This post was originally published on November 9, 2016 and has since been updated.
The world of injectables and filler can feel like the Wild West sometimes. The options are extensive, but where are they injected? And why? Here, the most common areas that need lifting, filling, and sometimes, left to a more invasive approach.
Facial Aging 101
“As we age, there are a number of changes the face undergoes,” says New York plastic surgeon Umbareen Mahmood, MD. “Not only is there an increase in lines, wrinkles and discoloration such as sun spots, but there is a breakdown in collagen and elastin fibers, and a loss of fat, which lead to sagging skin and areas of hollowness,” she explains.
The most common result of these changes, according to New York plastic surgeon B. Aviva Preminger, MD: “a loss of cheek fullness, deepening of the smile lines and the formation of jowls.” While the midface and lower face are the areas where these changes are most noticeable, Dr. Mahmood adds that the upper third of the face also begins to droop as we age, which can lead to a heavy appearance of the brows—a complaint she says is frequently made by male patients, as well.
As a result of these aging patterns, Dr. Mahmood says the midface and jaw/neck area often need lifting, “whether initially by fillers or nonsurgical devices, or ultimately by a surgical facelift and necklift.” But, how your doctor goes about fixing each one of these age-related issues varies from patient to patient.
In fact, Dr. Preminger explains that in many patients, there is a need for a combination of both lifting and filling. “Rarely will a patient have pure skin laxity as the only age-related problem,” says San Francisco dermatologist Vic Narurkar, MD. “There are multimodal aspects to aging, which also include reduction in facial fat (temples, midface, marionette areas and upper cutaneous lip), in addition to laxity. Also, there are submental fat, hyperdynamic wrinkles and neck laxity. So often, injectables will complement lifting.”
When to Fill
One area of the face that almost always needs filling, according to New York facial plastic surgeon Dilip Madnani, MD, is the cheeks, which lose volume. Dr. Madnani says they are a fantastic area to fill because they act as a pillar, holding up the skin. “Once they start to lose volume, our skin starts to sag, producing the beginning of jowling. To address the area, I routinely combine facial fat transfer to volumize the midface and cheek area with a lower facelift or necklift to erase the years.”
Other areas that often require filling: the tear troughs, temples, lips, nasolabial folds, marionette lines and superficial lines around the lips and mouth.
“Another area I like to fill, which is often overlooked, is the ear lobe,” says Baton Rouge, LA dermatologist Ann Zedlitz, MD. “We all want perky earlobes so our earrings face forward so they can be seen.”
When to Lift
Nonsurgical tighteners and injectables can help to temporarily “lift” areas more prone to age-relating sagging, such as the lower and midface, but if there is significantly loose skin, these “Band-Aids” may not do enough to give you the results you’re after. “Patients who have severe jowling and laxity are better candidates for surgical lifting and then following with fillers or aurologous fat for rebalancing facial fat,” says Dr. Narurkar.
It’s important to know that not all treatments will give the same longevity in terms of results. “Surgical facelifts last the longest,” says Dr. Madnani. “If surgery resets your appearance by 10 years, then you will always appear 10 years younger going forward, however you will continue to age from the point of reset. Most people come back for a touch up lift about 8–10 years after the first, and this can vary.” As for solutions of the nonsurgical variety, Dr. Zedlitz says a combination approach of dermal fillers and Ultherapy works well.
The Bottom Line
No matter what your specific concerns are, Dr. Mahmood assures us your physician will have a solution that can be tailored to your preferences. “With the impressive number of aesthetic tools available today, plastic surgeons can truly tailor a treatment plan to each patient’s individual needs and desires, which can include a combination of injectables, noninvasive technology, and surgical intervention.”