Question: I am 51 and noticing a loss of facial volume in my cheeks, temples, and nasolabial folds. I know I need fillers but want to look natural. How do I prevent my face from becoming distorted from fillers?

Answer: It is important to seek a highly skilled injector who not only has superior injector skills but also understands the complex facial anatomy and has a strong aesthetic eye for facial balance and proportion. Too often patients price-shop for fillers with the faulty belief that since it’s not surgery, anyone can do a good job. It’s easy to puff up a facial area with filler, but restoring volume for the long haul to give a more contoured facial structure with a natural, refreshed look requires a higher skill level.

In addition to skill, how long a filler lasts is important. For fine lip lines, it’s okay to have a 6-12 month hyaluronic acid (HA) filler like Juvederm, Restylane, or RHA, because the filler is placed in the superficial or upper skin layers as tiny, micro-deposits.

Temporary fillers for deep facial volume loss such as with hollow cheeks and temples or deep smile lines can lead to facial distortion over time after repeat injections to the same area. It’s important to be aware that each time you have filler, it leads to scarring under the skin surface along the injection pathway. Repeat filler every 6 to 12 months to the same area introduces additional scarring with each treatment. With serial treatments, scar tissue build-up gradually blocks the flow within lymphatic vessels, slowing down the clearance of toxins and resulting in fluid build-up and a puffy, artificial, and overly smooth look to the face in the treated areas. Unlike short-term fillers, permanent fillers like Renuva as well as Bellafill – the 5-year filler – introduce much less scarring or blockage of the lymphatic system since they last much longer and are not injected as frequently.

The type of filler is also important. It is well known that HA fillers like Restylane and Juvederm work by attracting water from your body. With the first few injections, HA fillers can make your face appear hydrated. Continued HA filler treatments, especially as one continues to age, can result in an over-filled or overly smooth appearance to the face. A biostimulatory filler such as Bellafill or a regenerative filler like Renuva works by stimulating your body’s own collagen or fat tissue. Because these fillers don’t work by attracting water molecules, they can give a more natural and contoured facial appearance.

If you want look natural and avoid scarring, fluid build-up and the resulting puffy, artificial look that develops over time from repeat temporary HA filler treatments, a long-term filler placed by a highly skilled injector can prevent facial distortion, Bellafill – the 5 year biostimulatory filler – or Renuva – a regenerative filler – can be very effective options for improvement of hollow cheeks and temples, deep nasolabial lines or marionette lines. Long-term fillers are an even more important consideration if you are considering facial rejuvenation surgery since scarring from repetitive temporary filler treatments to deep soft tissues can interfere with surgical tissue planes.

As a specialist in the face and neck, Dr. Mandal’s philosophy is to reverse the signs of aging without making you look different, unnatural, or distorted. She believes that after a cosmetic procedure, patients should appear rested, refreshed, more youthful, and look as if they are simply aging beautifully without obvious signs that a cosmetic procedure was performed.