Patient age, volumizing needs drive injectable filler choice

Key Points

Men and women for two decades have been reaping the benefits of smoother, younger-looking skin thanks to products such as Botox (onabotulinumtoxinA, Allergan) and other injectable fillers.

"Today, injectable treatments have become mainstream and people are no longer embarrassed to admit that they've had a little work done, whether they are in their 40s, 50s or beyond," says Nowell Solish, M.D., a cosmetic dermatologist in private practice in Toronto.

As the face ages throughout the decades, different injectables come into play.

Younger patients in their late 30s and early 40s typically have one of two concerns, Dr. Solish says.

"As people age, it is common that they are starting to get lines around their forehead or their eyes - these are dynamic lines from years and years of repetitive movement. These patients are excellent candidates for Botox," he says. "This will serve two main functions: it will significantly improve the lines and also act as a preventive measure to slow down those muscles that are causing the lines.

"The other common problem that bothers patients as they begin to age is nasolabial folds. Here, fillers are great," he says. "For the younger patient, I will typically start out with hyaluronic acid like Restylane (hyaluronic acid, Medicis) or Juvéderm (cross-linked hyaluronic, Allergan) or one of the other hyaluronic acids."

As patients move into their late 40s and 50s, facial volume diminishes, and instead of chasing a line or two, the focus becomes restoring volume and improving the overall shape of the face. Patients may start complaining about their deep nasolabial folds and their falling or sagging skin.

"That's when we get into more volume injectables or fillers," Dr. Solish says, "and that's when you can get the illusion that the face has had a minor lift when the patient hasn't had any surgery at all."

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Injecting the cheeks will give them lift, which also lifts the nasolabial folds upward, according to Dr. Solish.

"Injecting the marionette lines that are sagging below the mouth and dragging that area down can be lifted, and injecting the lateral cheeks or the entire face-cheek area will give volume and help lift the face overall," he says. "These are all accomplished using different types of fillers."