Volume depletion occurs with aging, and this is not just due to reduced fat cells, but also to bone loss. The maxilla rotates inward with age, and bony mass in the chin decreases. Put this together with reduced fat and sun exposure, and you have a strong aging effect visible with the changed draping of the facial skin, Dr. Carruthers said.
Explore This IssueAugust 2008
One way to describe the effects of aging on the skin in relation to the bone and fat changes that occur is that the tablecloth is too big for the table, she continued. The skin on the face slowly and inexorably sags.
Typically, we use Botox and injectable fillers together. Botox treats the dynamic action of the muscles and relaxes them, preventing creases from getting deeper. If the crease is severe, we use Botox plus fillers, Dr. Henderson commented. Dynamic wrinkles respond to Botox, whereas sun damaged skin requires fillers and resurfacing.
In the past, surgically placed implants were used to plump up areas such as the chin and the cheek. The downside of implants is that they are palpable and sometimes become visible over time. Also, they are delicate to place.
Implants are not ideal, because even after you place an implant, the aging process continues. Now we augment surgically placed implants with injectable fillers, Dr. Carruthers said.
-Jean Carruthers, MD
Injectable fillers give excellent results for folds and wrinkles on the face, depressed mouth corners (marionette lines), sunken under-eye folds, and other frown lines, Dr. Carruthers said. One advantage of using injectable fillers is that patients can watch the procedure and participate by responding to the effects. Usually, injectable fillers need to be repeated every five to eight months. Another advantage of fillers is that that they work right away, whereas Botox takes two to five days for the full effect to be visible. Injectable fillers that are good for superficial procedures include hyaluronic acids such as Restylane™ and Juvederm™; Juvederm Ultra Plus™ and Perlane™ are preferred as deeper fillers. These fillers are made from naturally occurring substances and are very rarely allergenic.