Filler techniques have evolved over the last 15 years. Gone are the days where fillers simply involved injections to corrected lines and folds. Contemporary application of fillers requires a far more advanced knowledge of anatomy and physiology to aesthetically enhance the face.
While each patient presentation has to assessed and treated in a bespoke approach, much more emphasis is directed towards youthful contouring of cheeks, lips, jawlines, temples, nose and forehead. Tear troughs and eye hollows can be gently corrected although great care must be taken to avoid lumpiness and vascular complications.
We now have much better appreciation of skin attachments to deep fixed tissues. These are called the facial ligaments http://asj.oxfordjournals.org/content/33/6/769 that contain and constrain regions of injectable target tissues. A knowledge of where these ligaments are situated affords an advanced practitioner the possibility to fine tune and optimise aesthetic outcomes. From an engineering perspective these ligaments slacken with facial ageing and associated soft tissue volume loss. They are re- tensioned and re-suspended by appropriate filler placement.
We now also have an increasingly sophisticated array of filler choices. Fillers are marketed with various levels of hyaluronic concentration, bonding, particle size and elastic recoil. This allows a practitioner further tailoring choices for ideal filler placement in different areas of the face.
Some practitioners favour sharp needle depot injection techniques like the “8 point injection” method while others prefer the use of broader cannula delivery.
From the patients perspective it does not matter too much which technique is used as long as pleasing outcomes are achieved and the effect is reasonably long lasting.
More on this subject soon!