No one wants to look older than they feel. However, as we age, the tissues of the face undergo some dramatic changes. Bone remodels, and in many cases the bony support to the overlying skin, subcutaneous fat and muscles is lost. At the same time the soft tissue support becomes weaker, allowing gravity to pull the tissues downward. In some areas, subcutaneous fat is resorbed, making the process even more dramatic. As a result, facial wrinkles, or rhytids, are one of the first signs of aging.
A filler is a substance that is injected into the tissue in order to replace tissue volume. Because they create lift and fullness to tissues, they can reduce the appearance of wrinkles. However, fillers can also be used to sculpt the face. Areas that work well for fillers include the cheeks, the naso-labial folds (wrinkle between the nose and corner of the mouth), lips, marionette lines, and jowel.
Typical fillers come in a variety of formulations. Hyaluronic acids (brand names include Belotero, Juvederm, Voluma, Vollure, Volbella) occur naturally in the soft connective tissues of the face and the fluid surrounding your eyes. These products work like a water “sponge”. As the product is broken down by the body, the hyaluronic acid actually holds more water. The result is that the volume that you see remains relatively constant during the longevity of the product.
Calcium hydroxyl apatite (brand name includes Radiesse) naturally occurs in bone. These fillers are biosynthetically created, meaning that no animals or animal products are used to make them. Because the molecules in this product are somewhat larger than hyaluronic acids, it cannot be used in delicate tissues like the lips or close to the skin surface. As the product is broken down by the body, it stimulates the creation of collagen, which is a natural part of the soft tissues. This causes the skin to regain thickness, and help to reverse the natural aging process. The results are immediate, and can last a year or more.
Fat and skin (dermis) are natural fillers. They require surgery at a different part of your body to provide “donor” tissue. This donor tissue is injected or placed into the area that needs more volume. Permanent improvement in skin quality, especially in radiated skin, can occur. In some cases, pigmentation of the skin can also be improved. Unfortunately, not all of the fat which is transferred survives this process, and the results can be less predictable than over the counter fillers. Results, once stabilized, tend to be permanent.