Cosmetic Injector Dos and Don’ts: What I Would Do to My Own Face

Interview with Amber Lewis, Owner & Lead Aesthetician / Cosmetic Injector / Surgical Assistant / Medical Assistant

When it comes to cosmetic injectables, what you put in your face matters—but who is putting it there matters just as much. As a cosmetic injector and someone who personally uses aesthetic treatments, I look at everything through the lens of anatomy, aging, and long-term results. Your face is going to change. Your bone structure changes, muscles change, fat pads shift, and lymphatics matter. What looks good today still needs to make sense five or ten years from now.

Here are some of my biggest dos and don’ts when it comes to fillers, lip injections, Botox and other cosmetic treatments.

Let’s start with fillers.

When it comes to fillers, I think it's important to remember the integrity of the face, starting with the bone structure, muscle structure and lymphatics. As we age, all of those things are changing. Every decade our face looks different because what's underneath is changing—bone, muscle, fat and everything supporting the face.

Where your cheeks are today isn't necessarily where they're going to be years from now. If I put a permanent filler in a particular position today, that filler is still going to be there as my face changes around it. Then I may end up chasing a filler pattern I created a decade ago because the filler is sitting where my anatomy used to be rather than where it is now.

That's why I'm a huge proponent of temporary, biocompatible fillers that break down with the body as you age. They allow us to adjust as your face changes and work with the dynamic movement of your muscles and changes in your underlying bone structure.

There are products made with things like ground plastics, ground sutures and calcium phosphates. There are a lot of different products and different names for them.

I personally like to use hyaluronic acid because it's biocompatible and breaks down naturally. I think you have to ask: How old are you? How long do you anticipate using fillers? Are you considering a facelift eventually?

I don't think other fillers are necessarily bad. There's a time and a place for them. I'm just a huge proponent of using something I can dissolve if I need to, build upon or adjust as my face ages and changes.

Look for fillers that use hyaluronic acid. There are different brands and formulations designed for specific areas of the face.

It's also important to understand that filler isn't just filler.

Fillers are made with different molecules, strengths, structures and G-primes. A hyaluronic acid filler designed for the cheeks is going to behave differently from one designed for the lips. A cheek filler can age beautifully when it's placed in the cheek because it's made for that position. You wouldn't necessarily want to use that same filler in your lips.

That's why I don't look at filler as one product that we use everywhere on the face. Different fillers belong in different places, and you also have to think about things like lymphatics and how that product is going to behave in the tissue over time.

What about Sculptra? Is that a product you use and/or you recommend?

I wouldn't say I'm not a fan of Sculptra. I would say not everybody is a candidate for it.

When you inject Sculptra, you're stimulating the body to create collagen in that area. So one of my questions is: Are you planning to have a facelift in five years? Is creating additional tissue in that area the right option for you?

There are different things we need to consider during the consultation. It's not that one product is universally good or bad. It's whether that particular product makes sense for your face, your age and where you're headed.

So are temporary or semi-permanent fillers generally the way to go once you're over 40?

I wouldn't make that a blanket rule because everybody's needs are different. That's where having a provider who can really assess you becomes important.

Have you already had a facelift? Have you had an upper blepharoplasty? Are you looking for volume correction in your temples? Are you trying to correct a scar in your cheek? There are all kinds of reasons we use fillers.

There are even what people are calling “skin injections” now that use hyaluronic acid. There's a time and place for everything.

Just because your girlfriend got Sculptra doesn't mean Sculptra is necessarily the best thing for you. What was she treating? Has she already had a facelift? Is she looking for correction in her skin? What has she done compared with what you've done? Everybody's filler needs are a little different.

Talk a little bit about the importance of choosing the right cosmetic injector and having a consultation

Absolutely. Different products aren't inherently horrible; they're just different. That's why the consultation matters. We need to figure out what's best for you and where you are in your beauty journey.

If you're looking for immediate correction, Sculptra may not be what you're looking for. A hyaluronic acid filler may make more sense. If you're looking for something to hold you over until you're ready for a facelift, again, hyaluronic acid filler may make sense.

If you're in your 60s or 70s, you've already had a facelift, you know exactly what you want and you're comfortable with something longer-lasting, maybe another product makes sense. But if you come in in your 20s wanting extensive facial correction with something very long-lasting, I'm going to think very carefully about how that's going to age with you.

Let's talk about lip filler - yes, no and who should consider it?

Lips are definitely a hot topic, and people are very opinionated about them. But lips come in all shapes, sizes and structures, with different muscle dynamics. Again, it comes down to what you're actually trying to accomplish.

Personally, I like a more natural lip look for my clients. I think maintaining the integrity of the vermilion border—the border that lines the lips—is really important.

I also look at muscle movement. Do you have an overactive muscle that pulls your lips? Do you have a scar in your lips? What's your anatomy doing?

If you bring me a picture of somebody else's lips and their anatomy is completely different from yours, trying to recreate their lips on your face probably isn't going to serve you well. Your muscle structure around your mouth is different from theirs.

If someone has a very flat lip without much of a Cupid's bow and a really tight muscle, and we try to put two syringes of filler into that top lip, that filler has nowhere to go. You can compromise the border that keeps the lips healthy and taut, and the filler can migrate outside of where we want it.

I actually have a scar that runs through my own top lip line and has created an abnormal shape in my lips. If I tried to force filler into that scar, it would just move somewhere else because the scar can't be filled normally. As a cosmetic injector, you have to recognize what someone's anatomy is—and what that anatomy is actually capable of.

Can lip filler permanently change someone's lips?

Especially with younger clients, I'm cautious when someone comes in with beautiful, healthy tissue and a healthy vermilion border but wants to stretch the lips and create volume that just doesn't naturally exist for them. I don't think that's going to age well.

There's a lot of discussion about whether you can put a large amount of filler into your lips and they'll simply bounce back afterward. The answer is yes and no. We can create structural changes. We can change the vermilion border enough that it begins to lose its authentic shape. There are a lot of ways we can alter the structure of the lips.

The good thing about hyaluronic acid filler is that it can be dissolved. But I'm personally not a huge fan of going significantly larger than someone's natural anatomy.

If you naturally have really thin lips, I'm going to try to respect that anatomy because I care about the integrity and health of your lips. If you naturally have very full lips and you've lost volume with age, then we have plenty of room to play. I can restore and hydrate those lips because we're working with your natural anatomy rather than trying to create anatomy that was never there.

How much does the skill of the cosmetic injector matter with lip filler?

It matters tremendously. Part of being a good injector is also being able to say, “No, it's not time for more filler yet. It still looks good.”

Sometimes a little Botox lip flip may be enough. A little lip flip can go a long way.

Choosing your provider is important because what's right for your face today may not be what's right for your face ten years from now. You want somebody who is thinking about that journey rather than simply adding more product every time you come in.

What are some dos and don'ts for Botox and other facial injectables?

There are different muscles we can treat, and again, it starts with the consultation. What are you trying to accomplish, and how do we maintain the health and integrity of the muscle while doing it?

I don't necessarily want complete atrophy. I like a little bit of movement. If you're starting very young and completely eliminating movement in the forehead year after year, you can cause some atrophy in that muscle. We want to maintain healthy muscle integrity rather than simply flatlining every muscle in the face.

Age matters. Your goals matter. Are you trying to reduce lines and wrinkles that are already there? Are you doing preventative treatment because you don't want those lines and wrinkles to become established? Are we trying to address scarring?

Botox can also help with things beyond muscle movement, including pores, skin condition and skin quality. There are a lot of things Botox can do besides completely eliminating facial movement.

Bonus round: As someone in your 40s who is both a cosmetic injector and a client, what's something you absolutely would not do to your own face?

It's not necessarily something I wouldn't put in my face—it's something I wouldn't do to it.

I wouldn't use extremely high-temperature radiofrequency treatments over facial fat pads that are integral to the shape of my face. I don't want to shrink those fat pads because they're part of what's holding my face up.

For me, the potential benefit doesn't outweigh the possible long-term consequences of damaging or shrinking fat I actually want to keep.

Now, if I wanted to use a little radiofrequency under my chin where I don't necessarily want that fat pad, that's a different conversation. But the fat pads in my face are like liquid gold. I want to keep those for as long as possible.

Radiofrequency microneedling at incredibly high temperatures can potentially be very damaging to natural facial fat pads. I'm not against DIY treatments either—I love a good DIY. Just make sure it's the right one. You don't want the thing you're doing to make yourself look better today to create a bigger problem for your face tomorrow.

Choosing a Cosmetic Injector Is About More Than the Injection

A good cosmetic injector isn't just looking at the wrinkle, lip or cheek you're concerned about today. I'm looking at your anatomy, your muscles, your bone structure, your skin, your age and what you're likely to want five or ten years from now.

Sometimes the answer is filler. Sometimes it's Botox. Sometimes it's a different treatment altogether—and sometimes the right answer is that you don't need anything yet.

That's why I believe the consultation is such an important part of cosmetic injectables. The goal isn't simply to add product. It's to choose treatments that respect your natural anatomy and continue to look good as your face changes over time.

Top 5 Cosmetic Injector Tips

1. Choose an injector who understands how your face will age—not just how it looks today.

2. Favor biocompatible, adjustable fillers like hyaluronic acid when appropriate.

3. Respect your natural anatomy—especially when it comes to lip filler.

4. More isn’t always better. A good cosmetic injector should be willing to tell you “not yet” or “no.”

5. Think long-term. Today’s filler, Botox or skin treatment should support—not compromise your face five or ten years from now.

Have questions? Book a complimentary consultation with Amber now.