A. Well, I cannot give you a specific answer to this question since I have not seen you and done a proper evaluation, so I will answer in general terms that might help you and others. First, your concerns are justified. There is a lot of chatter on the internet about this technique. It is also a top topic at meetings like my Cosmetic Boot Camp. This area should be injected conservatively, using a thinner, less viscous hyaluronic acid filler to reduce the risk of lumping and persistent swelling. While either a needle or cannula can be used, the injections should be deep to prevent see-through the skin of the HA. I like to stage the procedure over 2-3 visits, since it is easier and safer to add than to subtract. Make sure the dermatologist knows how to reverse it if is lumpy. Be prepared for bruising and do stop vitamin E, aspirin, ibuprofen, and any fish oil that is in the ethyl ester form (the triglyceride form is OK). Choose an experienced injector. A good way to know is to ask to see their before and after results. I like to tell patients I try for a base hit rather than a home run. I never want to strike out and not give great results. Good luck.
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