Soft tissue fillers restore lost volume in lower face

Miami Beach, Fla. - Although the man behind Goldie Hawn's outrageously puffed lips in the movie First Wives Club was among the first to experiment with collagen in the lips, Arnold Klein, M.D., admits that, for that scene, he injected Ms. Hawn's lips with saline.

Dr. Klein says collagen in particular was originally designed to treat lines and scars, but he believes that the most important role for fillers today lies in their ability to offer rejuvenation - particularly to the troublesome lower third of the face - by restoring volume to the lips and the area below them.

This, of course, throws off the "ideal proportions," that is, where the lips should be in space.

"The distance from the ridge above the upper lip - called the Glogau-Klein (G-K) point - should be 18 mm to 20 mm and the distance from the G-K point of the lower lip to the chin should be 38 mm to 40 mm in the ideal face," he says.

With this in mind, Dr. Klein stresses the importance of injecting carefully so that the modifications made with fillers are imperceptible at every angle.

"You don't want to create fullness in the lip that looks fine from the front but appears unnatural in profile."

Filler options Dr. Klein says he uses different fillers for different applications.

"I'm the one who figured out how to inject collagen - now Zyderm/Zyplast (Inamed) and Cosmoderm/Cosmoplast (Inamed) - and I continue to use it, often in combination with Restylane (Q-Med Laboratories).

Dr. Klein says he is not convinced that thicker formulations of hyaluronic acid, including Hylaform (Inamed), are longer lasting. In fact, he believes the opposite may be true.

"It's less concentrated - with ¼ the hyaluronic acid - and you have to put it in deeper to avoid lumps - so it's reabsorbed more quickly."

It is because collagen, too, is injected at a deeper level, he says, that it loses its effect more quickly. However, he often uses Zyderm collagen in combination with Restylane, both for its anesthetic properties as well as cosmetic attributes.

"I frequently use Zyplast as a base to make the treatment area numb, then I layer Restylane and Zyderm on top."

Injection technique Dr. Klein says he injects very slowly using the serial puncture technique - never threading. Dr. Klein believes this injection method is superior to threading for several reasons.

"I am convinced that people who use the serial puncture technique get the best results, period. Having often filmed and observed the procedure as a paid consultant to Medicis and Inamed, I observed that the longest-lasting results in the nasolabial folds were achieved with serial punctures, and I also feel you can get more even distribution with this method."

In addition he maintains that threading with hyaluronic acid causes more bruising than the serial puncture method.

Noting that the only version of the hyaluronic acid Restylane now approved by the U.S. Food and Drug Administration doesn't flow as easily as collagen, Dr. Klein describes how he compensates for its flow characteristics.