New light on aging

Key Points

La Jolla, Calif. - Because of a shift to considering changes in the aging face to be the result of volume loss rather than gravity, effective new treatment options can now be implemented, according to Kimberly J. Butterwick, M.D., in practice at La Jolla Spa MD.

"Dermatologists are realizing that much of the stigma of the aging face is from loss of volume," she tells Dermatology Times. "Interestingly, the volume that is lost in the aging face is not just fat, soft tissue and muscle, but it is also bone. For example, women experience osteoporosis, and the entire skull gets a little smaller. There is shrinking and remodeling of the bone that changes the underlying foundation for the soft tissue of the face."

More volume

These fillers can be used in numerous areas, such as the sunken temple; the eyebrow, lips and nose areas; and the jaw line.

"For example, the lateral eyebrow tends to drop off from loss of volume," Dr. Butterwick says. "It is helpful to put in some volume there in the lateral eyebrow area to frame the eyes and actually lift the lateral brow. We add volume to the infraorbital area because this region of the skull remodels and the orbit actually enlarges, giving that hollowing look as the bone changes."

Fillers can also be used to effectively rejuvenate the mouth area and the base of the nose, which often droops.

"By placing volume in key areas around the base of the nose and lips, we can get them to lift and project more," Dr. Butterwick explains.

She also notes that in the chin and marionette area, fillers can also be used to enhance volume.

Changing goals

With a new understanding of the aging face come new goals.

"The goals for filling with volume are to restore the symmetry and fullness of youth and achieve an overall lifted appearance," Dr. Butterwick says.

She adds that dermatologists can train their eyes to look at these key areas and see the places that can be naturally enhanced. The jaw line is another important area for restoration. Because of gradual bone loss over time, the chin and jaw areas tend to buckle, losing a smooth continuous mandibular border.

"Therefore placing volume along the bone is very helpful for restoring a youthful neckline," she says.

Today, a variety of fillers are available for volume enhancement.

"In the past, we had to use fat because so many cc of volume were needed and other products, such as hyaluronic acid and collagen, were too expensive. It could get pretty expensive when you are using five or 10 cc of those products," she says.

However, Dr. Butterwick says some newer fillers, such Radiesse (calcium hydroxylapatite, BioForm Medical) or Sculptra (poly-L-lactic acid, Dermik Laboratories) can be used for volume. Other fillers also can be used for volume enhancement.

"Even the hyaluronic acids used in certain key areas can be helpful for small degrees of volume loss," she says.