First, why facial “fillers” at all? For those unfamiliar with the purpose of fillers, consider that as we age, we lose volume in our faces. This, combined with loss of skin elasticity and sun damage, is one of the primary effects of aging that make us look older.

As we age, very predictable and noticeable changes occur. The first visible volume loss is usually under the lower eyelids. In youth, the cheek goes medially to the nose, to the lower eyelid (with no concavities), and down to the level of the upper lip.

As the fat in the cheek gets “used up” and dwindles, it leaves the hollows or dark circles under the eyelids. If one has lower eyelid “bags,” this creates a shadow making the circles look even worse.

In youth, the cheek and the nasolabial fold lateral to the smile lines are one mound. With aging and loss of volume, this area becomes two mounds separated by an oblique groove called the “tear trough.”

When this volume loss occurs, the face sags. As a comparison, it’s much like a beach ball that deflates, sags and becomes wrinkled. Re-inflate it with air, and it will become round and smooth again. Fillers achieve a similar result in one’s face.

We actually lose volume over our entire face, and each area must be analyzed and treated very carefully and artistically to achieve a natural appearance and seem to “turn back the clock.”

The difference in the various fillers is in the thickness or viscosity of the filler, how long they last, and how much the filler actually elevates the skin and underlying tissues. A filler that is soft and more easily diffused into the immediately surrounding tissues might leave a smoother and softer appearance, but might not give as much lift.

A less dense filler can be injected though a very small needle and might be ideal for the wrinkles around the mouth, but not as good for the lips themselves because it might not last as long in such a mobile area.

Each area of the face requires a different approach and, for the best and most natural result, use of the correct filler in areas of the face to achieve optimum and long-lasting results.

Each patient must be evaluated and individualized, as everyone has different areas that have lost fat, bone or both. Obviously, those with less body fat overall will show more volume loss and will require more revolumizing.

In conclusion, fillers are able to reduce the signs of aging by providing a more youthful volume. The goal is to replace, without over-filling, the areas where volume has been lost.

Overfilling is not a desirable result, as the individual loses a normal look and can often look unnatural.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. www.fingerand