Joker Face

You’ve seen this face – it’s everywhere. There’s something muzzle-like about the nose and mouth. The lips are taut and bulbous, and a little wonky when she smiles. In extreme cases, the cheeks sit like ping pong balls under spongy skin, eyes peering out of puffy sockets.

The “pillow face”, our current answer to the 1990s wind-tunnel look, is down to dermal fillers. These semi-permanent gels are injected into the lips, cheeks and the lines between the nose and the mouth in a bid for youthful plumpness. Trouble is, the result is often not eternal youth, but a face like a water-retentive lion.

As ever, it started in red-carpet land. Not a week goes by without some unfortunate celebrity having her “joker face” held up for ridicule. Marie Helvin is the tabloids’ reigning Bride of Wildenstein, but LaToya Jackson, Gwyneth Paltrow and Sarah Harding have all prompted snide comments recently, and Carla Bruni, Madonna and Kylie are regular targets.

These cautionary tales don’t deter us, though. Since its launch 15 years ago, the world’s leading filler, Restylane, has been used for more than 11m treatments worldwide. The Harley Medical Group reports a 100% increase in inquiries about dermal fillers since 2008, and a 14% rise in injections of fillers since May 2010. They don’t come cheap, ranging from £200 to £350 per session, but nor are they prohibitively expensive. A glance at The Only Way Is Essex reveals the trout pout is alive and well, and not only among fiftysomethings who lunch.

Getting to the bottom of why fillers often look fake is tricky. Who is to blame: product, practitioner or patient? Marie Duckett is a member of The Restylane Faculty, created to promote best practice in injectables. “No matter which product is used, it is only the person injecting who can create a ‘pillow face’,” she argues. “It is not fair to blame the product — it is the amount injected and where that gives a distorted result.”

Dr Kate Goldie is a director at Medics Direct, one of Britain’s largest training companies in cosmetic surgery. “Facial rejuvenation does not require a large amount of a filler for subtle, natural results,” she says. “So less experienced practitioners may overinject, giving a puffy effect. We also see that people easily become enchanted with the quick results from fillers, and begin asking for excessive amounts in unnecessary places. Making sure you communicate exactly how you want to look is crucial. Taking along a picture of yourself taken 5 to 10 years ago can also be helpful. Filler treatment is an art, and some practitioners just have a better eye than others.”

Dr Véronique Simon, a leading French cosmetic surgeon and pioneer of new subtle techniques, points the finger at fillers themselves. “Fillers can’t address the slackening of the lower face that comes with age. As a result, there is a trend for overfilling the high part of the face — cheekbones, temples, lines from the nose to the lip — but it gives an odd, round look, as you see with Carla Bruni, for example. Often, a filler that is too thick is used in the lips, which looks ridiculous. No man would want to kiss that.”

Another easy scapegoat is celebrity culture. The leading cosmetic surgeon Michael Prager believes that ordinary women look at famous ones to gauge what is acceptable — despite the fact that, if filler is visible, it has manifestly failed. He claims that most celebrities are “visibly overdone” because surgeons will rarely turn away such clients.

It doesn’t help that the celebrity images we’re shown are often further distorted. Although she admits to having subtle fillers, Meg Mathews told Style how she was shocked by her own lips in recent photos for Hello! magazine: “In those pictures, the make-up and lip pencil really exaggerated my lips. At the time, it looked nice, but everything comes out different on camera. I’ve had fillers for 15 years in my lips, but I only have half a syringe — most people have a whole one in the top and the bottom lips. I see Frances at the Jan Stanek clinic — she can tell you my lips don’t really look the way they did in that shoot. It was a one-off, but people can’t see that. My mum hated those pictures.”

The lips are notoriously problematic — partly because a squiffy result distorts the whole face and also because the plumping process highlights any natural asymmetry. Dr Mike Comins, chairman of the British Association of Cosmetic Doctors, confirms: “If you are unhappy with the shape of your lips, then a filler will only enhance this negative. An experienced doctor will be able to see this ahead of treatment.”

The bottom line is that it’s all about the right doctor. Easier said than found, when any beauty therapist, or even vet, can take a half-day course in injecting fillers, and when fillers (unlike Botox) require no prescription. The good news is that this hitherto unregulated industry is cleaning up its act. Last month, the Independent Healthcare Advisory Services (IHAS) launched a new, patient-focused Register of Injectable Cosmetic Providers, to weed out the experts from the needle-wielding nobodies. Practitioners will be background screened and assessed before being added to the register, and you can now find a reliable practitioner at www.treatmentsyoucantrust.co.uk.

Such regulation is long overdue, not only for safety, but because hasty treatment can have huge emotional repercussions. Sarah Harding confessed in a recent interview: “I got a bit experimental and decided to have some filler. That was a big mistake. It didn’t work for me. It was a very distressing time.” Sally Taber, director at the IHAS, confirms: “I’ve had people sobbing on the phone after going to a cowboy doctor. There are a lot of misconceptions about fillers. The thicker ones can hang around for 2-3 years. That’s a long time for anybody to walk around feeling ashamed of themselves, particularly if they were appearance-focused in the first place.”

The broadcaster Nikki Bedi, 44, has had filler in different parts of her face, with mixed physical and emotional results. “I first had my lips injected, but the upper one was overdone — my husband called me Daffy and I had to really ham up my facial expressions to avoid knowing looks from friends. I also had filler in my nasal labial folds and, although I was happy with the results, I became paranoid that in certain lights I could see the filler. Interestingly, I’ve not asked for them again. I think that’s because I’m more happy and secure about my worth today. I don’t hyperfocus on the negatives of ageing quite so much.”

Of course, the safest (and sanest) option is to leave injectibles well alone. The consultant dermatologist Amrit Darvay sums up the medical establishment’s attitude to messing with nature: “Performed by trained experts, fillers can give impressive results. However, the procedure does have risks. Another option is to grow old gracefully. Avoiding smoking and excessive sunlight would help, too.” All very well. But Véronique Simon’s verdict will probably resonate more with the average woman: “Things have changed. You can’t just be a grandmamma making pasta and getting old any more. Sorry.”

What’s the alternative?

Antislackening mesotherapy
Dr Véronique Simon recommends mesotherapy — multiple pinprick facial injections — that are claimed to rejuvenate the skin. She favours injections of tricalcic phosphate, a substance used in orthopaedics, because it stimulates the production of joint-strengthening neocollagen. It can also firm up the face, neck and eye area.

Dracula therapy
This creepily named procedure employs micro-injections of the patient’s own blood platelets to promote cell repair. The result is plumper, glowing skin, with none of the lumps and bumps associated with fillers.

The old-fashioned facelift
Having fallen out of favour when fillers took off some years ago, the facelift is having a revival. It tackles the droopy jawline fillers can’t, and, if done well, can be very effective. Careful, though. One woman recently sued for £6m after a botched job.

Radiesse
One step ahead of hyaluronic acid-based products, Radiesse is a dermal filler that simultaneously prompts the body’s own collagen production. It lasts longer, and has a more lifting effect on saggy skin than fillers alone. It’s recommended for the sides of your chin — the charmingly named “prejowl sulcus”.

Source: The Sunday Times