Some things people bring to a med spa need a doctor rather than a treatment room. Some things people bring to a med spa are not aesthetic problems and need a doctor rather than a treatment room. See a physician or a dermatologist, not us, if you have a mole or a mark that has changed shape, colour or size, or that bleeds, itches or will not heal; a sore anywhere that has been there more than three weeks; a rash you cannot explain; a patch of skin that is newly numb, hard or ulcerated; sudden hair loss in patches, or hair loss alongside fatigue or weight change; or swelling, heat and spreading redness that could be an infection. And if you have had filler treatment anywhere and the area becomes white or mottled, severely painful, or your vision changes, that is an emergency — telephone us immediately if we treated you, and go to an emergency room if you cannot reach somebody within minutes. We would far rather you rang a doctor and never rang us at all.
Most modern fillers are a gel form of a sugar molecule your body already makes and already breaks down. It is placed under the skin in small amounts through a fine needle or a blunt cannula, and it does two things at once: it occupies space, and it draws a little water to itself. The result is visible as you leave, settles over two weeks, and is gradually broken down over the following six to eighteen months depending on the product and where it was placed.
The useful way to think about the face is that volume is lost from underneath before the skin creases on top. A fold running from the nose to the corner of the mouth is very often not a problem with that fold at all — it is the cheek above it having descended. Filling the fold directly makes a heavy face heavier; supporting the cheek lifts the fold and looks like nothing was done. Getting that judgement right is the entire skill, and it is why the consultation looks at your whole face rather than at the line you pointed to.
It is also the treatment where things go wrong most seriously, and we would rather you read that here than in a consent form. Filler placed into or against a blood vessel can block it, which threatens the skin it supplies and, in the worst and rarest cases, vision. It is uncommon, it is recognisable, and it is treatable if it is recognised quickly — which is why every client of ours leaves knowing exactly what to look for and with a number that is answered out of hours.
Where it works, and where we would rather not
Four areas, in descending order of how comfortable we are treating them.
Cheeks and mid-face
The safest and most useful area, and usually the one that changes the face most for the least product. Supporting the cheek lifts the folds beneath it, opens the eye area slightly and removes the flatness that reads as tiredness. This is where we start with most people, including many who arrived asking for something else entirely.
Jawline and chin
Definition rather than volume. A chin that is slightly short makes a jawline look soft and a nose look larger, and a modest amount of product placed on the bone changes a profile more than most people expect. Well suited to men, who tend to want structure rather than softness and are systematically under-served by this industry.
Nose-to-mouth folds and the corners of the mouth
Effective, and the area where over-filling is most obvious. Treated directly and enthusiastically it produces the heavy flattened look everybody recognises, so we treat these folds indirectly wherever possible by supporting the cheek above them, and we place very little in the fold itself.
The nose, and anything near it
We do not perform non-surgical nose treatment here. It is the highest-risk area on the face for a blocked vessel, the consequences include skin loss and vision, and while experienced injectors do perform it safely, we have taken the position that the risk-to-benefit ratio does not justify offering it. If that is what you want, we will say so honestly rather than talk you into something else.
The complication you should be able to recognise
Uncommon, serious, treatable if caught. Every client here leaves able to describe it, which is not true at every clinic.
What it is
Filler entering or compressing an artery blocks the blood supply to the skin that artery feeds. Because some facial arteries connect backwards toward the eye, in very rare cases it can affect vision. This is the reason filler is a medical treatment and not a beauty treatment, and the reason it should never be performed by somebody who cannot manage it.
What it feels and looks like
Pain that is severe and out of proportion, and that gets worse rather than better; skin that goes white and then mottled, dusky or blue-grey; and, in the rarest cases, any change in vision. Ordinary swelling and ordinary bruising are neither of these things. If you are unsure, that is what the telephone number is for.
What we do about it
We hold the enzyme that dissolves this class of filler on site, on every treatment day, and it is administered immediately rather than after a referral. Time matters enormously here — the difference between hours and a day is the difference between a full recovery and a scar. Nobody is ever charged for the management of a complication we caused.
How likely it is
Rare. Studies of large numbers of treatments put serious vascular events in the region of a few per ten thousand syringes, and lower still in areas away from the nose. Rare is not never, which is why it is written here rather than buried, and why we will not treat the highest-risk area at all.
Getting the amount right
The commonest disappointment with filler is not that it did too little. It is that somebody had too much, one syringe at a time, over three years.
One or two syringes, then stop and look
We treat conservatively and review at two weeks. Filler draws water to itself and continues to settle for a fortnight, so a face judged on the day is a face judged before the treatment has finished happening. Adding at two weeks is easy; removing at two weeks is a second procedure.
Beware the annual top-up habit
Some fillers last considerably longer than the marketing suggests, so topping up on a schedule rather than on an assessment quietly accumulates product. We assess what is still there before adding anything, and we will tell you when the honest answer is that you do not need any this year.
It can be removed
Sugar-gel fillers can be dissolved with an injected enzyme, usually within a day or two. That is a genuine safety net and one of the reasons we use this class of product. It is not a licence to be careless — dissolving is itself a procedure with its own swelling and its own small risks — but it does mean a result you dislike is not permanent.
We will say no
To anybody wanting a result their face cannot carry, to anybody bringing a photograph of a different person's face, and to anybody whose description of what they dislike about themselves suggests the problem is not one an injection solves. That conversation is part of the consultation and it is not a sales tactic in reverse — it is the job.
Dermal Fillers in western Queens
A gel placed under the skin to restore volume or change a contour. It works immediately and lasts months to years. It is also the treatment in this building with the smallest margin for error.
Every treatment here starts the same way: a full hour at a table in a room with no treatment couch in it, a proper medical history, your skin looked at in daylight, and then a plain statement of what we think would achieve what you described. You are told what it costs, how many sessions it usually takes, how long it lasts, what the recovery looks like and what can go wrong — on paper, to take home and read somewhere other than a treatment room. If the honest answer is a different treatment, or nothing, or a dermatologist, that is what you get instead, and it costs exactly the same.
Aesthetic treatment is elective medicine, and this page is not medical advice for you. Aesthetic treatment is elective, it is medicine wherever it breaks the skin, and nothing on this website is medical advice for you in particular. We do not diagnose disease. Every treatment here begins with a consultation and a medical history, because your health, your medication, your skin type and what you have had done before all change what is safe and what is sensible. Some people are told no. Being told no is a normal outcome of a consultation here rather than a failure of one, and it costs exactly the same as being told yes.
No before-and-after photographs, and no promised outcome. There are no before-and-after photographs on this website and there never will be. Every set you have seen somewhere else was chosen from a much larger pile, and the second picture is usually taken in different light, at a different angle, at a different time of day, often with makeup and frequently after retouching. Even an entirely honest pair shows you what happened to somebody else's face. What we publish instead is what a treatment typically changes, by roughly how much, how long it lasts, how many sessions it usually takes and how often people are disappointed. We do not guarantee an outcome, we cannot, and anybody who does is either guessing or selling.
The risks, plainly. Every treatment on this site has side effects and some carry real risks. The common ones are minor and short-lived — redness, swelling, tenderness, bruising, a day or two of looking like you have had something done. The uncommon ones matter more: burns, blistering and long-lasting pigment change from light-based treatment, which is a greater risk on deeper skin tones and on recently tanned skin; infection anywhere the skin is broken; and lumps, asymmetry and, very rarely, a blocked blood vessel from injectable filler, which is the one true emergency in this field. We screen for what makes each of these more likely, we tell you your own risk rather than the average one, and we decline to treat when the answer should be no.
What a med spa does not treat. We treat the appearance of healthy skin, hair and body. We do not diagnose or treat disease. If you bring us a mole, a changing mark, an unexplained rash, a sore that will not heal, skin that has become hard or numb, psoriasis, eczema, an autoimmune skin condition, or hair loss that came on suddenly or in patches, what you will get is the name of a doctor rather than a treatment plan. Aesthetic treatment applied on top of an undiagnosed skin problem can mask it, delay the diagnosis and occasionally make it worse. We would rather lose the booking.
Questions
Dermal Fillers — the questions we are asked most
How long does filler last?
Between six and eighteen months in most places, and longer in areas that move very little, such as the chin and along the bone of the cheek. It does not stop abruptly: it is broken down gradually, so the result fades rather than falls off. Anybody quoting you a single number for all fillers in all areas is simplifying to the point of being wrong.
Will it make me look like I have had work done?
Not if the amount and the placement are right, and that is the whole job. What people recognise as obvious work is nearly always volume in the wrong plane or too much of it in one area — filled folds, over-projected cheeks, a heavy upper lip. Treating conservatively, supporting structure rather than chasing lines, and reviewing at two weeks is how a result stays unremarkable.
Is it permanent?
No, and we do not offer any filler that is. Permanent fillers exist, they are not reversible, and a result you dislike or that migrates over a decade cannot be undone without surgery. Every product used here can be dissolved, which is a safety feature that matters more than longevity does.
Can filler be dissolved if I do not like it?
Yes, in the case of the sugar-gel fillers we use. An injected enzyme breaks the product down, usually within a day or two, and the area returns to how it was. It is a procedure in its own right with its own swelling and its own small risks, so it is not something to be casual about, but it does mean nothing you have done here is a one-way decision.
What is the recovery like?
Swelling for two to five days that is worse on the second morning, tenderness, and bruising in perhaps a third of treatments — more with lips, more if you take anything that thins the blood. Most people go back to work the next day and would rather not have a photograph taken for a week. Do not book this within a fortnight of an event that matters.
Do you do non-surgical nose reshaping?
No. We have taken the position that we will not, because the nose is the highest-risk site on the face for a blocked vessel and the consequences include skin loss and, very rarely, vision. Skilled injectors do perform it safely and we are not saying otherwise; we are saying that for this practice the balance of risk and cosmetic benefit does not justify offering it.
Related
Often seen alongside this
Injectables & Facial Balancing
Wrinkle-Relaxing Injections
A small amount of a purified protein placed in a specific muscle so it stops pulling as hard. It softens the lines that appear when you move. It does very little to the lines that are there when your face is still.
Read more
Injectables & Facial Balancing
Lip Enhancement
Filler placed in the lip to restore what has thinned, improve a shape or balance an asymmetry. Done well it is unremarkable. Done to excess it is the most recognisable treatment in aesthetics.
Read more
Injectables & Facial Balancing
Under-Eye Treatment
The hollow under the eye is the most technically demanding area on the face and the one most often treated badly. Half the people who ask for it here are advised against it, and the reasons are on this page.
Read moreA written plan and a written price before anything is booked
Book a consultation
Pick a clinician and an hour from the calendar — it shows only the times each of them genuinely has free. A consultation is a full hour at a table with no treatment couch in the room, and it costs $85, or $120 with the medical director. If you go ahead, that comes off your first treatment. If we tell you the answer is nothing, or a dermatologist, it costs exactly the same.