George Thanks for your kind comment - I think the main reason - and a fair reason - for the dislikes is that this video doesn't show the correct and required sterile technique. As you know, for all filler techniques it is essential to minimise infection risk and therefore the skin should be prepped and gloves worn. When fillers were first introduced (and this is a very old video) we treated them like botox and thought any infection would always respond to dissolving and antibiotics. We now know better! I've been tempted to take this video down, but also think it still has some relevance, and hopefully anyone actually injecting fillers will both see the comments and also know that sterile technique is required. Best wishes Ric
I find these comments very curious. This is a real video demonstrating how I teach others how to perform deep filler injection to the cheek. As explained in previous comments, the term Y lift is widely used in the UK to mean cheek filler. I'm not claiming to be anyone other than myself and this is quite clearly a real procedure. In the UK there are many surgeons doing many variations of this technique.
I think in this day and age ( even 12 years ago) ppl want to be bright and they are in their eyes. It's ridiculous that we çant even share a facial rejuvenation procedure without some know it all talking badly to a wonderful doctor doing what he does best❤️ thank you👏💕❤️
Injecting into an artery or vein carries great risk. You need to know your anatomy! The angular artery and vein are medial to this injection. If heading anywhere near any danger zone it is better still to use a cannula rather than a needle. The cannula still needs the needle used first to pass through the dermis, so for this single point of injection I still tend to use the needle, and swap to the cannula if going further medially.
This is the correct technique in my opinion, I am just SO confused as there are so many different variations and techniques on cheek filler - that I just don't know what to do anymore as its quite misleading. However, this is by far the best video I have seen and resonates with what I have been taught.
@larauc To be effective the deep filler needs to be between the skin and underlying cheek bone. You would still modify the location and quantity injected to suit each patient according to their facial structures.
Very much so. If someone is considering tear trough filler, but has a flat cheek, I always advise filling the cheek first, as this will lift the lower tear trough in particular.
In the UK the term Y lift is used as shorthand for a non surgical midface lift with fillers. I'm not sure anyone in the UK is aware this phrase is trademarked. The procedure itself is performed by many cosmetic and aesthetic surgeons.
This is one of if not the best video on this technique and topic. You saved me sir. I am dealing with this not only with myself but another patient. I plan on copying your technique with either Voluma or RHA 3 or 4.
It depends on the filler used, with the thicker fillers, eg teosyal ultimate the effects can last up to 2 years. The thinner fillers are easier to shape and mould, but do not last quite as long. There is something of a trade off.
Excellent video!!!! Do you offer any online training??? I don't understand the nasty comments on here at all. This is how I was taught how to do cheek fillers and it is infact the only clear demonstrative video I have found on UA-cam.
Hi Ric, love your videos. How long and wide are the cannulas you would generally use? Would you ever recommend using beveled cannulas for any treatment?
I almost watched all your videos and as plastic trainee found very educational. I wish could I get the privilege to operate with you, to learn from you.
Your explanation in how to do it safely is so good and reassuring. I have been terrified to get filler done incase they hit a vessel and inject then end up with serious issues like tissue death or blindness. I am thinking maybe I could ask my nurse who wil do it to ensure she does what you did to make sure there was no blood before filling ad that should rule out any serious complicatiosn right?
Hi Dandelion, the risks of filler can be minimised by a thorough knowledge of the anatomy, good training, careful technique, and the use of a cannula rather than a needle. Even with all these in place there is still unfortunately a very small risk of infection and vascular occlusion, for which you would have to give your written consent. A context is always useful, and there is always a risk of serious complication each time you travel in a car! Choosing a good driver will always make sense. Volumising the cheek is such an effective rejuvenation technique, that it remains very popular, and most patients can accept the very small risk. I wish you all the best. Ric
I like Teosyal ultra deep and 27 G needle. Teosyal ultimate and Sub Q recommend a 21 G but you can use a 23 G with a slow injection and strong thumb. Best Wishes. Ric.
I have a question....so u said that if u draw the lines of both cheeks etc. and find the middle point where the Filler can be placed, would this also be true for one assymetric cheek?
What are the risks? Would the consistancy of the filler block the blood flow, or would the blood thin it out? Because of what the filler is made of, would it be dangerous to travel through the body?Would a quick trip to the hospital be necessary? Depending on the vein or artery, could the damage be permanent? Which filler carries the greatest risks? Thank-you.
Good evening.I am seeking the best up to date treatment to erase the horrid(and ageing) creases that have formed both sides of my cheeks-the price of having natural dimples.There is no face cream to "soften" etc,make-up just doesn't work any more.This actually looks about the best option but it's a few years old has there been an improvement on the technique?and what is the cost now.
I assume you mean .2ml and .15 ml to other point. Do you use hydroxyapatite now? Is this OK near bone? Why not use lidocaine injected before as she does look in pain? Did read this can lower bruising?Never had an infection but I am a fan of minocycline prophylactic (very little resistance with this and anti inflammatory as well).
Dear Giselle I'm not a fan of any of the permanent fillers. My perfect filler has to be reversible just in case it looks wrong post injection. This is an old video, and needs updating but many of the principles are still there. The filler is best placed into the subcutaneous fat, but doesn't need to be as deep as the bone. All the recent fillers also contain lidocaine which helps with pain relief, but pre-injected lidocaine can distort the tissue plane I want the filler to occupy and make it more difficult to judge volume to inject, so I mostly avoid that. Using a cannula instead of a needle is now very popular and can reduce bruising, (A needle still makes the initial puncture through the skin). Interesting comment on prophylactic minocycline - I'm going to investigate that option. Very best wishes. Ric
Ughh terrible! The result is worth the pain though :P. I got my lips filled last week and it hurted quite much. Is the cheeks worse? I got a nerve block in the lips and it still hurted lol.
Maybe some people are more concerned with the slight but very possible risk of blindness or stroke from accidental injection into a blood vessel not everyone is going to risk blindness and stroke for temporary fuller cheeks
aia angle Dear Aia, there have been lots of attempts to find a safe permanent volumiser. They include using implants, your own body tissues or artificial tissues. They all have risks, not least that if you don't like the result, you will need surgery to remove the volume with associated risks of scarring etc etc. As we continue to age it is also necessary to adjust the position of volume to have best effect. Any permanent volume is just that. For these reasons I would recommend the reversible fillers. Best wishes Ric
I gave you an A, for the step by step instructions which I felt you did a very good on, however, you should have use a local anesthesia because it appears that this woman was in a lot of pain
I've seen it work when you put a reasonable about filler in one area remove the injection and then molded his face when I had it done it didn't take any money as well and it didn't hurt not that im saying the method this gentleman uses is wrong I just prefer it much quicker and seeing her wings I would definitely want buy 10% lidocaine on my face lol
Hi David - The voice over is recorded later. There is no original sound. If you're good at lip reading you'll see my patient answer "alright" at 2.30. (to my question " how do you feel?") The video is old and I now always wear gloves for fillers, and prefer a cannula, but I've left the video up as the video still shows the marking technique quite well. Best wishes. Ric
This technique is not very safe, as the needle tip could be placed inside the angular artery. Injection in this artery can result in serious complications; necrosis and even blindness. Waiting for a bruise is not a sensitive test. The fact that he injects very slowly limits the risks, but is still not recommended by current standards. It's safer to place the needle tip on the periostium (the bone), where there is an avascular space (of course after marking and avoiding the infraorbital foramen).
This is actually incorrect!! You are making her cheeks look less lifted and more droopy by this method. The first line you made was correct. Second line is made straight down from edge of eyebrow. That new intersection pt is where you want the MOST filler. It is the way to get the most lifted look, its the most ratio appealing look. The closer you get to nose the least you want to use. otherwise the filler drags and it might look ok but for older patints even younger, the best way is the line i explained, most doctors use this method. The intersection of the way i explained is the best way to get the lift look also highlight look. you want to use most filler there 0.2 maybe then a little above that pt 0.1 and then lower areas of cheek keep doing 0.1 (or however you want to split up)
First off-OUCH! Second, the comments here are much more informative than the actual procedure. Thanks to comments as I wanna get something done but fear of pain & mishap are stopping me. I also need to research as much as I can as I'm not a "Beverly Hills" woman. So once again, thanks comments!
Totally agree. This is now a very old video. We now know that fillers need to be treated with the same sterile technique as an implant. I could take the video down, but the principles of where to inject remain true.
I apologise for the late reply. There is almost no risk of nerve damage - compare any injection of filler to that of local anaesthetic. There is a risk of hitting a vessel and causing a bruise.
Indeed. This is an old video. You are quite right that there is now a recognised risk of infection. The recommended practice is now to treat filler as you would any other implant and disinfect with povidone iodine with full sterile technique. I may need to update the video!
Gloves get in the way of hand artistry. As long as everything is cleaned with alcohol gloves are not needed. Gloves aren’t Always sterile after traveling from a third world country yuck, your hands are cleaner than that.
This video made me cringe. The patient is very uncomfortable and the no glove thing is disgusting. Fingers and hands can carry mersa and many other things. We've known this for the last 100 years. Ugh
No Gloves,No Alcohol Sterilising and NO Local Pain cream!!!!! why put a Client through pain when there is no need unless he just doest like paying for it,like the gloves and wipes!!!!!, I wouldn't have him inject me for free!!!!
Hi Rebel. Totally agree about the gloves and skin prep. This is an old video. The local pain cream is less interesting as it isn't very effective. The other key difference is that we would now also use a cannula, rather than a needle as that is safer. I leave this video up despite these faults as it is still useful for the marking. Perhaps time to update! Best wishes. Ric
This isn't the Y Lift. The Y Lift is a trademarked procedure that is only performed by 1 doctor in New York. What he is showing here is someone getting fillers through injections.
![How NOT to inject the BRAIN! Dr Tim injects temples, cheeks & tear troughs [Aesthetics Mastery Show]](http://i.ytimg.com/vi/uFPNmbbk6xc/mqdefault.jpg)
![How NOT to inject the BRAIN! Dr Tim injects temples, cheeks & tear troughs [Aesthetics Mastery Show]](/img/tr.png)
What an absolutely amazing video, this is one of the best I have seen, showing where and how to do the cheek filler. Thankyou x
i am so confused why this video would have 100 dislikes. its actually one of the best technical explanations that exist on the topic!
George
Thanks for your kind comment - I think the main reason - and a fair reason - for the dislikes is that this video doesn't show the correct and required sterile technique. As you know, for all filler techniques it is essential to minimise infection risk and therefore the skin should be prepped and gloves worn. When fillers were first introduced (and this is a very old video) we treated them like botox and thought any infection would always respond to dissolving and antibiotics. We now know better! I've been tempted to take this video down, but also think it still has some relevance, and hopefully anyone actually injecting fillers will both see the comments and also know that sterile technique is required. Best wishes
Ric
He didn't numb the patient, didn't have gloves on , didn't cleanse the area, didn't aspirate back to make sure he wasn't in a major vessel. Horrible!
Because the world is filled with haters!
@@allaboutyouhomevisiting8092 👏👏👍
Totally agree! It's not a "fancy" video... ..no nonsense. It's a great one!
I find these comments very curious. This is a real video demonstrating how I teach others how to perform deep filler injection to the cheek. As explained in previous comments, the term Y lift is widely used in the UK to mean cheek filler. I'm not claiming to be anyone other than myself and this is quite clearly a real procedure. In the UK there are many surgeons doing many variations of this technique.
Ric Caesar
I think in this day and age ( even 12 years ago) ppl want to be bright and they are in their eyes. It's ridiculous that we çant even share a facial rejuvenation procedure without some know it all talking badly to a wonderful doctor doing what he does best❤️ thank you👏💕❤️
Injecting into an artery or vein carries great risk. You need to know your anatomy! The angular artery and vein are medial to this injection. If heading anywhere near any danger zone it is better still to use a cannula rather than a needle.
The cannula still needs the needle used first to pass through the dermis, so for this single point of injection I still tend to use the needle, and swap to the cannula if going further medially.
Why not use a numbing cream?
This is the correct technique in my opinion, I am just SO confused as there are so many different variations and techniques on cheek filler - that I just don't know what to do anymore as its quite misleading. However, this is by far the best video I have seen and resonates with what I have been taught.
She has wonderful face sculpt
@larauc
To be effective the deep filler needs to be between the skin and underlying cheek bone. You would still modify the location and quantity injected to suit each patient according to their facial structures.
How do you determine you have hit the bone level?
Very much so. If someone is considering tear trough filler, but has a flat cheek, I always advise filling the cheek first, as this will lift the lower tear trough in particular.
Is it!? More pain?? 😔😔
I've watched a lot of videos. I liked this video.
Thanks, very good video and useful
In the UK the term Y lift is used as shorthand for a non surgical midface lift with fillers. I'm not sure anyone in the UK is aware this phrase is trademarked. The procedure itself is performed by many cosmetic and aesthetic surgeons.
Great tutorial! Especially when you show, where rhe filler should be placed.
Great teaching video.
This is one of if not the best video on this technique and topic. You saved me sir. I am dealing with this not only with myself but another patient. I plan on copying your technique with either Voluma or RHA 3 or 4.
It depends on the filler used, with the thicker fillers, eg teosyal ultimate the effects can last up to 2 years. The thinner fillers are easier to shape and mould, but do not last quite as long. There is something of a trade off.
Excellent video!!!! Do you offer any online training??? I don't understand the nasty comments on here at all. This is how I was taught how to do cheek fillers and it is infact the only clear demonstrative video I have found on UA-cam.
Excellent...
Hi Ric, love your videos. How long and wide are the cannulas you would generally use? Would you ever recommend using beveled cannulas for any treatment?
Amazing , are you hitting the bone with the needle ?
I almost watched all your videos and as plastic trainee found very educational. I wish could I get the privilege to operate with you, to learn from you.
This technique is best.
Música
Para crianca
Good job i saw the results 👍
Your explanation in how to do it safely is so good and reassuring. I have been terrified to get filler done incase they hit a vessel and inject then end up with serious issues like tissue death or blindness. I am thinking maybe I could ask my nurse who wil do it to ensure she does what you did to make sure there was no blood before filling ad that should rule out any serious complicatiosn right?
Hi Dandelion, the risks of filler can be minimised by a thorough knowledge of the anatomy, good training, careful technique, and the use of a cannula rather than a needle. Even with all these in place there is still unfortunately a very small risk of infection and vascular occlusion, for which you would have to give your written consent. A context is always useful, and there is always a risk of serious complication each time you travel in a car! Choosing a good driver will always make sense.
Volumising the cheek is such an effective rejuvenation technique, that it remains very popular, and most patients can accept the very small risk. I wish you all the best.
Ric
Very good 👍
Thanks alot
I like Teosyal ultra deep and 27 G needle.
Teosyal ultimate and Sub Q recommend a 21 G but you can use a 23 G with a slow injection and strong thumb. Best Wishes. Ric.
Is aspirating more effective than cannula
Best of the best
Nice n precise
I have a question....so u said that if u draw the lines of both cheeks etc. and find the middle point where the Filler can be placed, would this also be true for one assymetric cheek?
Hi Doctor.what filler would you suggest for this area.? Thank you for you explanation
What are the risks? Would the consistancy of the filler block the blood flow, or would the blood thin it out? Because of what the filler is made of, would it be dangerous to travel through the body?Would a quick trip to the hospital be necessary? Depending on the vein or artery, could the damage be permanent? Which filler carries the greatest risks? Thank-you.
You said its a deep injection, Does deep mean subcutaneous layer, or is it deeper?
What if the filler was injected into an artery or vein anywhere on the face? If waiting for a bruise is not a sensitive test, what is?
How long does the cheek filling effect last, doctor ?
Good evening.I am seeking the best up to date treatment to erase the horrid(and ageing) creases that have formed both sides of my cheeks-the price of having natural dimples.There is no face cream to "soften" etc,make-up just doesn't work any more.This actually looks about the best option but it's a few years old has there been an improvement on the technique?and what is the cost now.
On the bone? Or in the middle layer?
خانم دکتر دستتون طلا
I assume you mean .2ml and .15 ml to other point. Do you use hydroxyapatite now? Is this OK near bone? Why not use lidocaine injected before as she does look in pain? Did read this can lower bruising?Never had an infection but I am a fan of minocycline prophylactic (very little resistance with this and anti inflammatory as well).
Dear Giselle
I'm not a fan of any of the permanent fillers. My perfect filler has to be reversible just in case it looks wrong post injection.
This is an old video, and needs updating but many of the principles are still there. The filler is best placed into the subcutaneous fat, but doesn't need to be as deep as the bone. All the recent fillers also contain lidocaine which helps with pain relief, but pre-injected lidocaine can distort the tissue plane I want the filler to occupy and make it more difficult to judge volume to inject, so I mostly avoid that. Using a cannula instead of a needle is now very popular and can reduce bruising, (A needle still makes the initial puncture through the skin). Interesting comment on prophylactic minocycline - I'm going to investigate that option. Very best wishes.
Ric
fuwm
They sometimes put lidocaine IN it.
отличная техника введения филлера
How many ccs are usually used?
hw many days it works
No pain
I did it las week
gonna do it soon allthow im verry young my cheeks are hallow
Ughh terrible! The result is worth the pain though :P. I got my lips filled last week and it hurted quite much. Is the cheeks worse? I got a nerve block in the lips and it still hurted lol.
M1981A any good results of fillers??
How deep would you say that is in cm?
Anyone who knocks this needs to know the psychological impact of looks on one's mental health and confidence.
And society and the dam media turning us all into soulless Barbies.
Maybe some people are more concerned with the slight but very possible risk of blindness or stroke from accidental injection into a blood vessel not everyone is going to risk blindness and stroke for temporary fuller cheeks
looks painful
Nice technic but... you forgot to wear gloves!
😂😂😂🙈
Plz can u tell me if there is a permanent way to full the cheeks generously?
aia angle
Dear Aia, there have been lots of attempts to find a safe permanent volumiser. They include using implants, your own body tissues or artificial tissues. They all have risks, not least that if you don't like the result, you will need surgery to remove the volume with associated risks of scarring etc etc. As we continue to age it is also necessary to adjust the position of volume to have best effect. Any permanent volume is just that. For these reasons I would recommend the reversible fillers. Best wishes
Ric
Thnx alot doc😊😊
She looks a bit terrified and in pain!
Yeah why dont just make her more comfortable numbing her first? 😳😳😳
Do we touch the bone ? Do we aspirate? Is the bruise the only indicator that we hit a vessel ? And Thank you so so much very informative video!!
ASPIRATE FOR SURE
Синяк не является показателем попадания в сосуд. Наоборот, бледность участка введения филлера. Наблюдать 10- 20 минут. И конечно аспирация!
Some drs say that aspiration doesn’t really work with the thicker G Prime fillers.
@@user-df2kw9wi7h как вам эта техника? Он же кости это делает?
How lond does cheek filling effect last???
Hi Fajar, typically 2 years. It depends on the filler used and the quantity. Best wishes. Ric
@@riccaesar thanks so kind reply😊
I gave you an A, for the step by step instructions which I felt you did a very good on, however, you should have use a local anesthesia because it appears that this woman was in a lot of pain
You said 1/5 ml in first injection site then 2.5mls then 1.5ml. I thought the first point has the highest amount of filler???
wow she looks like she is really in some serious pain
I've seen it work when you put a reasonable about filler in one area remove the injection and then molded his face when I had it done it didn't take any money as well and it didn't hurt not that im saying the method this gentleman uses is wrong I just prefer it much quicker and seeing her wings I would definitely want buy 10% lidocaine on my face lol
No aspiration?
how much you put in, you say 1ml syringe then put the rest of blah bla
Is it perminant.........
Plz ans....
Dear Nahirah - not permanent, but can last for some years with the more cross linked fillers. Eventually will need topping up. Ric
🤩
P.S. GLOVES!
🎉
did i hear him right that she is not numb yeah right
Abonniert!
Silent desperation is the English way, I hear. You can see it on this woman's face poor thing.
gloves dude
I agree. It's an old video. I now clean the skin and wear gloves.
Best wishes
Ric
God its lumpy what is he doing
Not one time did you ask your patient if she was doing okay which is very common in any medical practice with any procedure
Hi David - The voice over is recorded later. There is no original sound. If you're good at lip reading you'll see my patient answer "alright" at 2.30. (to my question " how do you feel?") The video is old and I now always wear gloves for fillers, and prefer a cannula, but I've left the video up as the video still shows the marking technique quite well. Best wishes.
Ric
@@riccaesar I apologize for trolling on you. I'm sure everything you do is professional in your practice. Thanks Ric!
Why didn't you let us see the finished result on both sides?
Hello sir
This technique is not very safe, as the needle tip could be placed inside the angular artery. Injection in this artery can result in serious complications; necrosis and even blindness. Waiting for a bruise is not a sensitive test. The fact that he injects very slowly limits the risks, but is still not recommended by current standards. It's safer to place the needle tip on the periostium (the bone), where there is an avascular space (of course after marking and avoiding the infraorbital foramen).
Anasthetic?
Where about are you please
This is actually incorrect!! You are making her cheeks look less lifted and more droopy by this method. The first line you made was correct. Second line is made straight down from edge of eyebrow. That new intersection pt is where you want the MOST filler. It is the way to get the most lifted look, its the most ratio appealing look. The closer you get to nose the least you want to use. otherwise the filler drags and it might look ok but for older patints even younger, the best way is the line i explained, most doctors use this method. The intersection of the way i explained is the best way to get the lift look also highlight look. you want to use most filler there 0.2 maybe then a little above that pt 0.1 and then lower areas of cheek keep doing 0.1 (or however you want to split up)
ua-cam.com/video/-pWugl6XQTI/v-deo.html 4:46 but whole video infomrative
First off-OUCH! Second, the comments here are much more informative than the actual procedure. Thanks to comments as I wanna get something done but fear of pain & mishap are stopping me. I also need to research as much as I can as I'm not a "Beverly Hills" woman. So once again, thanks comments!
Where are your gloves?!
Totally agree. This is now a very old video. We now know that fillers need to be treated with the same sterile technique as an implant. I could take the video down, but the principles of where to inject remain true.
She looks scared
I apologise for the late reply. There is almost no risk of nerve damage - compare any injection of filler to that of local anaesthetic. There is a risk of hitting a vessel and causing a bruise.
Ric Caesar
wow!
no gloves or disinfection...............
Indeed. This is an old video. You are quite right that there is now a recognised risk of infection. The recommended practice is now to treat filler as you would any other implant and disinfect with povidone iodine with full sterile technique.
I may need to update the video!
Patient is definitely in pain, why wasn’t she numbed? But, this is an old video, perhaps doc has changed his procedure😬
I think fillers in the past did not have any lidocaine mixed in. Now, all products automatically include anaesthetics.
That looked extremely painful, dr. didn’t wear gloves or ask her how she was feeling. 👎🏼
Isn’t this the danger zone area
o.0
she looked better before
you are to close to the nasolabial fold!
Step by step instructions so you can try this at home.
Aplying and touching all over without gloves 😵😷
Use guantes Dr que falta de profesionalismo
she should of just left it as it is there was nothing wrong with her cheeks now she has a bump on her cheeks
She looks like it's painful
Ugh no gloves yuck
Gloves get in the way of hand artistry. As long as everything is cleaned with alcohol gloves are not needed. Gloves aren’t Always sterile after traveling from a third world country yuck, your hands are cleaner than that.
This video made me cringe. The patient is very uncomfortable and the no glove thing is disgusting. Fingers and hands can carry mersa and many other things. We've known this for the last 100 years. Ugh
goodlife I'm sure he's washed them. Imbercile
Why is he explaining as if unqualified people are meant to know how to inject dermal fillers 😂.
Hi Tati
The target audience is oculoplastic surgical trainees. UA-cam doesn't filter access - which is a good thing.
Best wishes
Ric
Tati Lati my thoughts exactly lol 😂
incorrecy
incorrect
No Gloves,No Alcohol Sterilising and NO Local Pain cream!!!!! why put a Client through pain when there is no need unless he just doest like paying for it,like the gloves and wipes!!!!!, I wouldn't have him inject me for free!!!!
Hi Rebel. Totally agree about the gloves and skin prep. This is an old video. The local pain cream is less interesting as it isn't very effective. The other key difference is that we would now also use a cannula, rather than a needle as that is safer. I leave this video up despite these faults as it is still useful for the marking. Perhaps time to update! Best wishes. Ric
Horrrible
This isn't the Y Lift. The Y Lift is a trademarked procedure that is only performed by 1 doctor in New York. What he is showing here is someone getting fillers through injections.
Com,on, get a patient that has volume loss, This women only needs jowls lifting. Bad video not real results