Injectable fillers are just a close second behind Botox as a very popular anti-aging facial treatment. Beyond making lips bigger, the primary benefit of injectable fillers is that they add instant volume to aging facial tissues. It has become appreciated that as the face ages, for most people, fat is lost and the face deflates. In conjunction with gravity and time, this deflation leads to the development of classic nasolabial folds, marionette lines, jowling and thinning lips with wrinkles.
In more advanced aging, which chronologically means age 70 or greater, these facial signs become more pronounced. In many people, particularly women, the face becomes like a roadmap and the lines and wrinkles become deep and etched into the face. The mouth can become a virtual ring of wrinkles radiating outward from the lips. At this age the skin also becomes thin and stretched out further, contributing to the aging countenance.
This age group of female patients is increasingly coming to plastic surgery offices to be treated with the likes of Botox and injectable fillers. They are not interested in more invasive and effective procedures such as facelifts, browlifts and other excisional operations that can tighten and lift…and produce a really noticeable difference. Rather they are interested in only noninvasive methods of facial rejuvenation.
In reality, there is a significant mismatch between what an injectable filler can achieve in the advanced aging face than what surgery can do. Whether these patients appreciate that on the front end is unknown but many probably believe that results can be achieved that are greater than what is really possible. Lead by their popularity in the news and print media (where much younger patients with less facial aging are shown), they are intrigued and come in to potentially participate in these injectable ‘fountains of youth’.
The dilemma becomes, as a plastic surgeon, as to whether to offer some of these facial treatments in this type of patient. On the one hand, the use of injectable fillers can barely make a dent (no pun intended) in these deep facial lines and grooves. (at least at a reasonable cost) Is this not a poor value and waste of money? Conversely the ability to make an instant improvement, no matter how slight, should not be denied anyone who thinks it may be beneficial. Who is to say how any patient will judge their degree of improvement?
Is one approach more reasonable than the other? The answer is obviously a matter of practice philosophy and patient education. Having treated a fair number of these more elderly patients in my Indianapolis plastic surgery practice, many of whom come from more rural parts of the state, I can make several observations. While they do come for non-surgical treatments, they fully know and are not expecting surgical type results. Their interest in injectable fillers is for the nasolabial folds and marionette lines and not the lips. They usually do not want inflated lips even if it will mean some reduction in their lip wrinkles. Almost always, they express satisfaction and even some occasional amazement about their results.
Injectable fillers have a valuable role to play in managing the effects of facial aging, regardless of age or depth of certain facial folds and wrinkles.
Dr. Barry Eppley
Indianapolis, Indiana