Facial Plast Surg 2006; 22(2): 140-146
DOI: 10.1055/s-2006-947720
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Injectable Treatments for the Aging Face

Jeffrey B. Wise1 , Timothy Greco1 , 2
  • 1Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
  • 2Eastern Cosmetic Surgery Institute, Bala Cynwyd, Pennsylvania
Further Information

Publication History

Publication Date:
18 July 2006 (online)


The use of injectable agents, specifically soft tissue fillers and botulinum toxin type A, has risen dramatically over recent years, due to the increased demand for minimally invasive techniques. In fact, today they represent the most commonly performed cosmetic procedures in the United States, with botulinum type A injections topping the list. In the treatment of the aging face, these agents, when used individually or in combination, can effectively decrease rhytids and restore lost volume. The result is a fuller, smoother, more youthful appearance. This article provides an overview of botulinum type A (Botox Cosmetic; Allergan, Inc., Irvine, CA) and the two injectable fillers most commonly used in our practice, namely hyaluronic acid (Restalyne; Medicis Aesthetics, Inc., Scottsdale, AZ) and human-derived collagen (Cosmoderm and Cosmoplast; Inamed Aesthetics, Inc., Santa Barbara, CA). Although we commonly use autologous fat as an injectable filler for facial-volume augmentation, its discussion is beyond the scope of this article. Conceptually, the aging face can be divided into upper, middle, and lower thirds. Using this framework, we will discuss our treatment strategies for addressing each facial region. General principles, preinjection evaluation, and specific approaches and techniques for each anatomic region will be discussed, with particular emphasis on the benefit of using dermal fillers in conjunction with botulinum toxin type A to achieve optimal aesthetic results for facial rejuvenation.


Jeffrey B Wise, M.D. 

145 East 27th Street

#8C, New York, NY 10016