Loss of facial fat is a common occurrence as many people age. With loss of this fat volume comes tissue sagging, some of which would not have occurred if it was held up better by retained tissue support. One of today’s new uses for injectable fillers is in the treatment of this facial pseudoptosis. Using injectable materials to replace lost fat volume and restore contours to a variety of bony and soft tissue facial contours is now best known as filler rejuvenation.
Much of filler rejuvenation is focused on the temples, orbital hollowing and the submalar region, classic facial areas affected by fat volume loss/atrophy. Injecting into these areas can help plump back fat lost and soften a face that may have become gaunt and hard due to a skeletonization effect. While the volume of filler needed can often be substantial, 2ccs or more, the facial rejuvenation effect can be quite significant.
Choosing the right injectable filler, however, is critical as not all fillers create the same effect at the same injected volume. In addition, each filler has a different duration of effect. What one would use for superficial lines and wrinkles is different than what should be used for facial folds. The amount of ‘push’ of the filler needed is quite different. But what works for facial folds is similar to the type of fillers needed to create a facial volumization effect.
The four injectable fillers today that are most appropriate for filler rejuvenation are Juvederm Voluma, Radiesse, Sculptra and Perlane. The latter three are well known, having been around for awhile. Juvederm Voluma is the newest filler and is the only hyaluronic acid-based filler that is FDA-approved for cheek augmentation, a specific facial volume effect. What creates the lifting effect of Juvederm Voluma is the cross-linking of the hyaluron molecules so they have more viscosity. This greater stiffness allows for a better push on the surrounding and overlying soft tissues.
While there are proponents for each of these voluminizing fillers, they have various advantages and disadvantages. Voluma, Radiesse and Perlane work very similarly and are injected through slightly larger needles than their thinner more superficial wrinkle counterparts. What separates Sculptra from the others is that it is better suited for an overall treatment of a thinning face even beyond the fat pads into all subcutaneous facial planes. Its more liquid composition allows for larger volumes of material to be delivered.
Filler rejuvenation provides a variety of temporary but helpful effects. They can pick up a sagging midface to lighten a heavier lower face. This allows the focus to be redirected back to the eyes. Restoring lost temple volume makes one look healthier and helps balance out the face.
If one likes these filler rejuvenation effects, injection treatments can be repeated or the consideration given to fat injections for a hopefully a greater long-term effect.
Dr. Barry Eppley