Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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The treatment room is a clinical environment designed for sterility and focus. The patient is positioned in a semi-reclined chair, often at a 60-degree angle. This positioning allows gravity to act naturally on the facial tissues, giving the practitioner an accurate view of the sag and volume deficits.
Lighting is critical. Surgical-grade overhead lights are used to eliminate shadows and reveal the actual contours of bone structure. The skin is thoroughly cleansed with a surgical antiseptic, such as chlorhexidine, to create a sterile field.
Patient comfort is managed proactively. A potent topical anesthetic cream is applied for 15 to 30 minutes to numb the skin surface. Most modern structural fillers also contain lidocaine integrated into the gel, which numbs the internal tissues as the product is injected.
For patients with high anxiety or low pain threshold, the practitioner may use a vibration tool on the skin. This stimulates the nerve endings and distracts the brain from the sensation of the needle (Gate Control Theory).
There are two primary tools for delivery: the sharp needle and the blunt cannula. Sharp needles are often used for deep, precise placement in the bone (periosteum) at the chin and cheek apices. They allow for a “bolus” injection that provides maximum lift.
Blunt cannulas are flexible tubes with a rounded tip. They are used for more superficial layering and for navigating through dangerous vascular zones. Because they are blunt, they slide past arteries rather than piercing them, significantly increasing safety and reducing bruising.
The hallmark of structural augmentation is the depth of injection. The needle penetrates through the skin, fat, and muscle to rest directly on the periosteum (the connective tissue covering the bone). This is the safest plane for injection as it is generally devoid of major blood vessels.
By placing the filler here, the practitioner essentially expands the bone. The filler acts as a pillar, pushing everything above it—muscle, fat, skin—outward. This provides a natural look because the soft tissues drape over the enhancement just as they would over natural bone.
The procedure typically follows a strategic sequence, starting with the lateral cheeks. By anchoring the lateral face first, the practitioner creates a “frame” for the remaining features. This lateral lift often improves the jawline and nasolabial fold before they are even touched.
Once the lateral width is established, the practitioner moves to the medial cheek to soften the under-eye transition. Finally, the chin is addressed to balance the new midface width. This top-down approach ensures harmony and prevents overfilling the lower face.
Safety protocols are rigorous. When using a needle, the practitioner may perform an “aspiration test” by pulling back on the plunger to ensure the needle is not in a blood vessel. While not foolproof, it is a standard safety check.
The injection itself is performed slowly and with low pressure. This prevents the filler from flowing retrograde into the arteries and minimizes tissue trauma. Small aliquots (volumes) are used to build the result incrementally.
Once the filler is injected, it is malleable for a short period. The practitioner uses their gloved fingers to firmly mold and shape the product. This “sculpting” phase is critical to ensure the filler sits flat against the bone and blends seamlessly with the natural contours.
This is the moment where the artistry comes into play. The practitioner smooths out any irregularities and ensures symmetry. The patient is often given a mirror to provide immediate feedback before the product sets.
Immediately after the procedure, the treated areas will appear fuller and may be slightly red. The anesthesia in the filler may cause the face to feel numb or stiff for an hour or two. Swelling is normal and typically peaks the following morning.
Some pinpoint bleeding at the injection sites is common, which stops within minutes. The patient leaves the clinic looking largely presentable, though they may feel “tight” due to the volume expansion.
While technically a “no downtime” procedure, there is “social downtime.” Patients may experience bruising that can last for a week. The chin, being a muscular area, often feels sore or achy, similar to the feeling after extensive dental work.
Swelling can make the face look slightly asymmetrical or “boxy” for the first few days. Patients are advised not to judge the result until the 2-week mark. This period requires patience and self-care.
The most serious risk is vascular occlusion (blocking a blood vessel). Signs include severe pain, skin blanching (whitening), or a mottled purple pattern. Patients are educated on these signs before leaving.
If an occlusion occurs, the clinic initiates an emergency protocol that includes injecting hyaluronidase (to dissolve the filler), applying warm compresses, and administering aspirin. This rapid response can reverse the blockage and prevent tissue damage.
Send us all your questions or requests, and our expert team will assist you.
One significant advantage of hyaluronic acid fillers is that they are fully reversible. If you are unhappy with the shape or volume, the practitioner can inject an enzyme called hyaluronidase that dissolves the filler within 24 to 48 hours.
The amount varies wildly based on anatomy. A subtle enhancement might require two syringes (1 for the cheeks, 1 for the chin). A transformative “profiloplasty” might require 4 to 6 syringes. The practitioner will give you a specific estimate during the consultation.
Yes, you can drive yourself home. The procedure involves only local anesthesia, so you are fully alert and functional. There is no sedation involved.
“Pillow face” is caused by overfilling the medial cheek (the middle of the face) or using too much hydrophilic (water-loving) filler. When placed correctly on the lateral bone structure by an expert, the result is sharp and contoured, not puffy.
It is best to wait at least 12 to 24 hours before applying makeup. The injection points are tiny wounds, and applying makeup too soon can introduce bacteria and lead to infection.
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