Introduction

Published on 16/03/2015 by admin

Filed under Dermatology

Last modified 16/03/2015

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1 Introduction

Jean Carruthers, Alastair Carruthers

Summary and Key Features

• Volumization is the key to aesthetic success with facial fillers

• Changes in the concept of beauty, visualization of age-related changes in the face, and validated assessment scales have aided in achieving optimal outcomes

• Reversers and better pain management have enhanced augmentation procedures

• The future holds great promise and expectation for fillers as both drug and delivery vehicle

We have come full circle in the aesthetic approach to the face with soft-tissue-augmenting agents. The volumizing effect of the first filler – autologous fat – was studied over a century ago when it was harvested and inserted into the face. With the development of synthetic fillers, such as hyaluronans, calcium hydroxylapatite, poly-l-lactic acid, and silicone, it became possible to inject fillers specifically into different tissue layers, although still using a two-dimensional approach along visible linear lines, folds, and wrinkles. The emergence of fillers with superior lift capabilities, while still maintaining the desired position, opened the door to the concept of volumizing as not only a possibility but also the accepted norm for achieving optimal aesthetic results, in addition to more superficial filler placement.

In addition to the manufacture of tissue-friendly, long-lasting fillers, we have become aware of more etiologic detail about the anatomical structure of facial aging. Computed tomography (CT), magnetic resonance imaging (MRI) scans, and anatomical cadaver dissection have allowed us to visualize accurately the underlying bony structures, the facial fat pads, and the changes in the overlying facial skin. Studies of a new, descriptive language of age-related facial changes with sequential photographic facial scales have been published, demonstrating their value in improving communication not only with our patients in our clinics, but also with each other as we work toward better treatments, often in multiple research centers simultaneously.

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