April 28, 2021 – Injectable skin fillers offer a minimally invasive approach to reduce fine lines and wrinkles on the face while restoring facial volume and fullness. Over 2.7 million dermal filler procedures were performed in 2019, according to the most recent statistics of American Society of Plastic Surgeons (ASPS).
Even as the popularity of dermal fillers continues to soar, plastic surgeons are still looking to maximize their benefits for patients seeking non-surgical facial rejuvenation. Most studies used subjective scoring systems, with little objective evidence of the results obtained.
A recent study suggested that in addition to their “volumizing” effects, dermal fillers may also have varying “lifting” effects.. Sebastian Cotofana, MD, PhD, of the Mayo Clinic, Rochester, Minnesota, and colleagues designed a study to measure the true lifting effect of soft tissue fillers in different areas of the face. Their study appears in the May issue of Plastic and Reconstructive Surgery®, the official medical journal of the ASPS.
In the experimental study, the researchers performed standardized injections of skin filler in specially prepared facial cadaver specimens. The injections were given to areas commonly targeted in minimally invasive facial rejuvenation procedures: the forehead and temple; the medial face region, comprising both the medial (central) and lateral (sides) areas; and the perioral area (mouth and chin) and jaw.
To measure the effects of the injections, Dr Cotofana and his colleagues performed before and after scans of the facial surface using advanced three-dimensional scanning technology (Vectra 3D imaging system). The same type of 3D digital imaging system is now commonly used to assess and even simulate the results of plastic and reconstructive surgery procedures.
Scans performed after skin filler injections showed significant increases in local soft tissue volume in the central areas of the face. This was consistent with the well-established clinical effects of “injectable” therapy in the medial regions of the forehead, mid-face, and mouth and chin.
Central facial injections have also shown local lifting effects, including up to a millimeter of vertical “lifting” in the forehead area. However, there was no accompanying regional lifting effect – for example, forehead injection produced no lifting effect in the central areas of the middle or lower face.
Injections in the lateral areas of the face such as the temple, middle of the face and jaw also produced local volume and lifting effects. In addition, the side facial injections created “additional regional lifting effects” in the surrounding areas of the face. For example, the injection into the temple had a slight but significant lifting effect on the lateral medial aspect and jaw.
The combined injection techniques have provided even greater benefits. Added to deep fill injection, a superficial temple injection technique produced an additional 17.5% increase in temple lifting effect, plus a 100% increase in lifting effect of the jaw.
“These results indicate that lateral facial injections co-influence adjacent lateral facial regions and thus may induce regional lifting effects,” write Dr. Cotofana and his co-authors. The results are consistent with previous knowledge of in-depth facial anatomy: Filler injections can cause a change in the tension of the connective tissue (fascia) under the skin, resulting in “repositioning” of the upper layers of the skin.
In this way, filler injections can provide a small but significant lifting effect in a minimally invasive and repeatable procedure. Of course, the gravity-defying lifting effects don’t come close to the impact of facelift surgery. In addition to confirming the previous results on the lifting effects of facial injectables, the study “also broadens their applicability to the total lateral face … to obtain local and regional lifting effects.”
DOI: 10.1097 / PRS.0000000000007857
About Plastic and reconstructive surgery
For over 70 years, Plastic and reconstructive surgery® (http: // www.
the American Society of Plastic Surgeons is the largest organization of certified plastic surgeons in the world. Representing more than 7,000 member physicians, the society is recognized as a leading authority and source of information on aesthetic and reconstructive plastic surgery. ASPS comprises over 94 percent of all board certified plastic surgeons in the United States. Founded in 1931, the company represents physicians certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada.
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