Understanding Where Fillers Work — and Where They Don’t
Fillers can create stunning results or can create a whole new problem for you. Knowing exactly where to use fillers to replenish the volume loss. But you need to walk away when it is used as a mechanism to lift the sagging face, which can actually cause your face to look older. So, I am going to explain to you where filler works, where it fails, and when you need something else altogether. I'm Dr. Kevin Sadati, a board-certified facial plastic surgeon, specializing in Preservation Deep Plane Facelift. I have performed over 5,000 facelifts over the past 20 years.
How Aging Affects Facial Volume
When we get older, we lose facial volume. Even though the skin may not appear thin, it becomes less supple. We're losing fat in specific areas. Fat pads deflate and migrate downward. This may result in hollowness of temples, sunken under-eyes, flattened cheeks, and a loss of volume around the mouth. During the aging process, some of the facial volume is lost, and some of it is actually displaced. That's why just adding filler everywhere doesn't work. In my practice, I perform a procedure called the facial fat grafting in conjunction with my Preservation Facelift. Putting these two types of procedures together is what gives the face that natural facial rejuvenation that helps my patients look decades younger, but still like themselves.
Where Fillers Actually Work Best
So, let’s discuss where the use of fillers actually makes sense. There are four places where a little bit of filler is ideal. After twenty years of practicing as a facial plastic surgeon, I now understand better what the benefits of filler are as a tool in my toolbox, rather than just stating the fillers are horrible, fillers have problems, fillers aren't good, but I’m going to discuss specifically where fillers are great and maybe better than the alternatives.
Fillers for Lip Enhancement
Number one, lips. Fillers work great for the lips. Why? Because fat transfer does not work well to volumize the lips. This is because all that movement and chewing and talking prevent the newly grafted fat a chance to vascularize and survive. In addition, fat survives where previously it didn't exist; lips don’t have fat in them. So, a bit of lip filler is a perfect solution for volumizing them. However, I'm not a fan of it when people are attempting to excessively augment the lips and make them look bigger and out of proportion to the face; they aren’t going to look natural, and everyone will notice that.
Fillers for Under-Eye Hollows (Tear Troughs)
Number two is filler under the eyes. If you're in your 20s and 30s and see a bit of hollowing in your tear troughs, it is a good idea to get a bit of filler for the hollowness. But if there is significant hollowness and under-eye bags, then fillers are counterproductive; you may need lower eyelid surgery. A small amount of filler in the tear-throughs and the correct position is a very good solution. It’s perhaps one of the best options because it's controlled and it isn't going to cause many side effects. However, large volume and incorrect filler type can cause the Tyndall effect, a dark-blue color under the eyes. The best filler for this area is the one that doesn’t absorb much water. Restylane is generally a better product than Juvéderm. Juvéderm is, for sure, a nightmare under the eyes. On the other hand, I don’t recommend repeated filler for the under-eye area, maybe once or twice in your lifetime. As opposed to what the filler companies claim, that fillers last 6-9 months, in fact, fillers last under the eyes for years. So, this is not something you should be doing repeatedly. Now, when you do overfill the under eyes, you risk the Tyndall effect, a dark bluish, almost dark discoloration under the eyes. I can immediately notice it as soon as I walk into a room, seeing someone with overfilled under eyes because of the dark bluish discoloration. Now, if this happened to you, a professional provider could dissolve the hyaluronic acid product with hyaluronidase, an enzyme that can break down the filler and eliminate the Tyndall effect.
Fillers for Temple Hollowing
Number three is fillers to the temples. A bit of filler for the temple hollowing can be very effective. As we age, the temples become hollow due to loss of fat and muscles in the deep and superficial areas. Therefore, when you put a little bit of filler in the temple area, you can get a more youthful shape back in that upper third of the face. You must be mindful when choosing an expert to fill this area. Injecting filler into the temples and around the eyes can be incredibly tricky and risky if not performed by an expert. Because the filler can potentially be injected into blood vessels, since there are networks of blood vessels around this area. Therefore, injection into a blood vessel can lead to severe complications like blindness and disruption in tissue circulation, leading to skin necrosis. I always tell my patients, if you’re going to get a filler injection anywhere around the eyes, make sure to choose a provider who knows what they’re doing and knows their anatomy. I believe Sculptra is more suitable for the temples. This filler is more of a tissue stimulator, and it is a good choice for deep tissue injections. It is better than hyaluronic acid fillers in temples.
When Fillers Fail: Trying to Lift the Face
Now let’s talk about filler failure. The most common one is when it is used to lift the face. Fillers don't lift; they add volume. If you're trying to fight gravity by adding weight, it will backfire. Trying to lift with a filler creates that heavy, really weighted-down look. It makes your bottom look heavy when the downward displacement of the tissues is causing issues. Basically, it actually adds fuel to the fire.
When Too Much Filler Creates an Unnatural Look
Another filler failure is when it is used in large volumes everywhere on the face. If you're putting filler in your temples, under your eyes, your cheeks, and your jawline all at once, assuming a comprehensive volume loss treatment. That's not the time for filler as a treatment option; instead, fat grafting would be the most effective solution. In reality, if you need to put that much filler all over your face all at once, that means you're far along in the aging process, and putting filler everywhere all at once is a recipe for deforming the face, making the face look different. It's a lot of burden on the tissues to have that much foreign body added at once. In fact, this is the reason why people end up with the pillow face deformity, trying to solve a big problem with lots of small solutions.