The Evolving Use Of Injectable Fillers for Aesthetic Facial Enhancement

Injectable fillers have come a long way since the approval of the first non-collagen based product in 2002. While once conceived as only a way to make lips bigger and nasolabial folds less deep, injectable fillers have evolved into a popular aesthetic technology that has a wide number of facial uses.

Injectable fillers are used for two aesthetic facial applications, spot filling and volumetric enhancement. It is the latter that is often coined as ‘non-surgical facial sculpting’. That term is probably more accurate than not as it definitely takes skill and a good eye to get pleasing facial results with fillers. There is more art to it than science.

When it comes to facial volumetric enhancement with fillers, they are often compared to and even viewed as a substitute for surgical solutions to the same problems. Some injectors view synthetic fillers as  a better treatment choice as they are easier to do and have less risk of complications than surgery. While that is partially true,  they rarely  give better results than surgery or offer the best value for the money invested to do them.  Fillers can be a quick non-surgical fix but the benefits will ultimately fade away.

For skeletal augmentation of the three facial highlights, chin, cheek and jaw angles, injectable fillers can be used to create a visible external effect. When placed down at the bone level, I prefer Radiesse. Its calcium hydroxyapatite composition makes it the most viscous filler which provides a better push of the overlying soft tissues per cc of volume.  But when comparing it to synthetic facial implants that have been used for decades, it has several disadvantages. It takes a fair amount of syringe volume to get a visible effect, often at least two or three syringes depending upon the area.  The effect will never be as significant as a surgical implant and the filler material will go away by about one year after injection. This makes using an injectable filler for bony augmentation very patient selective. Filler are best used when one is uncertain about how a surgical implant may look (trial ‘implant’) or if the effect is time dependent based on an upcoming event and one doesn’t have the time to recover from surgery.

The face is also made up areas whose shape is not dependent on the underlying bone. These include two large areas in the lateral face and the temples. In the triangular area between the cheeks, chin and jaw angles, lies the lateral facial region. This area has garnered a lot of attention in facial aging as it becomes more concave in some people as they age due to fat atrophy. Plumping it up with fillers has become popular as a rejuvenative manuever. I prefer Sculptra for the lateral facial triangle because of the volume of material needed. Using an 8cc reconsitution of Sculptra in an almost pure watery form, it is easy to get a good amount of material over this large area. Sculptra does not work immediately and it takes time and three total injection sessions to get a result. But its effect may last for up to two years.