The aging face is the summation of several different factors. Skin pigmentation (hyperpigmentation, solar lentigos) and textural changes (wrinkles, pores) are the results of accumulated UV damage (sun damage), age related tissue changes (loss of collagen, thinning dermis) and over-activity of the facial muscles. These skin issues can be improved with lasers, chemical peels, neuromodulators (Botox or Dysport) and a high quality skin care regime that includes some form of Retin A (or retinoid) and growth factors. However, the most significant reason a face “looks old” is the due to volume loss. As a person ages, fat, muscle, and bone are lost leading to:
- Temporal wasting which also causes laxity of the skin around the eye
- Bags under the eyes
- Droopy upper eyebrows and eyelids
- Tear trough and malar (cheek) groove formation
- Sagging or loss of well defined cheeks
- Deepening of the nasolabial folds
- Jowls and marionette lines
- “Pointy” chin
- Lengthening of the space above the upper lip (because of bone and fat absorption)
- Hollowing in the area in front of the ear
- Loss of the well defined jawline
- Loss of lip fullness
- A nose that appears longer (actually its not, but looks that way because the surrounding tissue has resorbed)
Another “by-product” of volume loss is overall facial skin laxity. Up until recently, the consensus among plastic surgeons was that the loose skin was mainly the result of the effects of gravity. This lead to the rational for tightening the face with facelifts. Unfortunately, many people who had this procedure, had tighter skin but actually looked worse. The surgeons weren’t accounting for the volume loss, and faces looked windblown or skeletonized.
In reality, many people can be completely improved with fillers for volumization and avoid surgery altogether, or at least put if off for several years.
The popularity of dermal fillers has grown from filling the smiles lines and lips to placing them in just about every aspect of the face. Fat loss is the primary reason for the volume lost in the face and there are dozens of named fat pads throughout the face. The most popular products, such as Juvederm and Restylane, are made from hyaluronic acid (HA), a naturally occurring component of the skin and joints. There is a “dissolver” called hyaluronidase which can be injected into the filler and within hours to days can remove any misplaced product. This is a nice safety valve for the patients that have some hesitations about the procedure. Unfortunately, the results of these fillers usually last for about a year. A new hyaluronic acid filler, Voluma, has been reported to last up to 2 years.
Another class of fillers is called “collagen stimulators”. These products, when injected, stimulate the body to produce collagen. Newly formed collagen can last years if it was not subject to breakdown by UV exposure, oxygen radicals, and aging. Radiesse and Sculptra fall into this category, and are made from naturally occurring substances in the body, calcium and a sugar, respectively. These products last longer than the HA fillers, up to 2-3 years for Sculptra, and there is no “dissolver” for these. Most patients who get these fillers have already tried the HA’s and want a longer duration correction.
Bellafill is a collagen stimulating filler that can be considered a permanent filler. It is composed of poly methyl methacrylate (PMMA), a synthetic material, which has been used in the operating room since 1949. The filler is composed of millions (per cc) of symmetric, identical spheres of PMMA, that are a little bigger than a white blood cell. They are suspending in bovine collagen which is absorbed in 4-6 weeks. There is a chance of an allergic reaction of the collagen, so all people need to be tested (by placement of a small quantity in their forearm) before getting Bellafill. The correction obtained by the Bellafill is long lasting because the body can’t break down the PMMA. As the body digests the bovine collagen, it is creating its own collagen in response to the PMMA spheres. Studies have shown that the correction at 5 years is even better than the 1 year result. The only other fillers that come close are fat and silicon. Fat requires a harvesting procedure (liposuction) and is very difficult to fine tune. It also has unpredictable “take” so touch ups are the norm. Silicon, is not an FDA approved filler, and requires multiple procedures to get to the end result. It has also been noted to have a significant risk of granulomas, something that has not been borne out with Bellafill.
Bellafill is typically injected in a kit of 5 syringes, but many people will require more than this. Also, it is probably best to plan the full correction in 2 stages – with the first one being about 2/3 of what is actually needed and upon a follow up visit 2-3 months later, the fill is completed.
Certainly Bellafill is not for everyone getting filler. The best candidates are patients with mild-moderate volume loss who are experienced with other fillers and have “injection fatigue”. Although the cost upfront is more than other fillers, it is more economical than all other fillers when considering its longevity. One other very important factor is to choose your physician carefully. The results of Bellafill are permanent, so you want to go to a very experienced injector who is very comfortable with using blunt cannulas (the preferred method for filling) and knows the anatomy of the aging face extremely well.
Dr. Steven Weiner is a Board Certified Facial Plastic Surgeon practicing in Santa Rosa Beach, Florida, between Destin and Panama City Beach, Florida. After laying down his scalpel in 2005 he has devoted his practice to Lasers and Injectables.