Injectable fillers are used today to restore a natural, youthful appearance to the face and other areas which appear older due to the loss of volume associated with the aging process. Fillers may be used to help correct age-related volume loss in the temples, around the eyebrows, under the eye, in the cheeks, along the jawline, in the lips, chin, hands, and other areas. Injectable fillers continue to be used to treat fine lines and wrinkles as well. Due to the improvement in available materials and a better understanding of the changes that occur in our faces as we age, injectable fillers produce a more natural and effective rejuvenation than had ever previously been possible.
Types of Injectable Fillers
- Hyaluronic Acid: Over the past several years, products made from hyaluronic acid, a naturally occurring molecule that is a normal component of skin, have become available in an injectable form. The hyaluronic acid products have a natural look and feel, and may be used to create a youthful, rejuvenated appearance to the entire face. Hyaluronic acid products all have a gel-type consistency and exert their effects immediately. A wide range of hyaluronic acid products is available in the United States; each of these products has unique qualities and characteristics. Therefore, it is common to use a combination of hyaluronic acid fillers during a treatment session if different parts of the face are being treated. Another advantage of hyaluronic acid fillers is that, if desired, they may be readily dissolved by injection of a product that quickly removes the filler.
- Sculptra: Sculptra is another injectable product that is FDA approved for use in facial rejuvenation. In contrast to HA fillers, Sculptra exerts its revolumizing effect by stimulation production of collagen by our bodies, a process that requires up to 8 weeks to have its full effect. Sculptra is an excellent product to add structure and volume to the cheeks, along the jawline, in the temples, and in the hands.
- Radiesse: Radiesse is a synthetic product that may be used for volume enhancement in the face and hands. It adds structural support to the face and is the only product FDA approved for rejuvenation of aging hands.
- Bellafill: Bellafill is the only FDA approved permanent filler. Biesman uses Bellafill for the treatment of some depressed scars including acne scars.
Who Benefits from Injectable Fillers
As we age, the soft tissue distribution throughout our face changes—and anyone who experiences this could benefit from injectable fillers. Signs of this include:
- Hollowness beneath the eyes (especially the portion nearest the nose)
- Hollowness of the temples
- Sagging of the eyebrows
- Deflation and descent of the “apple” of the cheeks
- Loss of definition of the jawline
- Heavy lines between the nose and upper lip (nasolabial folds)
- Loss of fullness in the outer part of the cheeks
- Thinning of the lips
- Vertical ‘smokers’” lines on the upper and lower lips (even in people who have never smoked!)
- Loss of projection of the chin
- Downward turning of the corners of the mouth
- Loss of volume of the earlobes
- Changes in the shape or symmetry of the nose due to trauma, surgery, natural down-turning of the tip, flatness of the bridge, and others
A somewhat under-recognized truth is that fullness, as opposed to “tightness,” is perhaps the most important hallmark of youth. Careful study of aging faces reveals both “deflation” of tissues that had once been more full and downward shifting or sagging of facial fat pads. Correction of these changes gives us a more youthful appearance in a very natural, unaltered way. Volume restoration is thus a cornerstone of facial rejuvenation.
The Most Important Factor in Facial Rejuvenation
Soft tissue volume correction is the least appreciated but possibly the single most important factor in facial rejuvenation. Often I hear patients say something to the effect of “I don’t want all those injections, I will just have surgery”. Such statements are flawed, as surgery and soft tissue volume correction accomplish entirely different objectives. Surgery is used to remove extra tissue or to re-suspend tissues that have fallen. Low eyebrows, heavy eyelids, large jowls and fullness in the neck all require surgical repair. In contrast, surgery does not restore the age-related volume loss seen in the temples, cheeks, central part of our face or around the mouth. Performing surgery in patients who primarily look older due to volume change can result in an exaggerated, hollow or “windswept” appearance.
- Soft tissue volume loss is one of the most important signs of aging
- Soft tissue fillers are used to enhance or replace volume that was never present or was lost with aging
- If administered properly, fillers should produce a natural, refreshed look and should not be readily apparent to even a careful observer
- Restylane, (including Restylane, Restylane Lyft, and Restylane Silk) Juvederm, Voluma, and Belotero are all HA fillers and are the most commonly used products for treating facial wrinkles and lines, enhancing lips, filling in dark circles under the eyes, enhancing the cheeks, chin and contouring the jawline
- Sculptra is used to fill in hollow cheeks and temples. It may also be used in some other areas but is not used like the HA fillers (Restylane, Restylane Lyft, and Juvederm)
- Fillers complement laser resurfacing, skin tightening, Botox and even surgery. They are not mutually exclusive of these other procedures
- Only Restylane products or Belotero should be used beneath the eyes
- Permanent fillers should only be used for the treatment of volume loss associated with depressed scars.