Over the last decade I have been using an increasing amount of facial fillers to rejuvenate aging. There are many reasons for this, including an aging demographic that is in a competitive work environment and retiring later, the recognition by doctors of the importance of replacing tissue loss to aging, and the efficacy and safety of the facial fillers we have for injection.

In spite of there being almost 200 fillers of one type or another available today, by far the commonest used are the hyaluronic acid (HA) fillers. These temporary fillers last from 12 to 18 months, and in some cases even longer. They are very safe, as our bodies are constituted in great part by hyaluronic acid. We also have an enzyme, hyaluronidase, that can remove the product quickly if for any reason the desired effect is not achieved.

These facial fillers are popularly used to augment tear trough depressions below the eyes, the cheeks, cheek-lip folds and “sad lines” at the corner of the mouth. They can also augment lips and lip wrinkles – more about this in a moment.

But I also like Juvéderm® dermal filler and Restylane®, the most common HA fillers, to rejuvenate other, less obvious volume deficiencies.

For example, with aging the bony superior eyebrow margin diminishes, contributing to the look of a sagging eyebrow. Judicious filling in the lateral brow region replaces the lost bony volume and supports the brow, giving it a lifted and more feminine appearance. Some people also note wasting of the temporal muscle which causes a hollowing in the temporal region. Filler here returns a more pleasing contour to the temple.

In the earlier days of facial fillers, a very common use was in the cheek-lip folds. Today I like to place relatively more filler under the nostril base of the nose (called the pyriform margin) to replace bone loss that occurs there.

Everyone knows that facial fillers are used (sometimes, unfortunately, over-used) to “plump” the upper lip. I avoid the overdone look by assessing each lip carefully and then sculpting the lip by judicious placement of filler. Do you know that, in fact, the red lower lip should ideally be about twice the height of the upper? Or that by placing small amounts of filler in the two lower and one upper lip cushions a more sensuous but not over-done look can be achieved? Or that by filling a flat philtral column in the central upper lip a more youthful look is achieved? These are some of the fine details of lip augmentation that experienced injectors know.

Initially most of us used fillers to augment the downturned corners of the mouth or “sad lines.” In recent years I’ve come to really value the benefit of extending the filler down into the pre-jowl sulcus – the hollow in front of the jowls along the jaw line. This recreates a more youthful inverted triangular appearance to the lower face.

Similarly, I now more frequently fill the mental crease, which is the horizontal furrow in the central chin. This replaces lost soft tissue and bone volume and supports the lower lip, creating a subtle but real rejuvenation.