In short. Slow results are the easiest to over-read, especially by the person paying for them. Photographs, one change at a time, and comparing months rather than weeks.
Key points
- Two photographs a fortnight apart will mostly show the light and how tired you were.
- Two photographs two months apart show what the course is doing.
- The reason patients conclude early that nothing is happening is almost always that they are comparing the wrong two images, often a photograph from the day of the session with one taken a week later.
A slow change is the easiest kind to over-read, and the person paying for it is the least able to judge it. It is how a gradual result works, and it is why the assessment of a course depends on something other than how the face looks on the day.
Photographs, taken properly
The camera is the only instrument that does not have an opinion. Standardised photographs, taken before the first session and repeated at the same time of day in the same light and at the same distance, are what a change is measured against. They should be front on and in profile, because contour is read from the side and a front view can hide a change entirely.
Compare months, not weeks
Two photographs a fortnight apart will mostly show the light and how tired you were. Two photographs two months apart show what the course is doing. The reason patients conclude early that nothing is happening is almost always that they are comparing the wrong two images, often a photograph from the day of the session with one taken a week later.
Change one thing at a time
Where two treatments are running in the same area, or where a resurfacing treatment or a stimulating material has been added partway through a course, nothing that follows can be attributed to either. That is the reason a course of this class is allowed to declare itself before anything else is added to the same area. A plan that changes two things at once does not test either of them.
The bias that runs towards improvement
Someone who has paid for a course and attended several visits has a reason to see a change, and the mirror is a generous instrument. This is where a patient is most likely to report an improvement that cannot be photographed, and where a clinician who agrees unquestioningly adds to a result that was already adequate. That is the commonest regret in this class.
The bias that runs the other way
The opposite error is more common in the first two months. A patient who expects a visible change within weeks and finds none concludes that the treatment has not worked, and asks for more at the point where more cannot be reconsidered. The measurement that answers both errors is the photograph taken before anything was placed.
These distort the judgement
- A comparison between a photograph taken today and a face remembered from a year ago.
- Two things changed in the same area, so that neither of them can be attributed.
- An early conclusion acted on, rather than an early conclusion written down and reviewed.
What the ceiling is, and why it is agreed before the first session, is set out in The Ceiling Comes First in a Class You Cannot Dissolve. What should be recorded at each visit so that the judgement has something to rest on is covered in Why Records Matter More in a Non-Dissolvable Class.
Frequently asked questions
How should I take the photographs?
The same way each time: the same room, the same light, the same distance, the same expression, front on and in profile, at the same time of day. A set taken at the start and repeated every month is the only comparison that can be trusted. A set taken at different hours in different rooms shows the light changing and very little else.
I am sure the area looks different. Why can I not see it in a photograph?
Because a change that is read in movement, or in the way light falls across a contour, often does not survive a flat image. That does not make your impression wrong, and it does not make it evidence either. Where the impression and the photographs disagree, the assessment is where the question is settled, and the photographs are what it will be settled against.
Is it a bad sign that nothing has changed at two months?
Not on its own. The change from this class is usually judged over months, and a course that has run one session has not had the chance to accumulate. What would be a bad sign is concluding at two months that more is needed and adding it, because that is a decision taken before the class has shown anything.
Risks & Limitations
- There is no dissolving agent for this class. Injected collagen is absorbed over months but cannot be neutralised or removed by an injection, so a result you want less of is addressed later, in part, and by other means.
- Lumps and nodules can appear weeks or months after a session. The timing is part of how they are assessed, and the answer is not another injection to dissolve the material, because for this class no such injection exists.
- The change is gradual and it is not lasting. The material is absorbed at a rate that varies between people, no interval can be promised in advance, and a course repeated across years accumulates in a class that cannot be reversed.
- Injection carries the ordinary risks of any injectable, including bleeding, bruising, infection and irregularity, and the rare vascular event that belongs to material placed into the face. A history of cold sores can be reactivated by treatment in the same area.
When to Seek Care
- Severe pain out of proportion to the injection, or tissue turning white, grey, mottled or dusky, requires immediate assessment.
- Any change in vision, including blurring or a patch of lost sight, requires emergency care.
- A lump, firmness or a change in contour appearing months after a session should be reported when it appears, not at the next scheduled appointment.
- Redness, heat, pain or discharge at a treated site, or fever with any of those, needs prompt assessment.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.