Fashion & Beauty

Fill Her Up!

July 31, 2022

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iStock photo.

By Valerie Monroe

For nearly 16 years Valerie Monroe was the beauty director at O, The Oprah Magazine, where she wrote the popular “Ask Val” column.

If you’re interested in feeling happier about your appearance—especially as you age—you might like reading what she has to say about it. For more of her philosophical and practical advice, subscribe for free to How Not to F*ck Up Your Face at valeriemonroe.substack.com.

Can’t get enough Valerie Monroe? There’s more at https://valeriemonroe.substack.com.

I JUST SPENT a few minutes doing the mirror meditation. It didn’t go much of anywhere.

Among the distractions, a careful reader pointed out that in a recent post I misspelled both Olivia Colman’s and Maggie Gyllenhaal’s surnames, in spite of my confession that I looked up Gyllenhaal’s name several times to try to spell it right. These kinds of mistakes make me want to throw up. (How can you trust me? How can I trust myself?) But being the lemons-into-lemonade type, I decided to use my humiliation and focus this week’s post on mistakes. Naturally, they’re f*cking-up-your-face kinds of mistakes.

Are you familiar with the concept of pillow-face? (Different from what you see in the morning when you’ve slept on your side.) Pillow-face was recently reintroduced to me by this informative Instagram from plastic surgeon Christian Subbio. The term describes a face so plumped with filler that it looks puffy and moves unnaturally, as the filler interferes with the musculature. Superb reporter—and my former colleague—Jolene Edgar writes about it here.

I started thinking about pillow-face when the Sex and the City reboot began and an overfilled Kristin Davis (Charlotte) pranced gaily into the picture. I want to mention here precisely why I think it’s important to bring up Davis’s face, because Sarah Jessica Parker (Carrie) and others have remarked that the buzz around the actresses’ faces (and gray hair) in the reboot is misogynistic. I agree—if the criticism is that the women are less attractive (which they are not, IMHO) because they’re older and grayer. But to use that as a reason not to bring up Davis’s sadly distorted face is wrong. Why? Because ignoring it normalizes it, and it is not normal. Go ahead and call me mean. I have nothing against Davis and I don’t hold her accountable for her pillow-face; I hold accountable the physician who injected her.

Subbio’s response to Davis’s condition aligns with what my facial plastic surgeon friend Steven Dayan told me about overfilled lips. The problem isn’t with the filler, necessarily, but with the way the injector learns to inject it. Subbio maintains that the Davis problem is a result of injectors using filler to try to lift faces rather than to fill in areas that have become hollow with age. He points out that filling in conservatively can work well for a while, but after a certain point (different for each patient) filler begins to look weird. Why? Because though it’s possible to get a bit of a lift in some areas, lifting the planes of the face is, for the most part, impossible without surgery.

Yet drug companies insist it is possible, encouraging injectors, says Subbio, to use more of their products. Similarly, Dayan maintains that the trout-lips we continue to see are often a result of some injectors being poorly trained in ways that are likely to produce unnatural-looking results. One reason he offers: In order for a drug to pass FDA approval, the drug must be shown to yield a certain level of effectiveness on a static photo, which unfortunately requires more product than a face might need. That means when an injector chooses not to follow FDA-approved protocol, he or she may be going off-label. That’s obviously not a good thing. But—as we can see—neither is it a good thing to precisely follow protocol.

A number of doctors also told me that the drug companies producing fillers are gung-ho about selling their products to anyone willing to learn how to inject. So these companies offer many opportunities to learn rudimentary injection skills—but not the aesthetic judgment required to create a sophisticated result.

To give you some idea of what’s involved in making such aesthetic judgment: The dimensions of the lips look best in proportion to the dimensions of each particular face—so when you submit to lip filler, even in the hands of the most technically skilled physician, you’re vulnerable to his or her personal evaluation of what will look good on you.

Increased fullness is only one aspect of a successful lip augmentation. It’s critical to restore definition and structure to the lips, which means not only filling the body of the lips, but also redefining the vermillion border (the edge of your mouth). It’s also important to consider the depth and length of the philtrum (the vertical groove between the bottom of the nose and the upper lip), which tends to lengthen as we age. You don’t want to smooth the lips so much that all the little lines disappear. A completely smooth mouth looks as unnatural on a face that is not a baby’s as trout-lips do on a face that is not a trout’s. What you’re often seeing on a woman with trout-lips is filler injected into the body of the lips with poor consideration (or none at all) for resculpting.

It fascinates me why a woman might not be able to see such a mistake on her own face. Dayan told me, “Even if you think something looks strange at first, you can get used to anything.” Dermatologist Sabrina Fabi has called this “perception drift.”

Back to honoring the responsible party. Should patients know when to stop asking for treatments? Though I think people walking around with distorted faces due to overtreatment may want to reexamine their priorities, I don’t think it’s their responsibility to tell their doctors when to stop. Several dermatologists told me they will inject filler even when they believe it won’t work to a patient’s best advantage; if they don’t do it, they know the patient will simply go to another willing doctor. (This jaw-dropping confession aligns with the common complaint among some dermatologists that patients hopscotch between them, making retention in their practice difficult.)

But if doctors refused to treat patients obviously overdoing it, wouldn’t there be fewer people with faces not found in nature? Could injectors not unite to support this decision?

The beauty industry—that includes doctors and aestheticians of all kinds—tries to appeal to us by promising it exists to help us feel happier about ourselves. Maybe people with pillow-face and trout-lips do feel happier; maybe their perception drift is radical enough that they don’t remember their baseline and can no longer perceive distortion.

But the way I see those of us who have fallen prey to those who over-inject? We are the emperors with no clothes—for which we have paid dearly—and that is very sad.



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