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It Takes Two: Foundation & Refinement

Dermal filler results created by Dr. David Mabrie in San Francisco, CA after a series of treatments.

Over the past decade, I’ve helped thousands of patients rejuvenate and enhance their appearance using nonsurgical dermal fillers and neurotoxins. Experience has taught me that the softest, natural, and healthy-looking results require more than one appointment. Patients should plan for 2 to 3 appointments for the best outcomes. When it comes to fillers, layering is key. Here at Mabrie Facial Cosmetic, we refer to these treatments as the “foundation” and “refinement” appointments. Read on to discover the benefits of layering treatments.

In this blog post, you will learn that achieving the incredible results featured in our patient photo gallery is achieved by our It Takes Two approach and why too much filler too quickly can make your treatment obvious and unnatural. We’ll delve deeper and explain why our patients benefit from scheduling a minimum of 2 treatments when rejuvenating or enhancing their features and how it sets our practice — and your results — apart from the rest.

The Essentials of Layering

Patients tempted to maximize filler and neuromodulator treatments in one appointment may be disappointed with the unnatural results produced by such an approach. Another provider may recommend trying to accomplish everything at once, but as an expert injector, I know that over-injecting a single treatment area can produce results that don’t meet my standards.

That’s because excess filler tends to spread out, rather than create a natural, lifted look. By injecting less filler, I can make sure it stays put, just where I want it. Too much filler will spread and can make a patient look puffy. No one wants to look puffy.

Layering filler at a second appointment allows me to “stack” onto the first layer and double the volume in the places where you need it. This second appointment is especially important for the under-eye area, where you want to completely eliminate shadows. In fact, all patients should think of the second appointment as an extension of the first appointment, which establishes the foundation.

Refining Results – Your Second Visit

This is where our patients go from happy to ecstatic. We schedule the refinement treatment somewhere between 1 to 3 months after the first appointment. There is a specific reason for waiting—swelling. We don’t want to add any additional filler until you’re completely healed.  No, you won’t look swollen for months, but it can take up to 4 weeks for the residual swelling to completely dissipate.

When I assess the results of your foundation treatment, I want to be sure I’m looking at the actual outcome so that I can identify specific areas to refine. Besides waiting for all the swelling to resolve, waiting a month or so gives the fillers time to disperse. Think of it this way: It’s like applying 2 coats of paint or nail polish. When the first coat dries, it contracts and thins in certain areas, so a second coat is required to reach the desired result. Similarly, after the initial filler treatment, we must wait for the swelling to subside because the results will contract and different areas may need more filler.

Refinement treatments are the key to getting the amazing results that my patients want. There are no shortcuts. That’s why we say, It Takes Two.

A Special Note About the Under Eye

This is one of our most popular requests. Treating the under eyes (tear troughs) is an anatomically challenging area that should only be performed by an expert injector,  an area of our expertise where an It Takes Two process is required for results. During the initial appointment in creating the foundation for our next session, we treat adjacent areas (particularly the larger midface and cheek) to support the orbital rim and tear trough. Ignoring these “support” areas can create heaviness under the eyes or pooling of filler — the exact opposite of our goal.

To successfully treat the under eye, we must focus on creating a supportive foundation for the tear trough treatment to rest upon. At this stage, visible results may or may not be apparent after the first treatment. Understandably, this can cause patient distress and the reason that we always want to prepare our patients with as much information and education as possible.

The tear trough can be directly addressed in the refinement visit(s), during which patients will start to see a visible improvement. However, it is not uncommon for patients to require a third appointment to reach optimal results. Proceeding gradually is key to the best outcomes. Overfilling at any stage, particularly for the under eye, can produce unnatural or obvious results.

Contact us using the online form to learn more about nonsurgical facial enhancement. Or call us at (415) 445-9513 to schedule an appointment.

Dr. David Mabrie

Dr. David Mabrie

Facial Plastic Surgeon & Founder of Mabrie Facial Institute

Dr. David Mabrie is a recognized leader, innovator, and educator in the use of dermal fillers for facial sculpting and has dedicated his practice entirely to facial rejuvenation with injectables. Years of experience led Dr. Mabrie to pioneer the Illumination 360° approach, just one of the ways Dr. Mabrie brings life to his practice’s mantra: “your face, perfected.”

2 Responses to It Takes Two: Foundation & Refinement

    • Hi Marissa,
      I’m sorry to hear that you’ve had a negative experience with under eye filler. Puffiness is not a common result but can happen for various reasons. Some of these reasons include: your immune system is having an inflammatory reaction to the filler, the area was over filled, or the filler has migrated too closely to the surface of the skin. I recommend reaching out to your injector, as there are treatments to correct this. I hope this information was helpful.

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