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A Plea for Sanity with Facial Fillers

Even a good idea becomes silly if it is carried to extremes.  Based on what I have seen over the past couple of years, we seem to have reached the point of silliness with injectible facial fillers.

Fifteen years ago I became a proponent of volume restoration as a key component of facial rejuvenation. I realized that if a cheek becomes hollow as part of the aging process, just lifting it will not restore its beauty.  I began to work with facial fat transfer and found it to be a wonderful way to restore the fullness of the youthful face.  Since that time the technique of autologous fat transfer has been one of my most useful tools.  There is no better method to restore volume in the upper cheek, along the jaw border, and in the supporting framework of the lips.

My patients also benefit from the variety of injectable fillers that have been introduced since that time:  restylane®, juvederm®, and radiesse® to name a few.   These are very useful in specific applications to fill in creases and to a lesser degree for deep volume enhancement.

Good as these materials are, they have their limits.  This is particularly true in the creases that frame the mouth, often known as nasolabial folds and marionette lines.  It is normal for young people to have nasolabilal folds, but as the cheek structures descend with age, what was once just a soft demarcation can become a deep hollow.  Some doctors make the mistake of injecting huge amounts of filler into deep creases in this area.  This only gives a distorted and mask like appearance to what should be a very expressive area of the face.  An even worse mistake is to inject large amounts of filler into the area out past the fold as a compensation for structural descent.  This balloons out an area of the face that was never meant to be full.  Once the cheek has settled significantly, the only real solution is a surgical lifting.

Why do some patients accept a distorted, over-volumized look when a surgical lifting could produce a much better result?  This may be due in part to a misunderstanding of what facial rejuvenation surgery entails. Many patients have the mistaken notion that a cheek lift is invariably a major procedure with weeks of downtime.  I offer a wide range of procedures, some of which can be performed under local anesthesia in the office with a relatively easy recovery.

Injectable fillers are very useful.  Every day I and my team make use of Restylane®, Juvedern®, Radiesse®, and Sculptra® to enhance aspects of the facial appearance.  If these materials are used in a refined and sensible way, they almost always produce very happy patients.  If they are pushed to extremes, however, some very peculiar things can happen.