The facial aging process is complex and volume loss is a substantial component.  Replacement of facial volume loss can be accomplished through the use of autologous fat transfer, which is using the patient’s own body fat cells and transplanting them into the face, or through the use of syringe based fillers.  The most common types of fillers used are hyaluronic acid (Restylane, Perlane, Juvederm) and calcium hydroxylapetite. (Radiesse) Poly-L Lactic acid (Sculptra) is another filler which can be used for volume loss however it requires multiple treatments to appreciate the results and therefore we do not frequently use it.  We prefer to use Radiesse for subcutaneous tissue augmentation as the results are immediate and the longevity approaches that of sculptra.  Autologous fat transfer is another topic for another Blog.  We will talk more about the use of syringe based fillers.   

We usually use a combination approach for overall facial rejuvenation with fillers.  We utilized Restylane for the teartrough deformity of the lower eyelid, Radiesse for deep cheek augmentation, and then a combination of Restylane, Perlane and Juvederm for perioral rejuvenation.  The tear trough or orbital groove is a hollow at the junction of the lower eyelid and cheek.  It is responsible for giving the lower eyelids their bag-like tired appearance.  Restylane is very useful for filling in this groove.  By filling up the hollow it changes the way light catches the eyelid cheek junction removing the appearance of the tired eye and adding light and therefore a refreshed appearance. 

The loss of volume of the lower eyelid usually extends into the cheek region as well into what is referred to as a malar groove.  It is an oblique line that separates from the orbital groove and extends down the cheek.  When present the cheek has lost is youthful fullness and become a series of lumps and hollows again creating unsightly shadows.  In this area we prefer to use Radiesse or Perlane to add the youthful fullness back to the cheek. 

The other common area for facial rejuvination is the perioral area including the smile lines, marionett lines, and the pre-jowl sulcus which is the hollow along the jaw-line just in front of the jowl.  By adding volume to this area the lines of age are again filled out to a more youthful configuration.  The pre-jowl sulcus being filled hides the appearance of the jowl and leads to a cleaner looking jaw-line. 

Fillers are great because of their ease of use and limited down-time.  Dramatic results can be obtained through their use, especially if a total facial approach is utilized.