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Designer Faces: The Evolution of Dermal Fillers

February 3, 2020 by Richard O. Gregory, MD

Our self-image is so important that we frequently pick a tiny defect on our face and magnify it to the degree that it interferes with our activities, self-image, and confidence. In the past, correction may have meant intensive surgery, anesthesia, and recovery time. However, using today’s minimally invasive techniques and technology, we are able to improve these minor defects relatively easy. For instance, lasers have been used for cosmetic purposes for more than 40 years and Botox has been used for more than 20 years. Even fillers have come of age in the past 10 years making them a wonderful “volumizing” tool for lifting cheeks, plumping lips, or even temporarily improving structural defects such as those of the nose or chin.

When fillers made their debut in the 1970s, bovine (cow) collagen was used. However, as it was foreign to the body, it had severe limitations. Over the years, permanent fillers and fat injections have also been used, but have been associated with a variety of problems and limited usefulness. While a variety of fillers are on the market today, the advent of hyaluronic acid fillers allows us to customize injectable results.

Hyaluronic acid is a sugar that is biosynthesized. It is a natural substance in the body which lines and lubricates our joints. It also serves an important role in plumping the skin and attracting water to the foundation of the skin. Unfortunately, there is a limited amount of hyaluronic acid in our bodies which decreases with age. In fact, when our skin is plumped after a shower, it is largely the water absorption into the hyaluronic acid that creates this visually pleasing effect.

Restylane, Juvederm, and Boletero are the more common forms of injectable hyaluronic acid on the market. Each of these manufacturers makes variations in the product which will affect the thickness and duration of its effect. The differences in manufacturing primarily relate to the stiffness or cross-linking of the molecular structure making them suitable for different purposes.

In addition to the differences in the product, there are many differences in technique which will affect the result. Some of these differences relate to the location and purpose of the injection. For instance, tear troughs require a lighter product and have their own special needs and risks. Lips, likewise, require customization to achieve the desired effect. Unfortunately, many patients are so turned off by the extreme results they see on celebrities that they summarily reject the idea of lip fillers. This is regrettable because a knowledgeable injector can achieve with precision the beautiful lip lines that a patient desires without the unnatural appearance.

Beauty is a matter of achieving symmetry, balance, and the youthful aspect that each of us desires. Many times, restoring volume to the face can be enough to forestall the need for surgery or as a complement to other surgical or non-surgical procedures.

Finally, it is important to understand that there are many injectors who are marginally trained. As results are greatly impacted by the skill of the injector, you should seek a plastic surgeon or someone oriented to caring for the entire face, spanning the entire armamentarium from injections to surgery. In the long run, this will provide the most desirable enhancement, prolonged use, and correct the aging face.

To learn more about dermal fillers, or other non-surgical and surgical options, schedule a consultation with a professional at The Institute of Aesthetic Surgery by calling (407) 409-8000.

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Filed Under: Blog Tagged With: fillers

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