Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.
Soft Tissue Augmentation with Facial Fillers
11 January 2005 (online)
The field of facial plastic surgery is constantly evolving, and this is especially true in recent years. More people are aware of the ability to alter appearances as witnessed by the constant onslaught of news articles and the media's recent fascination with plastic surgery makeover shows. We are in a transition period where plastic surgery has become an excepted norm and is no longer taboo. Due to the sensationalism of our specialty, patients have the perception that cosmetic procedures have minimal downtime.
There is also a paradigm shift in treating the aging face, as a more three-dimensional approach is desired to sculpt a rejuvenated facial appearance. This in part entails achieving facial harmony and youthfulness with soft tissue preservation, rather than reduction. Repositioning and filling areas is in juxtaposition to older ideas of unrestrained excision and removal of tissue. Facial fillers have become instrumental in replenishing facial areas deplete of volume.
Facial fillers have exploded in popularity because of new availability of various products that offer rejuvenating results in a lunchtime procedure. Young patients want to fill out lines to ward off early affects of aging, and older patients wish to plump facial areas to regain youth. These procedures offer beauty instantaneously, which is appealing to today's fast-moving society.
New fillers have emerged on the market at a staggering pace. It is almost incomprehensible to imagine a few years ago bovine collagen stood alone and dominated the filler market; now we have a multitude of agents. This issue of this journal is dedicated to the rapidly growing and changing field of facial fillers. It is my hope that it will cover most of the popular current choices available to physicians for facial augmentation. I have asked the authors for reviews of each product to familiarize the reader and to serve as a physician reference. More importantly, I have asked for a candid viewpoint from those physicians to help assess strengths and weaknesses of each product.
Although some products appear to work better than others in certain situations, the myriad choices that exist suggest no ideal filler exists. This issue can act as a companion guide for physicians to review and assess the available products. Critical information will be addressed, such as risks and benefits, what product to inject, injection techniques, how much to inject, where to inject in the face, and depth and location of injections in the skin.
The Food and Drug Administration approved Restylane this year in the United States, and many more products are being investigated for approval. Other products, like Radiance, are approved for laryngeal surgery and are used off-label for facial augmentation. I have been extremely impressed with these two products and offer both to my patients. Depending on the patient, I now prefer to fill facial folds with Restylane or Radiance; I prefer Restylane only for lips. I also continue to enjoy excellent results from Advanta Implants and have included a discussion on this topic, as this is also a minimal downtime procedure.
As we process all this new information, we must continue to educate the public on their options and be critical in assessing patient outcomes in the future. As physicians we have choices of permanent or temporary fillers. Some physicians question if we need permanent results. Do we want permanent results or permanent patients? Is it good to inject something we cannot remove? Singer Jimmy Buffet's comments about tattoos can be applied to fillers: “a permanent reminder of a temporary feeling.” I believe if a permanent product is utilized, then injections must be conservative so as not to overcorrect.
Many physicians, like me, also are developing preferred practice patterns. I continue to use Botox more than ever and stress that Botox and facial fillers are not mutually exclusive but instead are synergistic. Patients have embraced the concept of total rejuvenation and understand the benefits from both weakening facial frown muscles with Botox and simultaneously receiving fillers. The added benefit is improved longevity of the facial fillers when Botox is used to relax muscles and limit filler degradation.
As physicians increase their knowledge of fillers, their comfort level and results will improve. It is no doubt that this is the future of facial plastic surgery, providing youth in a quick and effective method. There is no better time to embrace the plethora of new information on fillers, so sit back, relax, and most importantly enjoy.