, not the official answer coming now. If you think about it, if the mechanism of this is we're basically inserting these microscopic plastic beads and they're stimulating collagen formation, okay, those microscopic beads aren't going anywhere, so they're ability to make you produce collagen isn't going anywhere either. So, in that sense, to me it makes sense that this is probably, to some degree lasting forever but what we're seeing is you go enough years out, you continue to age and you need more volume to replace the additional stuff you've lost. That's my answer, that's not the official answer. The official answer is several years to around five years.

But to me it doesn't make any sense that suddenly, magically at five years this is going to stop doing it.

Okay, first syringe down. We've gotten all of this from one syringe.

You look great.

That's crazy.

Can I look?

Yeah.

Oh my God.

Looks better without the little blood drops.

I'm a bleeder, it's not his fault. Wow. I can see already just what you did lifted this up.

Mm-hmm (affirmative). Look at how this looks here.

Your profile looks totally different.

So, are you able to bulk this up where I've had some dental issues, or no?

Yeah, we can do that.

Wow. I have a bleeding disorder, it's not his fault I'm bleeding. Just want to make that clear.

Thumbs up.

And it doesn't hurt at all. I'm amazed.

You're really not bleeding that much.

Really?

Yeah.

We can get the carpet changed. Okay. So let's get this done. This should be pretty numb.

I don't feel that at all.

Okay. See here I'm just fanning into here a little bit. We want to soften... We don't want to completely eliminate this line here because when you do that with filler, it kind of looks unnatural. So really what we want to do is just decrease the depth and soften the transition from where it's high over here to where it's lower on the lip. It's like everything else in the face, we want to maintain the curve of the face, but what you want to do is soften the transitions and the angles. No sharp transitions. So, there we go on that side.

Oh, wow.

We need a little more in here though. That's pretty common. Usually one crease is significantly deeper and more resistant than the other one.

Can you use it anywhere other than the face?

Yeah, it can use it on... Well, really you can use it anywhere so I've done it on the neck, I've done it on the hands. You can do it on the chest, you can actually do... Again, this is not standard, but you can do at least a subtle buttock augmentation with this.

Oh, wow.

Don't need that.

It works well, the only problem with it is it takes a fair amount of it, so it can get costly on that.

We have someone asking, how do I know if I should get Botox or Bellafill?

Kind of depends on what the problem is-

Do both like me.

You can do both. Botox is really best, I mean, the mainstay of Botox is really getting rid of these lines, like the forehead. We're going to do that a little later today, so... It's getting rid of these lines, the lines in between the eyebrows and the lines around the crows feet around the eyes. So, there's other things you can do with Botox, but those are the big three for Botox.

Do you do Botox armpits?

I do Botox armpits.

Awesome. Sign me up.

Do you do Botox in the jaw?

I do do that and the reason you do that there is for people who have overly developed-

Bethenny Frankel.

Yeah, masseter muscles, for some women it makes them look too masculine, so you put a little Botox in there, the muscle shrinks for a few months and it just looks prettier. Okay, we're almost there.

Wow.

And the other thing about this, which you won't see today, we've discussed this before, but Bellafill pretty uniformly gives you better skin in the area you inject it and it's not completely proved why that is, it definitely happens, we've seen it happen in a lot of people-

Is it the collagen?

It's probably the collagen and probably that it produces more blood vessel formation in the area so the skin gets better nourished by blood and it just looks... There's no question that we see people get sort of a nice healthy glow in the areas.

Maybe it's just because they're so happy.

There's that too.

That's a bi-product as well.

When you use it on men do you inject the same areas, or...

No, not necessarily. There's things that I do differently on men. For one thing on men I would tend to use, I'm not going to say less Bellafill because it's actually probably the same or more, just because they have bigger faces and more volume to fill, but sort of you do less of a correction is the best way to put it. In other words, and it's the same way if I'm doing a facelift on a man, it's kind of like with men less is more. You do not want to over-correct a man, whether it's with Bellafill, any other filler, eyelids, anything like that. It does not look good. So, anything I'm doing on the face with men, the techniques are sort of the same and the products can be the same, but I guess the aesthetic goal is different. I think we're good there for now. I don't want to put anymore in. We can always come back and add more. And that's something about Bellafill is that it's always safe to add more.

You can layer more and it wouldn't-

Yeah, I say do it at two weeks, I generally give it about six weeks or so before we put more in just because you want to give it time to really settle in and have a good look at where it is, make sure all the swelling is gone. But, yeah, you can layer this in. We can do more a year from now if you want.

How does it work if somebody has divots from acne, does it help plump that up?

Yeah, it does work on acne. In fact, that was the first thing that it got FDA approval for. So, essentially what you do is you go into the deeper ones and fill it from... You're essentially filling it out from the bottom.

Is Bellafill what they use for like the liquid nose job kind of thing where you fill out like right here if you have like a bump or something?

Yeah. I've done noses with it. I mean, you can use most fillers for that and probably the most commonly used thing for that is Reslin or Juvaderm because they're easy to work with and they're relatively thin and they don't last that long, so if you're not quite confident in what you're doing or you're not sure you want to do it, that's not a bad choice. But if we know exactly what our goals are and if it's a patient that I'm really familiar with and I know that they're going to like what we're doing, I have no hesitation about using Bellafill for that because then you're basically doing it maybe just once and you're done.

Can Bellafill be used for bags under the eyes?

Sort of. Depends what we're talking about here. So, what I like to use it for is a lot of people have a little hollow in this area and you can definitely fill on that. Some people have almost like a pouch there hanging down and really you've got to take more of a surgical approach to that because that's not a fill issue, that's actually a reducing volume issue. But for the little hollows here, which Tonya doesn't really have, but for people who do you can definitely do a nice correction there and soften that little hollow there, which makes you look... You know, when you have those hollows it makes you look tired even when you're not. You can pretty much eliminate that.

So if somebody my age, and I'm going to be 55, was thinking about surgical correction would you want to try something like this first just to soften things up?

I think it depends. The way I approach all of those situations is the consultation is critical. So, we're going to sit down and first of all we're going to carefully listen to them to find out what's bothering them, okay, because that's in some ways the most important thing. There may be something there that's visible that isn't that critical and if it doesn't bother them, I'm not going to try and make someone feel self conscious about something that didn't bother them when they walked into my office.

Like my bony temples?

We're doing a demo here, so it's a little different. No one said bony temples either.

Hey, I'm happy to have one bony thing at my age.

In some countries bony temples are well sought after.

Really?

I don't know those countries, but I've heard that's the case in some countries.

Uh-huh (affirmative).

Get back to me on those, though.

I feel like I'm in a time capsule.

Countries where men are going, oh she's a terrible mean woman, but just look at those temple hollows.

Yeah.

Really?

We might want to live in a world where that...

Where a woman is judged not by her character, but by the boniness of her temples?

Yes.

Jessica has had her temples filled as well-

I did.

With Bellafill.

Right. Which is making her much less attractive in her homeland.

I know.

Of, ironically, Temple, Texas. Which is true.

That's very true, y'all, Temple, Texas.

So, price wise how does it compare to other fillers?

Each syringe is a little more expensive. It's about 20% more. I may be getting that a little bit wrong, but in the long run, I mean, it's way less expensive because you're doing this years apart as opposed to like every six months or every year depending on the other stuff you're using, so I mean, it's way more cost effective. So I guess in a sense it's like better for you, worse for me.

Okay. So, what I'm doing right now... I haven't really talked about this, is I'm kind of filing, there's a little bit of jowling right here and I'm kind of filling in the transition between that jowled area and the front of the chin. I don't want to put any in here on Tonya because she's already got good chin projection, we don't want to make it too big, but filling this little dip right there hides the jowl. Yeah. It hides the jowl. And I'm also going to fill up into this in like a little triangle that goes from the corner of the lip and sort of goes like that, almost like a little delta there. Filling that also tends to look really attractive. I just need a new needle here. This one's gotten a little dull.

I've been doing some of this filling down by the bone and so if you touch the bone with the needle it dulls almost instantly.

You look really good.

Okay. There we go.

So do I get like a written post-op instruction like Netflix and chill for three days?

Sounds like you have an agenda here that you want me to participate in.

Like an old school excuse note, like I can just...

I need you not to do any of your homework for the next month, okay?

Okay.

Do you have to avoid working out or anything like that?

You know, I don't make people do that. I mean, most people probably want to wait about 24 hours, but really if you're dedicated to doing it I have no problem with you doing it. Now, most people, I can tell you this now based on my own personal experience, because now I've been on the other side of this, which was actually a really valuable experience for me, you know? At least for me, and I think Jessica, your experience was not quite, you had almost no discomfort at all, did you?

I worked out and I went out that night and I had cocktails.

She sure did.

The trifecta.

Yeah, perfect.

I woke up the next morning and I felt great.

Well, I worked out and I went out that night, but I'll tell you my jaw was sore. Now, we did some injecting into my muscles and things so it hurt a little bit to chew, but it was like a take a couple of Advil's kind of painful, so not anything really problematic in any way.

Can you put make up on right after?

I did. But I use a very light, sheer kind of thing.

A sheer foundation?

Just did lips and eyes?

Yeah. For me I think less is more, you know. But, yeah, you can put it on, just put it on gently. Okay.

I'm going to do a little bit basically behind the jowl too. Again, we're going to hide that a little bit. Now she's got a good jawline here. We're not going to put in very much, but some people you can really sharpen the jawline right there with the Bellafill.

Yeah, I love what he did with mine. Gave me a little bit wider jaw.

See, so just a little bit there and by doing this and that little bit in front of the jaw we've basically hidden it. I mean this is stuff, to get this kind of effect you used to have to do a facelift to do this.

Y'all keep the questions coming if you have any.

I was going to ask you, does any of that topically help postop?

Absolutely. Yeah, we have some products that you can use post procedure and then also in conjunction to help... I always say it's like a twofold approach, he's going in and putting insulation back in the ceiling of your house, or the attic of your house and then we're working on the shingles of your house, so resurfacing and doing things that are-

Like, I wouldn't want to inject here, but I'd really like to smooth it up. This neck skin.

They have some great products to help do collagen of the neck and you can also put Bellafill in the neck lines.

Mm-hmm (affirmative). It actually works pretty well for that.

Yeah, we'll save that for next time.

Okay.

We always try to tell our patients that coming to see Dr. Swartz is like working out with a personal trainer but you need to work out every day on your own so using good skin care is the way to do that. Protecting your investment. And obviously maintenance.

It's like working out with a personal trainer?

You're the trainer.

I am?

Yes. You.

Hmm.

You gotta go to see your trainer and get some heavy duty, get your butt kicked a little bit and then you keep it up at home on your own.

I'm not sure I'm going with this analogy. I don't know.

We'll edit this part out.

I think this is kind of a strained one here.

I understood what she was saying.

She knew it. She knew what I meant.

Is there anything that people can do to help with swelling or bruising afterwards?

Arnica helps, no question. Some people like to give a brief steroid course for this. Honestly, not a big fan. I don't think typically the swelling is that bad from this and steroids are not without risks so if someone really wants, or has had a problem in the past, I'll do it but otherwise I really think it's not a risk-free drug to take. I think the benefits are pretty minimal.

Do you recommend ice?

Yeah, if someone is so inclined to do, they can go home and gently ice this, but we generally don't see a whole lot of issues with it to be honest with you. Let's see where we are now. Okay.

Hardly recognize you.

Yay.

So we can do an online poll right now and the people watching decide where we're going to inject next.

Yay.

So are you still on number two or is that number three?

We're on number three. We're just about to finish number three.

Should we do my eyebrows? Or after Botox?

Well, I kind of want to Botox you first before we do that.

So we know where the eyebrows are going to be. I'm so numb.

We know.

So, Tonya does have a clotting disorder so she does bleed a little more than most people so periodically we've got to stop and hold a little pressure on something. It doesn't make for the most exciting video moment. But then again we can probably spare her a big bruise by doing this.

It's good to know you're not contraindicated.

Are there any health issues that would prevent people from being able to get Bellafill?

Well, allergies to the collagen in it would be one. Obviously if she had a really severe bleeding disorder that would be a problem. Serious health issues would always be an issue. If someone had a heart condition or blood pressure issue we probably wouldn't be able to do the block because of the adrenaline in that. But I mean, it doesn't come up very much that we have an issue that prevents us from doing it.

It looks really good.

Let's see where we are. You can take a look.

Oh, my God. This looks so much better.

That looks really good.

Let me see now, hang on a second, I'm going to walk in front for a sec.

You look gorgeous.

Let me see.

It's crazy amazing. Sorry, did I-

Got a little bit just under those crows feet and then let's do the upper lip. We're going to put very small amounts in these areas. We can always add, but it's an area with thin skin, not a lot of subcutaneous fat, we definitely don't want to overshoot.

Because then you'll look like a scary real housewife.

Who's had way too much stuff done.

Okay?

Mm-hmm (affirmative).

This is an area where it's not numb.

Girl power.

It was really genius of them to have the lidocaine in the Bellafill.

They should do that with Botox.

Right?

That's all we're going to put right there.

My hubby's out of town, he's not going to recognize me when he gets home.

Can I have that alcohol wipe, please?

Am I building a big fan club out there?

Wave to the camera.

I've told all my friends to tune in.

How many followers do you have on Facebook?

On our page, about 78,000 I think and then on Instagram about 100,000 and Twitter's 300 maybe. So we posted it everywhere hoping people would watch.

Go ahead and plug what you do, let's do that.

I was going to say, grab a plug.

Bling is the New Black, it's her, not me.

I'm here observing.

Bling is the New Black?

Bling is the New Black.

Talk about what you do because it's pretty cool.

We make custom bling apparel and crazy items like guitars and all kinds of things like that and we sell tour merchandise for all the big bands, so Aerosmith, Ringo Starr, Willie Nelson, and a bunch of other people.

So if you go to a concert and buy a crystal shirt it was probably made by us.

Celine Dion, Carrie Underwood, Bon Jovi.

We should've got bling shirts for this.

We should. That's how this all started, actually was Juviderm and Restolin and all those used to send crystal logo shirts and I couldn't find anyone to make 10 shirts, so I had her make them and I put a picture on Facebook and here we are.

The rest is history.

Eight years later.

I think Dr. Swartz needs bling scrubs.

I think y'all need some bling scrubs for the new office.

He needs a cape like Elvis.

Oh, yeah. We've made those. For Mohammed Ali and Joe Perry.

Wow.

Have you made a lot of plastic surgeon capes?

No, but you definitely need one.

That's why we love him guys.

I think that would be interesting because the cape would be a good way, like at the hospital, to distinguish the plastic surgeons from you know, the non-

From the OB/GNs

Yeah, whatever the other surgeons are, I'm not sure. But, you know, we should have our own. I think the cape look would he the way to go.

Yeah.

Yeah.

Or just her you know, you might need to wax first or...

Pretty smooth.

I wouldn't know.

I'm just wary of the permanent bling to the skin itself. You know, styles change.

They used to do-

Yeah, it's like Bedazzling.

That's what I was going to say.

We had one person ask if I would do that. I was like, um, no.

It's very different from doing that on a human from doing it on a shirt.

Yeah.

There's a whole like-

Science behind it?

Um, cleanliness.

T-shirts don't bleed. I'm just switching out the needle. Just take this out.

It looks really, really good.

Can't wait to do this, so exciting. I was really nervous that it would be painful and it's surprisingly nothing.

I was waiting for Dr. Swartz to have a big melt down about the pain and he was... He did great.

You realize I'm standing right here?

He's been my patient in the past, so I know what a weeny he is. I know what you're saying.

Okay.

This is so not true.

It's not you specifically, but men generally sometimes don't know how to tolerate pain like women. I think we can all thumbs up and heart that on Facebook right now.

Not me. I'm not thumbs up or hearting it.

We should have something on our Instagram.

Okay, so all we're going to try to do here is restore a little bit of this volume lost.

I want those lips.

And soften these lines.

I was born with these, I'm sorry.

I was too, 55 years ago.

You didn't have lips, sorry. I don't know where these came from.

So I'm not actually going to put this into what's called the vermilion, the red part of the lip, so it's really not indicated for that. We'll use something else in there, but we can restore a little bit of the volume into this fleshier part of the lip. But we're not going to put very much in. This is something I would definitely want build up over time.

Those lines are not noticeable at all compared to earlier.

This should be completely numb from the block.

Mm-hmm (affirmative). Totally.

Okay. So you can see how that softened up a little bit but this is one of those areas, and this is the nice thing about using Bellafill is it's not necessarily something where we gotta get this completely corrected today. We can take our time and be careful about this because we don't want to over correct here.

And I don't want to look like Bart Simpson.

Well, the yellow's just from the color of the wall, so...

So, just some technical difficulties, we're back on.