New Concepts in Fillers

In my opinion, dermal fillers still provide the most aesthetic “bang” for the buck. I would estimate that 75% off all facial aging can be attributed to volume loss. Thus, fillers combat one of the fundamental problems of facial aging. Now, with fillers that can last up to 5 years, their value increases exponentially. Here are some important newer ways we are thinking about fillers:

1. Our face changes shape as we age – The easiest way to think about this is our face changes from a triangle, to more of a square as we age (and, eventually, to an upside-down triangle). This is because the middle third of our face is the most volumized when we are young, and with time, this area “deflates”. At the same time skin becomes loose and jowls form in the lower third of the face. We need to reverse this by adding volume back into the middle third, thus “pulling up” the lower third. The lifting quality of fillers is one of the most important.
2. Fillers are not just about filling lines and wrinkles – Lines and wrinkles form for several reasons: our skin thins out with age due to less collagen and elastin; we lose volume underneath the skin; our skin is damaged by sunlight, smoking, and other factors. We used to think of fillers as products that simply go after these lines and fill them back up. That can be done, but we do not want to miss the forest for the trees. Volume correction is how we achieve a more youthful result, not filling in lines. Even lines around the mouth require volume support in addition to the typical “filling in” of smokers lines, etc.
3. It is best to look at full facial rejuvenation – Older thinking was simply to correct an “area” such as cheeks, mouth lines, etc. Newer thinking is to provide full facial correction and have it last for many years. Collagen-stimulating fillers such as Sculptra and Bellafill can achieve this. We want to look at not only each area of volume loss, but how it relates to the areas around it. For example, to fill cheeks but ignore the temples above and the jawline below is to provide an incomplete treatment, one which changes the normal proportions of the face. It is not wrong to do this, but does not yield the best possible result.
4. Fillers can last a long time – With the above-mentioned collagen stimulators like Sculptra and Bellafill, we now can provide results that last 5 years or more. This completely changes how we think about these products, and how we perceive their value. Whereas traditional fillers will last typically a year, disappear, and then require full treatment again, collagen-stimulators are placed in a series of treatments, get better over the ensuing 6-12 months, then require only minor touch-ups over the next 3-5 years. Thus the cost-curve is reversed: Sculptra and Bellafill get cheaper with time, where traditional fillers get more expensive.

As more and more products become available, our approach to using them continues to evolve. I think that collagen-stimulating fillers are the most exciting development in this field so far, and are a true game-changer. If you want to learn more about how to integrate these newer technologies into your aesthetic plan, please come in for a free consultation.

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