Volume Replacement

Just like death and taxes, facial volume loss with aging is going to happen.

As we age, we lose volume. This happens in both the boney structure of the face and body and in the soft tissue fat pads of the face and body. It is a natural fact of aging and as aging progresses; we lose more and more of this volume. This is one reason those of us in aesthetics advise patients to start early with collagen building and volume replacement procedures. The idea is to get ahead of this aging changes and slow it as much as possible. For the purpose of this blog, I will focus on the face since I am working in facial plastic surgery.

What are signs of aging?

The age-old question that does not ever seem to have just one correct answer. Every person’s face is different and we all age at different rates. Some of these signs of aging include: under eye hollowness, dark circles under the eyes, laugh lines or nasolabial folds starting to form, jowling, cheek boney prominence or sub-malar hollowness, temple wasting, lip atrophy, and overall skin thinness and wrinkling. Many of these form in the early 20s for my patients and it is at that time that I start talking to them about long term plans to slow these early signs of aging. There are several ways to slow the aging process of volume loss. They include, but are not limited to, HA fillers, Fat transfer to the face and collagen building procedures like RF microneedling and Sculptra/Hyper-dilute Radiesse.

1. HA Fillers:

Hyaluronic acid fillers are, by far, the most popular and easiest to find. Hyaluronic Acid is something our body forms naturally. As we age, we form less and less and begin to lose more and more. These synthetic forms come in different formulations in relation to what we are trying to correct. Several companies produce these types of fillers. The most know is Allergan, with the Juvéderm line of fillers. But you also have Galderma with the Restylane line and Revance with the RHA line of fillers. When correcting boney volume loss, a more cohesive/thicker filler is used in a deeper plane of the face. On the other side of the spectrum, when correcting more superficial lines, we use a thinner, but still cohesive filler. These are placed with different gauge needles and cannulas. The idea is to get into the space where the volume loss is present and fill that space in. These fillers typically last 8-24 months depending on where they are placed and which HA filler is used. Fillers placed in more dynamic spaces like the lips or peri-oral lines do not last as long in the face as those that are placed in temple or under eye. The more movement in the space, the increase in rate of filler breakdown.

2. Fat Transfer:

We can also use a patient’s fat, fat injections, in order to fill in areas of volume loss. The fat is harvested from places like the abdomen, flanks, or inner thighs. Due to different areas of the body having different consistencies of fat, once the fat is harvested, it is run through sizing transfer systems in order to make it the consistency of facial fat. When at the right consistency, it is injected into places of identified volume loss on the face much like HA fillers. The advantage here is that a patient’s own fat lasts much longer than any HA filler.

3. RF Microneedling:

Radio Frequency Microneedling is a procedure that is done to improve skin texture and tone. As we age, our skin becomes thinner and less tight. The mechanism of action for RF microneedling is creating collagen and elastin in order to help improve the thinning and
looseness of the skin. In creating collagen volume loss is improved. This is not volume correction like HA filler and fat transfer. This is the “cherry on top” volume correction. It helps, but it is not the full cake. The full cake is fat transfer or HA fillers.

4. Sculptra and Hyperdilute Radiesse:

Sculptra (Poly L-Lactic Acid) and Hyperdilute Radiesse (Calcium Hydroxylapatite) are both collagen and elastin stimulators. Radiesse is a dense calcium based filler that, un-diluted, is beautiful in the cheeks for extensive volume loss due to aging or genetic makeup. When
Radiesse is diluted, it becomes more of a skin wash in order to provide skin texture change. It is used in crepy skin in the neck, face, hands, elbows and knees. Sculptra works very much this way as well. As the product is absorbed in the body, it helps to re-build collagen strands. Both products, by stimulating collagen and elastin have been shown to improve the volume loss and skin texture changes that we see in the aging process.

So, what is one to do?

In conclusion, with all of the options for volume replacement, our focus should be preventative and not reactive. When there start to be signs of aging in a patient, in order to anti-age, treat the problem and focus on the solution for a long-term benefit. These changes start as early as your 20s and continue as we progress through life. It is important to start early in order to constantly stay on the front side of the aging process. It is important to have a consultation with a provider that you trust and someone that you feel comfortable with. This creates a team that is unmatched in your anti-aging journey.

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