Unveiling Ninja Techniques for Tear Trough Rejuvenation with Dr. Lonny Green

In this engaging episode of the “Anti-Aging Insights” podcast, Dr. Teri Fisher sits down with the renowned “Ninja Injector,” Dr. Lonny Green, to delve into the intricacies of tear trough rejuvenation. Originally aired as a live session with the Canadian Board of Aesthetic Medicine (CBAM), this conversation is packed with expert tips and insights. Dr. Green, celebrated for his unique approach and artistry in aesthetic medicine, shares his philosophy on achieving natural and harmonious results while navigating the challenges of treating the sensitive periorbital area.

Listeners will gain valuable knowledge about assessing candidates for tear trough fillers, understanding vital anatomical landmarks, and learning advanced techniques that minimize complications such as the Tyndall effect. Dr. Green emphasizes the importance of a holistic facial analysis rather than compartmentalized treatment to ensure patient satisfaction and safety. Whether you’re a fellow practitioner or someone interested in cosmetic medicine, this episode promises a wealth of information and a glimpse into the innovative practices at the forefront of aesthetic treatment.

Tune in to learn from two experts who passionately advocate for safe, effective, and aesthetic-driven cosmetic procedures. Plus, discover how to get involved in upcoming CBAM events, complete with a special discount code shared by Dr. Fisher for attendees. Don’t miss out on this insightful episode filled with nuggets of wisdom and practical advice for anyone interested in the art and science of non-surgical cosmetic enhancements.

Today’s Guest

Dr. Lonny Green

Dr. Lonny Green is Medical Director and an aesthetic injector at Rêvée. He received his Bachelor’s of Science from Stanford University, his Medical Degree from UCLA and his Master’s of Business Administration from the University of Saint Thomas. Dr. Green did two years of general surgery training and then completed the Harvard Program in Urology. He spent two decades as a urologic surgeon, until a chance circumstance exposed him to the field of aesthetics. A fire was lit in his soul, he left the operating room in 2020, and has never looked back.

Dr. Green is very passionate about aesthetics, and envisions a world where everyone wakes up confident in their own skin. he and his team at Rêvée Aesthetics strive each and every day to achieve this. He is all about creating a look that is complete, harmonious and natural, and treats areas of the face as a whole rather than simply addressing single deficits. Dr. Green is also passionate about training and views himself as a lifelong learner.

Dr. Green lives in Richmond, VA with his wife, six children, and two goofy dogs.

Episode Summary

In this enlightening episode of the “Anti-Aging Insights” podcast, Dr. Teri Fisher invites the esteemed Dr. Lonny Green, known as the Ninja Injector, to delve into the complex world of tear trough rejuvenation. This session, initially broadcasted as an Instagram Live event with the Canadian Board of Aesthetic Medicine (CBAM), offers invaluable insights for both practitioners and clients seeking aesthetic eye treatments.

Dr. Green, Medical Director and Aesthetic Injector at Revee, brings a wealth of expertise, transitioning from urology to aesthetics with impressive credentials from Stanford, UCLA, and Harvard. His journey from surgery to aesthetics is as compelling as his unique brand, inspired by a patient’s playful remark and solidified through Instagram fame.

The discussion navigates the intricacies of treating the delicate tear trough area. Dr. Green emphasizes a holistic approach, advocating for enhancing surrounding facial areas rather than directly targeting the tear trough, which aligns with his philosophy of achieving a harmonious and natural look. This method often reduces the need for direct intervention in the tear trough, minimizing risks and maximizing results. He also shares critical insights into assessing candidates for treatment, highlighting the importance of evaluating skin laxity and fat herniation, and always considering the client’s overall facial structure.

Crucial advice is offered on technique, advocating for the combination of needle and cannula use depending on the specific area treated. Dr. Green discusses his preference for blending fillers to reduce complications like the Tyndall effect, and advises on filler selection based on skin type and desired outcomes.

For enthusiasts looking to further their knowledge and skills, Dr. Green will be speaking at the upcoming CBAM Congress in Vancouver, where attendees can anticipate further learning opportunities. Listeners are encouraged to register using the discount code DRFISHER-CBAM for a significant registration saving.

This episode not only provides technical guidance but also underscores the importance of professional integrity and client safety in cosmetic procedures. Whether you’re a seasoned injector or new to aesthetics, Dr. Green’s “ninja” tactics offer fresh perspectives on achieving and maintaining youthful looks safely and effectively.

Key Insights

• Dr. Lonny Green, known as the Ninja Injector, discussed his unique approach to tear trough rejuvenation, emphasizing a holistic and minimalistic technique to achieve natural aesthetics.
• Dr. Green highlighted the importance of evaluating the surrounding facial areas before treating the tear trough to reduce the amount of filler needed and enhance overall facial harmony.
• The conversation included discussions on using cannulas over needles for specific areas of the face, reducing trauma, and minimizing complications like the Tyndall effect and edema.
• Dr. Green shared insights on patient evaluation, stressing the significance of understanding patient concerns, assessing skin laxity, and identifying candidatesensitiveto tear trough treatments.
• The episode provided information on the upcoming CBAM Congress 2025, where Dr. Green will be presenting, and shared a discount code for registration.

Episode Transcript

Dr. Teri Fisher: Have you been wondering about how you can best rejuvenate the tear trough area, you know, that tricky area right underneath the eyes? Well, if that’s the case, this podcast is for you.

I am thrilled to be able to share this recording with Dr. Lonny Green, the Ninja Injector. This is actually something that we did recently as an Instagram Live with CBAM, the Canadian Board of Aesthetic Medicine. If you don’t know, the CBAM Congress, the Canadian Aesthetic Congress, 2025 is taking place February 28th to March 2nd. There’s going to be a ton of great speakers, including some demonstrations and even some hands on workshops if you want to participate in those. And Dr. Green is one of those people that is going to be talking all about the tear trough rejuvenation. And so it is absolutely my pleasure to be able to share this recording with you.

Just a little bit about the Ninja Injector. He is the Medical Director and an Aesthetic Injector at Revee. He has a ton of credentials, including a Bachelor of Science from Stanford University, his Medical Degree from UCLA, his Master’s of Business Administration from the University of Saint Thomas. He did two years of general surgery training and then completed a urology program at Harvard Medical School. He spent two years as a urologist and then some circumstances exposed him to the field of aesthetics. A fire was lit in his soul. He left the operating room in 2020, and he never looked back. He is passionate about creating a look in his patients that is complete, harmonious, and natural. He loves teaching and you can see that from this conversation that I have with him.

So, if you want to get a discount code as well for the Congress that will be happening, stay tuned. I’ll share that with you at the end of the episode. But for now, let’s get to this conversation with the Ninja Injector, Dr. Lonny Green.

Welcome to this CBAM Instagram live. We are here with Dr. Lonny Green. Great to have you here. Maybe I can ask you just to start off by introducing yourself a little bit to, to the audience, and you also have to tell us how you came up with the name Ninja Injector as well as part of that.

Dr. Lonny Green: Absolutely. Well, listen, uh, first I just want to thank CBAM and I want to thank you for hosting and CBAM for having me. It’s, it’s really an honor. I’m humbled. I’ve already met some of the other faculty through Instagram and I’m already making great friends friends. Uh, and the concept of the way CVAM does this with didactic and then cadaver and ultrasound injecting. It’s amazing. What a great way to learn. It’s concentrated. I can’t tell you enough how, how wonderful that is. So thank you for, for doing it that way. I appreciate it. Um, uh, what can I tell you?

Look, uh, I had a career in urologic surgery for many years. Um, through a crazy turn of events, I did a little injecting. During COVID, I was wearing a mask that was pulling on my ears. I had a prior otoplasty, that hurt. I got a black surgeon’s cap. It was too heavy. I got something lighter. A patient came in and literally, if you look at my Instagram, it says, at Dr. Lonny Green, but she said, you look like a ninja injector. And the next time, the next time she visited, she had made a shirt. Her and her husband made me a shirt that said, Ninja Injector. I said, that’s it. I’m going to lean into that. And the rest is history. It’s fun. I have a great time. And one bonus, Teri, I got to tell you, I really recommend if anyone’s trying to choose an Instagram handle, pick something that already has an emoji. It’s like easy. You get to brand yourself.

Dr. Teri Fisher: That is amazing because I have noticed you have got some amazing branding now all around this ninja persona, which is incredible. I love it. I love it. So not only do people get to learn from you, but they maybe they can learn some ninja skills from you as well. Who knows?

Dr. Lonny Green: I have looked a lot into Ninja, you know, International Ninja Day is December 5th. I know a lot about Ninjas now.

Dr. Teri Fisher: Amazing, amazing. Alright, well let’s get into the topic here at hand, this whole periorbital and tear trough rejuvenation topic. And maybe we can just start off with what’s your approach? What’s kind of your, your overarching high altitude, your 50, 000 foot view approach to tear troughs and periorbital rejuvenation?

Dr. Lonny Green: Sure, that’s a great question, Teri. I think, I have to say, I’m a big fan of Zen philosophy, and I would say two things about that. First thing is, when is a tear trough not a tear trough?

And the second thing is, the best way in my hands to treat a tear trough is by not treating the tear trough. Now, let me explain. So what people use as a term tear trough is often misunderstood and patients come in with dark circles or pigment and things. So the first thing is really assess whether, you know, a trough is a depression.

Does the patient have a trough? And the second thing is if you approach this area, which is extremely delicate with the mindset, you want to do as little as possible, I have found that by building up everything around the tear trough and saving the tear trough for the last, definitely reduces the amount you have to do.

And so my approach is In general, I do fillers lateral to medial and superior to inferior. But when it comes to the tear trough specifically, if there’s lateral work to do, I’ll do it, but instead of starting superior, I actually start here, make sure everything around it, and I can tell you, I don’t have discrete measurements, but generally, the actual trough decreases by at least 30 percent when everything around it is supported.

So that’s my biggest, high altitude view of this.

Dr. Teri Fisher: Right. Just to follow up on that, so do you find that there is sometimes that people will come in thinking they need their tear troughs done, you do the areas around the tear trough, and all of a sudden they’re like, Hey, I don’t know if I need this anymore. Does that happen often to you?

Dr. Lonny Green: Well, yeah, I could tell you that it’s what, what definitely happens in my experience is someone who actually has a trough, and you do all the areas around it, I would say I almost always put something in there because at the minimum, I’ll put a glaze of a superficial one to try and hide the darkness, but definitely the amount that you would, if you just did their tear trough, you would use far more than if you explain to the patient.

And I don’t do, I don’t do one single area. I will not fill one line, I just won’t, and my patients know that, and I tell them. And so most of my patients buy into that idea that it’s, you know, it’s unnatural to fill one area and leave everything else looking like garbage, in my opinion.

Dr. Teri Fisher: Yeah, yeah, and I know that’s one of the big things that you’re really passionate about, is making sure that you’re not just treating one specific area, but the whole face and that facial balancing and all that sort of stuff.

Yeah, yeah, yeah. No, perfect. So, so when you do have a patient come in, what do you go through? How do you determine if they are actually a good candidate for that tear trough filler?

Dr. Lonny Green: Sure. Well, uh, I never want to not say the basics of, you know, spending the first couple of minutes just getting to know the patient and getting a feel for them.

Uh, but, uh, really, I love just understanding what they see. And, you know, sometimes you really have to say, look, don’t give me any terms. I want to know how you feel, what you see. And then, then we can kind of look at the areas together. And so, are they more concerned because it’s dark? Are they more concerned because there’s a bulge there?

Are they more concerned because they look tired? Is the tired feeling partly because the temples are also sunken in? You know, so really understanding where they’re coming from and what they see through their eyes. That’s crucial. Uh, that’s really the big thing. And then once, you know, I can go into the details, whether it’s more pigment, is it more an actual trough? Is it more of a fat herniation above? Um, what, what’s going on? That’s the biggest first thing that you have to really, in your mind, be really clear to yourself.

Dr. Teri Fisher: Do you have any particular tricks or does this really just come from the years of experience that you have in terms of how do you start to tease out which of those things are actually the problem?

Dr. Lonny Green: Well, I think that being systematic in your approach to a face, I can’t emphasize that enough. So it’s very tempting to either get hypnotized by the patient, fill my line, fill my line, fill my line, or you are so anxious and eager to please them that you forget to step back. So I may not do, depending on time, I may not, talk to them about the full face, but I never look at a face now, I mean, even if I go to the grocery store, I see a face, top third, middle, third, bottom third. I can’t help it. But you have to give yourself a second and assess the top third alone, middle third, bottom third. And then you won’t miss the temples. You won’t miss the forehead. You won’t miss the A frame deformity if you segment in your mind.

You could do it in 60 seconds. So that’s really important. Once you’ve done that, you can see, again, by looking not at the tear trough, but looking around it and, and you shape your focus into does the lateral cheek need some enhancement? Could it use moving the light reflex up just a millimeter?

What about the medial fat pad? What, what about the, um, the rim where the cheek meets the lid? What about those things before you even look at the tear trough?

Dr. Teri Fisher: Right. Okay. Really, really well said. All right, moving on. You’re starting to evaluate a patient. You’ve determined that this may be a patient for tear trough treatments, but what are the red flags that you’re looking for when you’re evaluating a patient?

Dr. Lonny Green: Yeah, and this is also important, Teri. I appreciate you asking that. You want to assess the skin, okay? The envelope is really important, and if there is a tremendous amount of laxity in that under eye skin, it’s not, they’re not a great candidate. So you can do a test, a snap test, where you pull the skin back and then you pinch it, a pinch test, and then you let go and see how long it takes to settle.

Without them blinking, how long it takes to, to shape back. Um, you can also pull the lid down and see how long it takes to get back up. And those things are pretty critical. You know, you have a 32 year old who has decent skin, you’re not going to usually find a problem there, but in the middle ranges you have to really assess that. So skin laxity.

Number two, is there a significant fat herniation? And you know, the orbital septum and I, and I, you know, can’t encourage, I go back and study this anatomy all the time. This is complicated stuff here. So the orbital septum is sort of this retaining wall, but it, like the rest of our body, weakens as we age.

And as that weakens, you can get a herniation of fat and if that is significant, and, you know, if you think about it, if that is so high that you’re going to try and meet that underneath with filler, then what’s underneath the filler is going to look weird. So if they have a really significant fat pad, I just say, look, you know, I, I’m not telling you to have surgery, but filler is not the answer, um, is that, um, you know, I, I just think that it’s just not in my hands. It wouldn’t be the right thing to do.

The other thing is, I didn’t mention this, I’ll make sure I don’t forget it. Is to get a history of whether they swell easily or not. You know, every time they have a salty meal, do they swell? Mm. Every time there’s a least bit of pollen, do they swell?

Do they already have edema? Just randomly? Because I gotta tell you, it’s much easier to stay outta trouble than get get outta trouble. Mm-hmm . And if your patient has a lot of periorbital swelling, very easily, they may beg you, they may really want it, but you really have to put on your, your big person pants and say, look, I’m just being honest with you.

And you know that they can go down the street and get it done, but that’s not, your, your, your oath is to do no harm. Forget about anyone else. It’s what you are going to do. They’re putting their trust in your hands, and if you don’t think it’s right, they’re You can’t do it.

Dr. Teri Fisher: 100%. I think integrity is so important, particularly in this industry. You can get caught up in all kinds of things that, yeah, and where you’re not doing it for the right reasons.

I appreciate what you said. Absolutely. A hundred percent. Um, you mentioned a little bit about the anatomy, but I wonder if you can just touch on that a little bit more. Are there other specific landmarks that you need to be aware of when you’re looking at treating this area?

Dr. Lonny Green: I think you certainly need to know the entire anatomy, but you really need to remember a couple of things. You know, as the, uh, angular artery ascends, it can do some interesting things and it can indeed live right in that high medial area of the tear trough. And so that is a pretty decent sized artery. And as we all know, this is a highway right to the orbit, right? And it’s also a highway to the connection between the internal carotid and the external carotid.

So, you know, blindness and stroke, we worry about that. Well, you have to be aware of that as you go higher and higher and more medial on the tear trough, there are tigers in there. So you have to keep that in mind. You have to be aware of where the infraorbital notch is and, and so where the Infraorbital Foramen is and where that artery and and nerves come out.

Because if you’re gonna build up the area below it, you have to be well aware of where that comes out. And you also have to be aware of when you go medial to the Infraorbital Foramen, what technique, are you going to go there, which I think it’s important most of the time to go there, what technique, what, what tool you’re going to use, what are you going to be thinking every time you put filler in there?

And so that’s a really key anatomy, and of course, just basics, the infraorbital rim and understanding that above the rim, on the rim itself, really no major vessels, not, not none, but in general, a bit safer than some of the tiger country. So, and then lastly is just the boundaries of the medial SOOF. You need to sort of study that and understand the boundaries of the medial SOOF, uh, because that’s an important component of support underneath.

Dr. Teri Fisher: Yeah. So, you may have already answered this next question, but I was wondering, you know, it’s generally considered less safe the higher up you go into the tear trough, and I’m assuming that it speaks to what you were just describing.

Dr. Lonny Green: It does. It doesn’t mean you can’t approach that area. It just means that, you know, when you, you know, you’re thinking about a lot of things in the back of your mind, but you know, you just need to be aware of what could be there, what statistically might be there more frequently, and how gingerly you want to approach it.

And I generally, again, we’ll, we’ll spend time and I’m, I don’t know how much you want to get into this, but I am a big fan of building up the piriform, even if it’s not clinically apparent that they could use piriform, I find that putting volume in the piriform and then in the medial fat pad, again, you really would be amazed at how much less you have a tear trough at that point, and you’re talking about a relatively safer area, but much safer in terms of not getting tindled, because this, the part of the tear trough that’s so troubling for us is, I don’t know if you, you know, you do cadaver dissection, that’s paper thin, you can almost read through that stuff.

And so you’re setting yourself up for a problem putting filler, when the skin is so thin, it’s just, the less you can put in there, the better.

Dr. Teri Fisher: Right, right. Okay, makes sense. So, let’s talk a little about the techniques then, because there’s, you can use a needle, you can use a cannula, um, what do you do and, and why? What’s your, what’s your thinking, your reasoning behind that?

Dr. Lonny Green: Yeah, I guess the answer is yes. So, um, you know, I, I think you have to be, it is a good injector you need all the tools. Okay. And furthermore, I would encourage, you know, I, I had some great surgical mentors and I can’t tell you how many times I got my hands wrapped because I wasn’t using my left hand.

If you can train yourself to use your left hand, well, at first you should always be using your non dominant hand always. But if you can actually inject with your non dominant hand. As you go to both sides, you’ll be ahead of the game. Technique wise, I like cannula, I like filler for different areas. And I think that it is a little bit of a misnomer to categorically say cannulas are safer.

I think that you can get into some serious trouble with cannulas, especially if you’re not aware of being parallel to arteries and stuff, but I will say I think they are less traumatic in general. And and so as if I’m medial to the infraorbital notch, uh, foramen, okay, if I’m medial to that, I am definitely going almost always with cannula, okay?

And the key with that is to go with cannula and you need to get into the deep fat pad here. Now here’s a little ninja tip I will tell you. That, that sucker hurts. If you’re deep in the medial fat pad. So if you wanna be kind, if you put like maybe 0.2 ccs of 2% lidocaine just at the infraorbital notch before you ever start, you can use a very small, a very small needle. You can pinch the skin up to the needle. They barely feel it. They’ll feel this lidocaine going in, but put a little bicarb so it doesn’t sting, and then when you go medial with that cannula, instead of them passing out and getting all vagal, most of the time there’s no response at all.

So I know it’s a tough area. It’s a dangerous area, but I highly encourage almost everyone could use a little support there and that’s what I’m talking about right here where you’re supporting the basement and suddenly there’s less trough.

Dr. Teri Fisher: So that’s really great. How can you minimize the risks of complications and things like tyndall effect, and of course the the VO stuff. And for maybe people that don’t know what tyndall effect is, maybe you can define that as well for the audience.

Dr. Lonny Green: Sure, tyndall effect is a physics phenomenon, um, and it’s why the ocean and the sky are blue, and it’s a refraction of light.

So to minimize the tyndall effect, you, what you want to do is use the smallest amount of filler you can. Uh, generally use a light filler, and we haven’t talked yet about type of filler, but I got it. I’m right here. I’m going to raise my hand. I’m a blender. I blend filler. Okay, and I will, uh, I will give the filler a little drink of water as my mentor, Dr. Swift says, and hydrate that before I put it in. And nowhere do I think is, is that more important than in the tear trough. So I’m using a very, very light, uh, low G prime filler, and I’m actually blending it, um, one to one with, um, you know, saline or lidocaine. And so this stuff will drip out like water. And you could say, well, what kind of effect?

Well, let me tell you. It gets a great effect and you have no idea how long this stuff lasts up there. It’s crazy. So, that will minimize your chance of Tyndall, not using too much filler and, uh, really paying attention to your depth.

Dr. Teri Fisher: Great, and that, that leads in very nicely into the next question.

So, so the type of filler you’ve described, low, low G prime, you’re, you’re diluting it, you’re mixing it with something. Um, I don’t know if you want to share specific fillers or not, or if that’s kind of where you want to leave it as far as the type of filler that you use.

Dr. Lonny Green: Yeah, just, just don’t use the D word with me. Never say dilute to a patient. You blend it. Blend it. You blend it.

Dr. Teri Fisher: Very good point. Very good point.

Dr. Lonny Green: If you use the word dilute, they think they’re getting cheated.

Dr. Teri Fisher: Uh, it’s a good point. You blend it. Yeah. Yeah. Excellent point.

Dr. Lonny Green: And so, um, you know, I, I will have an array of stuff out in front of me and I don’t do filler by syringes. That’s a whole nother topic, but you know, in the 20 years I did, 20 plus years I did surgery, nobody said, Dr. Green, I want you to do my surgery. How much do you charge per stitch? It’s ridiculous. You know, I went in and I created what I needed to create. So I don’t do it by syringe. So I have the, whatever filler I want to use, I have in front of me.

Out here, if they need to, they often do need to get their light reflex up a little bit. I use a very heavy, high G prime filler. In the medial cheek, I’ll use a medium G prime. Here, I’m using a low G prime that’s blended. So I generally use Volbella in the tear trough. I will use Voluma out here laterally, and I’ll often use either Voluma blended or Ultra Plus or sometimes Velour, depends on the patient’s skin.

But in the tear trough, for me, um, Volbella blended 1 to 1 is my go to. If they happen to have really thick skin, I might blend it 1 to 3. And this is where the art comes. Look, some of this is science, some of this is art, and some of it is just ninja. You know? It’s divine. What can I tell you?

Dr. Teri Fisher: I love it. Um, we do have a couple questions.

Um, just basically a question of how much filler are you typically using? What’s your volumes? What are you talking about?

Dr. Lonny Green: My patients will sometimes ask me how much filler you’re going to use. And I always look at them honestly, and I look deep in their eyes. I say the right amount. So, uh, just take that home. You’re going to use the right amount. So I got to tell you, I don’t even care if you do do filler by syringe or you don’t. Never leave unless you’re happy. If it costs you out of your pocket a little more, do it.

I don’t care if you have to break open another syringe for 0. 1 cc’s, because that patient is going to tell their friends and family and everyone else, and more importantly, you go home fulfilled knowing you did the right thing. So never, ever be limited by your filler. If you feel in your heart, this is not my best work, then I don’t care if you have to pay for it, just do it. So that’s number one.

Number two, in the actual tear trough, I would estimate of a blended one to one product, I probably use in a sometimes 0. 3 cc. So that’s 0. 3 cc of a one to one blend. So in actuality I’m using 0. 15 of filler blended. Once in a while I might use 0. 4. I never use more than that, and I never do it to 100 completion.

I’ll do it so it’s about 80, 85%, maybe 90% with a blend, but never all the way, because even with a blended light product, it’s going to absorb a little water. So, um, but I will use whatever it takes in the medial cheek. I’ll use, uh, often 0.3 ccs in the piriform. Sometimes more if it’s deep. I will use whatever the lateral cheek needs, but I want to support everything, and we didn’t talk about another area that I find a lot of injectors miss, where the cheek meets the lid.

There are different names for this. I call it the cheek lid junction, but if there is a step off there, and you do not correct that, You are not going to have a complete result. You’re just not, I tend to do it with a very small BD syringe directly. You want to put this, the needle in under this, the tear under the orbital rim, because this skin is too thin, bring it up, go down on the orbital rim.

You’re still going to aspirate, but that is, little tiny aliquots. It’s a safer, there’s no safe zone, but if you don’t do that, you’re, you’re missing out on an opportunity to go from a good result to a holy smokes result.

Dr. Teri Fisher: So that’s a really good tip. Another Ninja tip there from the, from the Ninja. There we go. You’ve got it. You need like a book, ninjas tips or something and just like, anyway, that’s not, that’s another business venture. We’ll talk about that some other time.

Um, so a couple of questions we have here are with regards to, you know, complications or things that could go wrong. So I think that we can kind of group those together. And that was sort of where I wanted to start to wrap things up here a little bit with you as well. So one question was, you know, what are the consequences if things are not followed correctly? I guess what are the potential complications? And then somebody else asked, um, you know, when, when, when blending, does it make it more prone to causing edema and that sort of thing? So maybe you can just sort of address complications in general.

Dr. Lonny Green: So blending actually makes it less prone to edema because hyaluronic acid can absorb many times its weight in water. If you blend it ahead of time, you’re giving it a drink of water. It’s pre hydrated. So you have much more control over what it’s gonna do in the body. Think about it. You know, these fillers don’t act in a vacuum. You’re putting it in the body. But if you, if you hydrate a little bit, you, you have already an an idea of what it’s gonna do. It draws in less water with blended. Um, the other question was…

Dr. Teri Fisher: yeah, like what are the potential consequences if you don’t heed your advice and these ninja tips?

Dr. Lonny Green: So obviously, um, you know blindness and stroke are are the things we really worry about when anywhere in the face, but certainly working up here, very high danger area. So you need to be always, I mean the only time I’m never thinking about that is probably when I’m unconscious.

I think about it all the time. So if you’re injecting always think about it might happen, it might happen. What am I doing to minimize the risk? So, then you get into the issue of, um, the patient looking weird. You don’t want your patients to look weird, so make sure you’ve done the area in a natural, harmonious way.

And then you get into the issue of make sure everything’s great, they love you, and three months later, you get that text that they woke up and their eye has swollen. Or one side has swollen. Knock on wood, I I don’t wanna jinx myself. But I can’t remember the last time it happened now that I’ve gone to what I’m telling you.

And I’m not saying it can’t happen in my hands. It has happened in my hands. But since I’ve gone to this approach with the blended product, using less and everything, it’s, and I screen my patients, it’s pretty rare. If it does happen, okay, then you walk them off the cliff, tell them it’s okay. It’s probably, you know, going to be okay with time.

But I often will find out if they had seasonal allergies, are they sick? Is this an immune response? Sometimes there’s no precipitating factor and if they’re really worried and you don’t want to wait, you can put them on a medrol dose pack in my experience. But, um, again, you, so those are the things, I mean, that’s not the worst thing, but that’s the more common thing than a vascular occlusion.

Dr. Teri Fisher: Right. Well, this is great. I’ll finish up with one last question. We’re just coming up on time here and then we’ll wrap things up here. And that’s just, I think it’s important to think about is when you’re talking with your client, with your patient, how are you setting realistic expectations for tear trough treatments?

Dr. Lonny Green: Sure. Uh, I think that’s just absolutely critical. I, I tell them, first of all, if they’re not a candidate, that’s a realistic thing for me. If they are a candidate, I will tell them that, you know, with each, this stuff lasts a long time. With each subsequent treatment, it tends to get harder to get that wow result.

I’m honest with them because even though you usually can get a good result, they continue to age, everything continues to change. And I really warn them ahead of time. I try to really educate them on the concept of a trough and I will show them because I have patients that come back two years later and they say, I need some more tear trough filler. There’s no trough there. They’ve just got more darkness and more pigment.

So I think that you just have to be very realistic with your patients and say, I’m going to do the best I can. This is your anatomy. And I will, my priority is safety and natural. I’m worried about your aesthetic third. I’m sorry. It’s just that’s that’s me. And if you want to come to me, that’s the way I do it. And um, but I want you to be safe and I want you to look natural.

Dr. Teri Fisher: Perfect. Wonderful. That’s a great way to finish off here. Um Thank you so much.

Dr. Lonny Green: I want to give a shout out for you for your podcast, you know people should know that you have a great podcast and uh, it’s awesome. I highly encourage that and uh, I also encourage everyone who possibly can attend because I’m telling you this is a spectacular way to learn. This is a first rate organization that puts value first. They’re not interested in doing this just to do it. It’s value for injectors. And you’re in a beautiful place with, with everyone I’ve encountered is such good people. They’re in this for the right reasons, so I highly recommend you consider going if you possibly can.

Dr. Teri Fisher: Absolutely, 100%. So let me just recap that for everybody. So CBAM, Canadian Board of Aesthetic Medicine, the first Congress, not, not ever in Canada, but in Vancouver. I’m really excited about because I’m here in Vancouver. Canadian Aesthetics Congress, Vancouver 2025, February 28th to March 2nd at the Fairmont Hotel Vancouver. It is going to be a great, great educational, uh, program. Master workshops with live demos. Hands on masterclasses, that is, that is, um, an optional, uh, part for those that want to get involved, but with that, you actually get a free Congress ticket.

We’ve got live virtual stations, and I mentioned there’s even a social part, a ski tour transportation involved. Um, so thank you to CBAM. I can also say that I personally went through the CBAM certified program and had an amazing time. And, um, so I can give you first hand experience of being educated by the folks at CBAM, which is just fantastic.

Um, I want to give a shout out to you as well, Dr. Green. Thank you so much. You are a wealth of knowledge. This has been a real treat for me. In addition to, I’m sure, all the listeners and all the viewers. I’ve learned a ton just speaking with you here today. And, uh, I look forward to seeing you in Vancouver and learning more from you there.

Everybody should be following you at Ninja Injector. If you haven’t, click on his name. Also, click on the CBAM Congress, uh, link, uh, handle. Follow, uh, follow these two, uh, handles because, uh, it’s great. And I just got a question. What’s the name of my podcast? Anti Aging Insights.

Dr. Lonny Green: Yeah, and I highly recommend the podcast. And if anyone is interested, I just started a YouTube channel. Uh, where we got some educational videos. I know it’s going to shock you, but the name of it is at Ninja Injector. So, um, check that out as well.

Dr. Teri Fisher: Amazing. Amazing. Well, thank you all of you finally, the viewers here, thank you for sharing some of your time. Happy New Year. Happy New Year. Um, you have lots of things that you could be doing with your time, uh, early in this, in this new year. And, um, you’ve chosen to spend it with, with us, with CBAM, with Dr. Green and myself. Thank you so much again. Um, and we look forward to seeing you very soon in Vancouver.

Dr. Lonny Green: Yes. Thank you for your time. I really appreciate it. Take care everybody. Bye guys.

Dr. Teri Fisher: Well, there you go. An incredible episode with Dr. Green. A ton of ninja tips dropped in that interview. It was such a pleasure to be able to meet with him and chat with him about periorbital and tear trough rejuvenation. As you can see, wealth of knowledge and he will be at the CBAM Congress.

As promised, I have a discount code for you. It is DRFISHER-CBAM, D R F I S H E R – C B A M. If you use that at your checkout when you’re registering for the Congress, you get $375 off of the registration for the Congress, so I encourage you to check that out. Once again, thank you to you, the listener for tuning in. Thank you to Dr. Green, the Ninja Injector, for spending some of his time and thank you to CBAM for making this possible.

It’s a pleasure to be able to bring these episodes and these interviews to you. And I look forward to seeing you all in Vancouver at the CBAM Congress here February 28th to March 2nd. Until next time, be well, and I’ll talk to you again really soon.