Much advertising cosmetic today touts the wonderful results that can be obtained with non-invasive injectable filler materials. When it comes to lips, nasolabial folds (cheek-lip grooves), and fine lines and wrinkles, injectable fillers are unrivaled in what they can achieve for these facial areas. However, the prevalence and easy-to-use nature of injectable fillers has seen their use expand to many facial tissue deficiency problems as well. In looking at a lot of training videos on injectable fillers and numerous internet sites, it is clear that some physicians are pushing the boundaries of what injectable fillers are made to do.
The use of injectable fillers is being pushed to the limits for facial rejuvenation purposes in some cases. Trying to use too much filler for an underlying volumetric facial problem, albeit from aging or congenital deficiency, can certainly lead to problems of disappointing results, only a temporary effect, and high costs for an injectable procedure…that may approximate surgical costs in some instances. Just because it is easy to do does not make an injectable filler the best treatment for all facial volume problems.
When it comes to volumetric problems of the midface, in particular, a facial implant is often (usually) a better solution. The difference between facial implants and injectable fillers is very clear, implants at the bone level provide permanent and very predictable results by adding support to the underlying soft tissues. As opposed to injectable fillers which add smaller amounts of indistinct volume that is only temporary. Through small incisions high up under the lip, facial implants can easily be slide into place and they come in a wide variety of midfacial shapes and thicknesses. The other nice thing about facial implants is that they are easily reversible, being able to be removed or exchanged quite easily.
When it comes to volumetric changes of the midface, one should think of the underlying bone anatomy first. Is the bone deficient or would adding bone projection (through an implant) be helpful for creating a favorable external change? I think too often today the thought first turns to soft tissue enhancement when, in some cases, underlying bone enhancement would create the same or even a better result. In the midface, in particular, where no masticatory attach since the upper jaw is a fixed bone, pain and recovery from midface implants is quite limited.
Dr. Barry Eppley
Indianapolis, Indiana