The "Wow" Effect

There are precious few procedures that we perform where, immediately after the procedure, we can hand the patient a mirror and their typical response is "wow". The injection of filler is the outstanding example of this phenomenon. The results are immediate and frequently very impressive. The final result, however, is more of an art, rather than a science. This is especially true now that filling has evolved from plumping up a specific groove to re-contouring the face, producing a more youthful facial structure. This is very operator dependent and it is unusual to see physicians who are not members of "core" cosmetic specialties (dermatology and plastic surgery) venture into this arena.

"I love you, Dr. Bock"

That is how I was greeted last week by a long time patient. She had undergone a number of noninvasive procedures in the past few years, but two weeks before I saw her I had, for the first time, injected filler in her cheeks. The aging of the mid-face has, with the development of better and linger fillers, become recognized as one of the primary events that makes a person look aged. The young face is full, with smooth, convex surfaces, while the aging face becomes concave, with the loss of deep tissue and other structures. This produces depressions such as the "tear trough", a groove that extends downward and sideways from the inner (medial) part of the eye. It was this area that was filled in my patient. She was smiling as she reported that even her teenage son, without knowing that anything had been done, told her that she looked good.

Volume Loss and the Aging Face

There are a number of factors that combine to make our faces look older with time, but the two most important factors are changes in the quality of the skin and the loss of volume. The skin quality changes, that are markedly worsened by factors such as sun exposure and smoking, have long been recognized, but the changes due to volume loss have come to be appreciated only recently.

The most underused cosmetic procedure

People come in to our office requesting a variety of procedures. Botox and fillers are among the most frequently requested procedures, but the newest use of fillers, what we call "facial Sculpting" is almost never the patient's initial request. Yet, when shown photographs of the results, many patients choose to have it performed at the time of the visit, or schedule a subsequent visit to have it done.

Fillers

Fillers are becoming an increasingly important tool in facial rejuvenation. It is interesting that most patients are unaware of the range of uses that fillers can be put to. Collagen was the first filler to find widespread acceptance, but, because of its short effective life, it is now used much less.