Fillers & the Aging Face: A Plastic Surgeon’s Perspective

By Ramsey J. Choucair, M.D., F.A.C.S.

Facial Volume in addition to skin quality and skin laxity, facial volume is a critical consideration when contemplating treatment options for the aging face.  

Youthful faces are full.  Lips, brows, cheeks, and temples exhibit a youthful, robust fatty layer that imparts facial fullness.  Adequate facial volume results in a smooth, soft, and gentle shape to the face. With aging, facial volume is diminished, leading to skin folds, hollow contours, and visibility of the facial bones, especially around the eyes.  An aging face can also appear somewhat deflated.

Fortunately, there are numerous soft tissue filler options available to restore facial volume with great precision, that can last a good while, and have minimal downtime.  These filler materials include off-the-shelf products such as hyaluronic acid fillers like Restylane and Juvederm, or a patient’s own fat. There are pros and cons to each filler option and an individualized treatment plan is essential to achieve a natural rejuvenation.  Recommendations to reverse facial volume loss may vary widely and are based upon individual factors. The most commonly treated areas include the cheeks, lips, and hollow appearance of the lower eyelids, brow, and temples.

Restoring facial volume is only one component of facial rejuvenation and not a substitute for appropriate facelift or eyelid surgery. In fact, attempting to avoid facial rejuvenation surgery by continuing to add facial volume often results in a distorted, overfilled and unnatural appearance.

Armed with these multiple filler options, a logical strategy is formulated to ‘turn back the clock’ based on each patient’s desires and expectations.   Patients are encouraged to obtain more than one opinion and proceed after confirming that their expectations are reasonable and achievable.

In most instances “what to do” is more relevant than “how it is done”.  Remember, you are relying on the JUDGEMENT of the physician as the most important ingredient for a successful outcome.