Injectable Fillers for Volume Replacement in the Aging Face

Abstract

In recent years, there has been a better understanding of the aging process. In addition to changes occurring in the skin envelope, significant changes occur in the subcutaneous fat and craniofacial skeleton. This has led to a paradigm shift in the therapeutic approach to facial rejuvenation. Along with soft tissue repositioning, volumizing the aging face has been found to optimize the result and achieve a more natural appearance. Early in the aging process, when there has not been a significant change to the face requiring surgical intervention, fillers alone can provide minimally invasive facial rejuvenation through volumizing. Multiple injectable soft tissue fillers and biostimulators are currently available to provide facial volume such as hyaluronic acid, calcium hydroxylapatite, poly-l-lactic acid, polymethyl methacrylate, and silicone. A discussion of the morphological changes seen in the aging face, the properties of these products, and key technical concepts will be highlighted to permit optimum results when performing facial volumizing of the upper, middle, and lower thirds of the face. These fillers can act as a dress rehearsal for these patients considering structural fat grafting.

Efficacy, patient‐reported outcomes and safety profile of ATX‐101 (deoxycholic acid), an injectable drug for the reduction of unwanted submental fat: results from a phase III, randomized, placebo‐controlled study

“…Loss of chin profile definition owing to unwanted submental fat (SMF) distributed both superficially and deep to the platysma muscle (preplatysmal and postplatysmal fat) is one of the signs of ageing of the lower face and neck that may lead to a negative self‐image . Unwanted SMF may be coincident with other ageing processes such as sagging and lipoatrophy of the lower face . Another morphotype related to young as well as older patients, the round face, could result from the combination of SMF deposits on the neck and face, without sagging or facial lipoatrophy .…”

Efficacy and safety of injection with poly-L-lactic acid compared with hyaluronic acid for correction of nasolabial fold: a randomized, evaluator-blinded, comparative study

“…5 Injectable PLA is a biostimulator rather than a traditional filler, which provides immediate volumetric improvement. 6 It was approved by the US Food and Drug Administration (FDA) for human immunodeficiency virus (HIV)-related facial atrophy in August 2004, and has also been used extensively in an off-label capacity to correct non-HIV-related facial volume loss. 7 As a biostimulator, PLA promotes volumization through the production of collagen and vascularization of existing collagen.…”

Five-year Experience with Perma Facial Implant

“…9,21–25 Regardless, donor-site morbidity, potentially protracted downtime, and unreliable take 11,12,26 render it suboptimal in our opinion. Noninjectable fillers, such as dermal-fat or fascial grafts and cadaveric dermis, exhibit resorption as well.…”