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Dermal Fillers - how do they help address age-related changes?

Dermal fillers often gets a bad reputation or a certain stigma attached to them and I think this is because of what we see in media as a whole but particularly social media. 

It is important to realise that these products have been designed to tackle age related changes but there are circumstances they are used in cases when these changes have not occurred or when they are used in excess and this leads to certain features of the face looking over augmented (over built) such as over enlarged lips or cheeks.  As this does not appear harmonious with the rest of the face it can often look unnatural and of course this can be concerning. 

The "unnatural" look is often one of the worries that many of my patients do express before having treatment.  However, the educational piece for these patients is that if dermal filler are used in the right quantities and with the right indications (i.e. to tackle age related changes) they can play a really important role in facial rejuvenation. I will try to attempt to explain why using a lovely patient of mine, who I saw very recently, as an example:

Before dermal filler treatment

What we have to establish from the outset is that facial aging is a three dimensional process and what I mean by this is that all the facial layers age (i.e. layers from the skin to the bone).  

Layers of the face

This diagram illustrates these various different layers and it is important to appreciate all of them change with time. 

We know that some of the most notable changes to facial appearance with age is due to changes in the superficial and deep fat pads. Superficial fat simply means fat that is closer to the skin and deep fat deeper down closer to the bone as illustrated in the image. It is dermal fillers that can often help counteract some of the changes to these fat pads.


The diagrams below shows what happens to these fat pads (shown in yellow) over time:

Changes to fat pads in an aging face

In summary there is a movement of these pad and also a change in shape, which contributes to the changing of appearance during facial aging leading to:

  • Jowling/sagging and loss of jaw line definition

  • Drooping of the side of the lips and lines extending down from the side of the lips (Marionette lines)

  • Folds from the side of the nose to the side of the mouth (Nasolabial folds)

  • Loss of lip volume and definition

  • Loss of cheek volume and definition

  • Hollowing under the eye (tear troughs worsening)

  • Hollowing in the temples

As mentioned dermal fillers is what we to help tackle some of these changes and I will attempt to demonstrate how, on this patient of mine:

Areas of the face to be injected with dermal fillers

This particular patient was looking for some facial rejuvenation and at the consultation we looked to address some of these changes namely the following:

  1. Loss of volume on the front of the cheek i.e. flattening of the apple of the cheek

  2. Loss of definition on the cheek bone

  3. Flattening and inversion of the chin

  4. Loss of definition of the lip border

  5. Dropping of the sides of the lips

To do this we discussed the use of dermal fillers (soft tissue fillers) to replenish lost volume, definition and also counteract some of the downward movement of the fat pads discussed.

It was important that we used enough volume to make a tangible difference but of course not too much so that areas looked over augmented or over filled.  Deciding this is an important part of the consultation process before any treatment.  In addition the products used for the different parts of the face have different characteristics. For example the cheeks need a more viscous product with greater lifting capacity than the lips.  This is a clinical decision for the practitioner to make.

It is important to note that with any procedure there is an element of risk and this should not be trivialised.  This again was an important part of the consultation process.

After the consultation, the patient opted to proceed and 3ml of dermal filler was placed strategically to help with this aspect of the treatment. The following pictures show the before and immediately after treatment pictures.

Before and after dermal fillers

Before and after dermal fillers

For this patient dermal fillers were placed in the following areas and the reasons why:

  1. The front of the cheek and over the cheek bone - Placing filler in the cheeks was incredibly important as this is often when volume changes to the fat pads takes place first. It is also an "upward vector" which means that by adding volume to the mid-face, where volume changes have taken place, helps provide a marginal upward "pulling" effect

  2. Into the chin - the chin often flattens and inverts with time. Placing filler helps create a more dainty chin and counteracts the inversion also

  3. The lip border - lips age with time and part of these changes is blunting of the vermillion border. What this mean is there is a loss of definition of the lips. Fillers help re-establish this.

  4. Below sides of the lips - people often do not like the down turning of the side of the lips, which can lead to a "sad" appearance even if you are not a sad person! This is normally due to the loss of volume under the sides of the lips (marionette area). By placing filler here it can help lift the corners of the mouth.

I hope this helps illustrate the importance dermal fillers may have on facial rejuvenation and how they can be used to create subtle changes that provide a natural rejuvenation. Of course, this may not be a treatment for absolutely everyone and is important to have a detailed consultation to discuss first.

I hope you enjoyed this blog but if you have any questions please do not hesitate to contact us so that we can provide you with some more information.

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