Filler 101 with Dr. Lexi Riopelle
In this week’s feature on The Amaranthine Collective, I’m thrilled to introduce Dr. Lexi Riopelle, a Mohs surgery fellow at UCLA and an expert in skin anatomy and facial aesthetics. As the demand for injectable treatments like dermal fillers continues to rise, so does the importance of understanding the anatomy and risks involved. Dr. Riopelle brings her knowledge of facial structure, filler complications, and emerging trends to our conversation, offering valuable insights for anyone interested in injectables, whether as a patient or a practitioner.
What areas of the face would you consider high-risk for filler injections, and why?
I would be careful with all areas of the face. Nothing should be taken lightly.
The textbook answer, though, would be the dorsal nose, glabella, and nasolabial folds. These are considered the highest risk because we have anastomoses in these areas, which means they feed really important vessels. When anastomoses are compromised in any of these areas, there is a risk of blindness. From a smaller scale, there is also a risk of malar edema, which is something I’ve seen quite frequently in my practice and is commonly neglected as a side effect. In addition to these three danger zones, the temple is an area that should make people nervous because of the high risk of necrosis due to vasculature.
Essentially, all areas of the face should be treated with utmost caution, especially the middle third.
What techniques do you use to avoid complications when considering the “danger zones” for fillers?
First and foremost, please see a medical doctor for any type of filler procedure—I recommend seeking out a board-certified dermatologist or plastic surgeon.
Secondly, you can talk to your physician about potentially using a cannula. I recently read a statistic that the likelihood of vascular occlusion with filler via cannula is 1 in 40,000 versus 1 in 6,000 with filler via traditional needle.
Thirdly, while this is more controversial, aspiration can be implemented.
I can’t stress enough about my first point, though. The person injecting filler must have a very thorough understanding of tissue planes and vessel anatomy, which you can only really grasp with an actual medical degree.
What are the warning signs of vascular occlusion or other filler-related severe complications?
Pain and pallor are the two most important things to remember. Call your provider STAT and/or go directly to the emergency room if either occurs!
Are there any newer trends in facial filler that you like? Any that you don’t like?
I’ve noticed recently that more people are moving towards ‘natural’ results. Los Angeles cosmetic consumers used to live by the motto “Go big or go home.” However, there has been a big push, especially in the plastic surgery community, away from filler and more towards subtle results. This has translated into more patient interest in things like non-surgical rhinoplasties. This is done with filler, and while I don’t have much experience with it, I’m interested to see how long this trend lasts. Injecting filler into the nose makes many derms nervous, including myself- see above!- so I'm not sure how much I’ll do this in my practice.
Another thing I’ve noticed is that more people have been paying attention to their hands and necks. People often forget that their faces aren’t the only thing aging! If you’re aiming for a more youthful facial appearance, you’ll want to make sure your hands and neck get some love, too, because they are aging just as fast.
In terms of trends that I don’t like, tear-trough filler. It looks puffy, and I think the results are often far inferior to what the patient hopes to achieve.
Dr. Lexi Riopelle, UCLA Mohs Fellow