Conclusions

Published on 16/03/2015 by admin

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Last modified 22/04/2025

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31 Conclusions

Jean Carruthers, Alastair Carruthers

Summary and Key Features

• Age is no longer a defining number

• Maintenance therapy with modern fillers will affect society norms and behaviors

• Future uses of filling agents will potentially extend beyond volume replacement

• The filler revolution has altered the aesthetic treatment paradigm

One of our dear friends, who is in her sixties, said recently, ‘I’m genuinely surprised when someone offers me his seat on the bus.’ She is not one to avoid new challenges; indeed, she embodies the new way of thinking about age: you are only as old as you choose to look and feel.

The social consequences of our new understanding of the anatomy, physiology, and treatment of facial aging with fillers and neurotoxins are highly significant. Age is no longer a defining number, but instead represents one’s outlook on and approach to life. It is impossible to ignore the significance of genetics and the damage inflicted on the skin (through either trauma or photodamage), but it is how one responds to these factors – by using fillers, neurotoxins, and energy-based devices and cosmeceuticals – that will determine the projected age of the face one presents to the world.

How will this affect societal norms and behaviors? With maintenance therapy, the lines between young and old will begin to blur or even cross. The 40-year-old who smokes, does not use sun protection, and hates to exercise will begin to look older than the 60-year-old who does exercise, uses topical tretinoin and sun protection, and who seeks out facial maintenance therapy with neurotoxins and fillers. Expected age-related changes in behavior may be replaced by an acceptance of maintenance-related behaviors, in which more people will continue to wear the same clothes and listen to the same music as they did when they were numerically ‘young’. There is already an absence of age-related deference in Western cultures; maintenance of appearance is essential in avoiding shibboleths about aging, especially in the work place. Perhaps businesses will hire older workers who look younger for their positive attitudes and continuing exemplary work ethic.

According to the Yankelovich report, most ‘baby boomers’ (born between 1946 and 1964) already believe that they are in prolonged and perpetual middle age; what better way to look the part than by using modern aesthetic technologies? Moreover, we believe that the ‘maintenance effect’ will have cultural ramifications in the younger generations that have watched their parents and grandparents deliberately keep their younger attitudes and energy levels.

The realization that with care, drive, energy, and faith one can indeed expand the healthy and rewarding time spent in middle age is so prevalent that the concept of ‘retirement’ has become a dated concept for baby boomers. As Woody Allen said, ‘If a shark stops moving, it dies.’

How will medical fillers change?

Fillers are designed at present to safely support and expand the subcutaneous space, thus achieving the facial contours seen in youth. A graduated approach is possible, and ‘overdone’ looks are avoidable. Subtlety in application imparts a culturally appropriate beauty. Tomorrow’s fillers may add more than just volume to the facial skeleton and subcutaneous and cutaneous structures. What if antioxidant vitamins such as vitamin C or E could be injected with the filling agent to improve the dermis ‘from the inside’ as well as enhancing the longevity of the filler? What if osteoblasts could be injected in the filler to restore facial bones? Could osteoclasts be used to reduce the bony volume of a large chin or Neanderthal brow? Injecting stem cells that would produce more fat cells in the facial fat pads could produce a more permanent expansion. Stem cells that would enhance the collagen and elastin deposition in the deep dermis could shrink the enlarged, sun-damaged skin envelope of the face and neck (dermatochalasis), thus reducing the need for surgical repair or treatment with ablative and non-ablative energy-based devices.

The second century of the filler revolution begins with a population that is highly aware of the advantages brought by modern injectable agents, physicians who are just as keen to discover the most effective and safest new agents, and regulatory bodies that understand the new high standards the filler world has brought to the aesthetic treatment paradigm.

Further reading

Carruthers J, Carruthers A, Monheit G, et al. Multicenter randomized parallel group study of onabotulinumtoxin A and hyaluronic acid dermal fillers (24mg/ml smooth cohesive gel) alone and in combination for lower facial rejuvenation: satisfaction and patient reported outcomes. Dermatologic Surgery. 2010;36:2135–2145.

Carruthers J, Carruthers A, Tezel A, et al. Volumizing with a 20mg/ml smooth, highly cohesive viscous hyaluronic acid filler and its role in facial rejuvenation therapy. Dermatologic Surgery. 2010;36:1886–1892.

Hanke CW, Rohrich RJ, Busso M, et al. Facial soft-tissue fillers: assessing the state of the science conference – proceedings report. Journal of the American Academy of Dermatology. 2011;64(4 suppl):S53–S85.

Murray JC, Burch JA, Streilein RD, et al. A topical antioxidant solution containing vitamins C and E stabilized by ferulic acid provides protection for human skin against damage caused by ultraviolet irradiation. Journal of the American Academy of Dermatology. 2008;59:418–425.

Pinnell S. Cutaneous photodamage, oxidative stress, and topical antioxidant protection. Journal of the American Academy of Dermatology. 2003;48:1–19.

Walker Smith J, Clurman AS. Rocking the ages: the Yankelovich report on generational marketing. New York: HarperCollins; 1998.

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