Innovations in fillers

January 17, 2009

Kohala Coast, HI - Addressing volume atrophy of the midface is the most critical correction that practitioners can offer for rejuvenating the appearance of most aging faces, said Richard G. Glogau, MD, at the Winter Clinical Dermatology Conference.

Kohala Coast, HI

- Addressing volume atrophy of the midface is the most critical correction that practitioners can offer for rejuvenating the appearance of most aging faces, said Richard G. Glogau, MD, at the Winter Clinical Dermatology Conference.

"Forget about procedures that aim to achieve skin tightening or using fillers to correct individual lines and folds, and think more globally instead. There is no question that the appearance of facial aging is related to loss of volume, and the real way to hit a homerun in reversing the appearance of the aging face has to do with using fillers to restore midface volume."

Dr. Glogau highlighted the effects of midface volume loss on facial aging with a series of graphics. Beginning once individuals reach their 20s and occurring over a period of decades, there is an evolution in the appearance of the central face from the convexity of youth to a flattened shape and even to concavity.

Studies show that the total volume of the premalar region per side of the face is about 9 cc, and most patients become interested in a rejuvenation procedure after they have lost about 33 percent of the total volume. However, the loss does not need to be replaced cc for cc.

Rather, Dr. Glogau said he never injects more than 1 cc of a hyaluronic acid filler into each cheek to achieve the desired 3 cc improvement. And, because there is likely a host response to repeat treatments, i.e., induction of collagenolysis, less volume needs to be used with successive treatments.

With a range of available fillers, Dr. Glogau noted that all products are associated with some reactions.

"We can debate for hours which may be most appropriate for this indication, but the bottom line is that no matter which you pick, they all have pros and cons," he said.

While the effects of volume restoration to the midface are subtle in one respect, the benefits are dramatic. This procedure certainly carries a "wow factor" element, and over the long term, it may keep patients out of plastic surgery offices and returning to their dermatologist.

Dr. Glogau suggested injecting just one side of the face and handing patients a mirror. Their reaction will show they are immediately impressed by the change in their appearance.

Patients who are treated with midface volume restoration will also be less focused on the appearance of their lower jowls. As a result, they will be less interested in seeking out services of plastic surgeons, he said. And once they appreciate how much younger they look with the midface treatment, they will be converted to believers in its value.

"With the new hyaluronic acid fillers, the benefits can persist for 6 to 8 months, but as soon as patients begin to notice the correction decreasing and that they are beginning to look a little tired and drawn, they will return promptly for retreatment," Dr. Glogau said. DT