It has been some time but every now and again I get asked if I offer 0.5ml lip filler. Equally, I get asked occasionally why I don’t offer 0.5ml lip filler as an option for touchups.  It’s a great question, so I thought I’d take the time to explain, rather than 1:1 as the occasion arises.  0.5ml filler is an option in many if not most, chain clinics, especially for lip filler, which is among the most commonly sought out injectables among young people seeking enhancement rather than rejuvenation.  Young people also have smaller budgets so it makes sense that they’d seek what they consider to be better value for their money by pursuing options they can downsize.  And yet…. Anytime I’ve given in on the spur of the moment, I’ve regretted my decision & lost money saying yes and risked feeling resentment towards the person asking, which is not my preferred method for dealing with tricky conversations especially around money and boundaries.  My personal feelings & business health aside, I’ve some solid reasons why I don’t offer 1/2 syringe options, ever. you’re paying for a service that includes my assessment, opinion & treatment. The syringe and how much of it I use is irrelevant to your stated and our agreed-to goal for what you wish to achieve.  I rarely agree to do touchups if I don’t feel you will need a decent amount of filler, usually > 0.5ml when you buy a meal you pay for the whole thing even if you only eat half of it, so why do we expect a 1/2 syringe option when the syringe comes in 1ml size?  once opened, that syringe can’t be stored so if I don’t use it, it’s wasted assuming I do it, it’s twice as long with two people, and more consumables including numbing cream on two people for the same price as 1 syringe.  legally that syringe is yours and yours only. I know many clinics will split a syringe between two friends on the same day but technically it’s not legal to do that. On the occasion I’ve done it, I’ve felt annoyed for feeling pressured to do it on the spot.  I dislike people “ordering” aesthetic treatments as if off a menu including number of units or mls.It’s not how I work and it doesn’t work for my business.  limiting me to your budget also limits what I’m able to achieve clinically. On the few occasions I’ve done this, patients have invariably come back for more because the dose (eg anti wrinkle) was inadequate to do the job or was barely visible (eg filler) once swelling settled. the dose I suggest we use, is the bare minimum to achieve the desired result/ outcome - this is a basic, sound medical principle, and dropping that dose to suit your budget often means you’ll get less than ideal results or need retreatment sooner.  I work in 3D and often need to use 0.6-0.8ml of a syringe on lips to achieve good results front, side and in aiming for symmetry, even for touchups.  In saying all that, there are many people who do offer 1/2ml syringes. I’m just not one of them. At Skin Essentials, I am all about as much transparency and healthy boundaries as possible and I like to think that patients who choose to see us understand and accept this. If they don’t then they should not be seeing me and I encourage them to go elsewhere. We value safety and following rules more than a quick sale, any day. 

I post a lot about safety with medical aesthetics, adequate experience and qualifications as well as aftercare protocols with the clinic you choose.  Why does this matter? I was in a surgical training program between 2002-2011 and did it full time for most of those years. Practice and training absolutely matters and cannot be disregarded.  At the same time, there are some common myths I hear all the time, and because I post about vascular occlusions to help raise awareness, it often puts people off, including some of my own patients. As always, it remains absolutely optional, but it is hard, if not impossible, to rejuvenate volume loss in a face without volume via either fillers or fat. So if a patient is adamant they would not consider fillers for volume replacement,  realigning expectations may be needed.  In saying that, when I hear people say they’d only consider fillers to certain parts of the face due to risk in other parts, I feel it is my job to correct medical misinformation, same as when medical aesthetics is passed off as “just beauty” with no risk.  So what do statistics and the evidence tell us?  For an indication, I looked at a recent article published in the dermatological journal JAMA Dermatology 2021; 157(2):174-180 The authors conducted a study looking at outcomes among a chosen cohort:  370 dermatologists followed for a year between August 2018 and August 2019. average experience between them was 22 years in practice Between them, 1.7 million syringes of filler were injected.  Their findings in summary:  1. The risk of vascular occlusion (VO) using a needle or cannula was 1: 5000 syringes used.  Overall risk using a needle was 1: 5410/syringe  Overall risk using a cannula 1:40882/syringe The authors emphasised that the choice of use of needle or cannula is nonetheless clinician dependent, and based on their experience, the area being injected as well as the anatomy of the patient.  2. VO can occur at any part of the face. Some areas are considered higher risk but no part of the face is no-risk eg lips, as many commonly believe  In this study, lips and the nasolabial folds (nose to mouth smile lines) were the most likely areas to be occluded. Highest risk areas include filler around the mouth, the nose, the frown lines.  3. Participants with > 5 years of experience had a 70.7% lower risk of VO than those with less experience.  By ten years of experience, this risk had evened out.  Risk of VO twice as high in someone with < 5 years experience.  As we know with surgical training, repetitive practice leads to fewer complications over time.  4. 85% of VO had no longterm consequences  Most VOs, if caught and treated in time, did not lead to any longterm problems such as scarring or deformity.  5. Highest rates of VO at lips and nasolabial folds  A common misconception is the notion that lips are low/ no risk and that risks of fillers, including of blindness, which is rarer still, is only with filler to the rest of the face. In practice, the literature indicates that lips are among the most common areas to have VOs.  6. Highest level of severity at the forehead  The riskiest areas to inject remain the areas around the lips, the nose and the forehead, and so it makes sense that if this happens, the highest likelihood of complications from a procedure is injecting these areas, especially the frown.  Take Home Message?  Experience trumps almost everything else, and the overall risk is still very low of a VO, and of blindness even lower but more catastrophic. Experience does not simply mean someone who has been doing this for 5 or more years, but also, in my opinion, someone who is safe, and has protocols in place, with followup and aftercare for more risky procedures so that nothing major is missed, and someone who can open the clinic up at 2am for you on a Sunday if needed.  So please, choose wisely. Price should not be your main determinant, and it’s better to have no treatment than to risk it with an inexperienced clinician. As I always say, medical aesthetics should be reassuringly expensive because it’s your face and side effects, while rare, can be catastrophic.  Source : JAMA Dermatology 2021; 157(2):174-180 doi:10.1001/jamadermatol.2020.5102