The Importance of Precision Facial Filling

Go to any cocktail party or benefit and you see them: Overfilled faces. Many women have lips and cheeks that are too big and clearly overinjected. It wasn’t supposed to be this way. Just 10 years ago, the problem was that faces were overpulled, flattened, and had bizarre earlobe deformities. When hyaluronic acid fillers and fat injections came to the forefront, it was felt that restoring volume was what was missing from facial rejuvenation. These volumizers were billed as a cure to the bizarre appearances you were seeing around town. However, we seem to have traded one set of deformities for another.

Why is this going on? There are many contributing factors, there are 3 things you should know as a patient considering fat or fillers: 1. The Foundation of Facial Anatomy. 2. Fillers are not a Cure All. 3. Respecting the Harmony of Youthful Faces. Precision facial filling is a catch-all term I use to describe the artistic and anatomically-accurate use of fat and fillers. Although plastic surgeons have the best background to accomplish this, any good dermatologist, nurse injector, or aesthetician can learn these principles and get really nice results.

The Foundation of Facial Anatomy

Doctors are busy. These days, you’re lucky to get 30 minutes of a doctor’s time. Because of this insane time crunch that doctors are under, we don’t go back to basics. Anatomy is the foundation of everything that we do. Ten years ago, I was the anatomical research fellow in the Department of Plastic Surgery at UT Southwestern in Dallas, Texas. At the time, it was the mecca of aesthetic surgery, with some of the world’s most renowned plastic surgeons. We discovered that the body’s fat was compartmentalized by fascial membranes which originate from the bone and deep tissues and insert into the skin. Previously, ligaments had been noted here and there, but until we used a special dye stain and microscopic dissection techniques, we didn’t see these membranes. This anatomy underlies the way the face looks, why you have creases in certain areas, and contributes to the way in which the face ages. An understanding of these anatomical nuances allows the surgeon to inject a little bit here and a little bit there to achieve the desired volume and contour, instead of having to randomly inject large lumps of fat or filler haphazardly.

Fillers Are Not a Cure All

In plastic surgery, the best results are typically obtained when more than one solution is thrown at the problem. Facial fillers are no different. When doctors try to erase every line with filler, they are going to have to use a lot. This is expensive, and leads to overfilled features. Fillers work best when they are injected deep and superficial, in lines and around them, and then combined with facelift surgery. Throwing ever more volume into the fat compartments doesn’t restore their youthful tension – that requires surgery.

Respecting the Harmony of Youthful Faces

If you look at a young face, it is full. Cheek and forehead highlights are round and glowing. As we age, those youthful contours flatten and dim. It makes sense that restoring this volume is an important part of facial rejuvenation. However, when fat and fillers are overinjected, instead of obtaining a nice contour, cheek contours are fat and blunted. When lips are overfilled, you see less and less of the upper teeth; upper tooth show is a huge part of looking young. These undefined looks aren’t pleasing to the eye, and it’s why you have a negative reaction when you see someone whose face has been overfilled.

As doctors, nurses, and aestheticians inject more and more filler, we are seeing more of these unfortunate results. As a patient, if you are armed with information, you can speak more intelligently with your doctor and work together to achieve the result you desire. An informed patient is a good patient, and that’s something we all want!

Yours Truly,
Daniel A. Hatef, M. D.