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As we age, the volume in our face both decreases and shifts downwards due to the pull of gravity. A more youthful appearance is characterized by a fuller round face while an aged appearance is more hollowed and elongated. Volume shifts in the face create both areas of hollowness and fullness. Hollowing or depressions occur most commonly under the eyes and in the cheeks, while fullness occurs in the fold extending from the nose to mouth and in the jowls. Fillers can be used to both fill the hollowing and to blend the fullness of folds, and most importantly when injected at the appropriate depth can actually result in a “mid face lift” and brow lift. Certain fillers are also used to augment the lips and others are used to improve fine lines.

While at first making the choice of what filler would be best for you may seem very daunting, it is much easier in reality as specific fillers have been designed to achieve maximal results in defined facial areas. For every changing part of your face, there is a specific filler to do the best job. Depending on both the type of filler and the area treated, the results may last from 6 to 10 months to up to a few years. Many even enjoy longer lasting results when the filler successfully promotes collagen ingrowth and leads to improved volume even as the filler dissolves.

Under Eyes: Dr. Heher prefers Restylane®

Restylane® was the first FDA approved hyaluronic acid filler in the US and while it can be used to treat many areas of the face, it is the safest of all fillers for the tear trough area. Dark circles can form under your eyes creating a tired looking appearance even when you are feeling well rested. This appearance is usually created by a hollowing that extends from the inner corner of the eye down towards the cheek. Restylane® is injected in this area to bridge the fuller lid above with the fuller cheek below, smoothing the transition of the contour. When the hollowed area is filled, the dark circles soften and become less noticeable. In some where there is too much puffiness in the eyelids above the dark circles, Restylane® will not work and blepharoplasty surgery may be a better alternative.

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Cheek Lifts: Dr. Heher prefers Voluma ™, Radiesse® or Restylane Lift®

Most of us as we age will notice a flattening in our cheek just below the cheek bone. This is caused by descent of the cheek pad that causes fullness of the fold extending from the nose to the mouth. Some will also develop a bag that sits right over or above the cheek bone. Both of these aging changes can be improved by injections of a filler in the cheek to replace volume and smooth the contour. Fillers are now available that will actually both fill and “lift”. Placement of fillers over the outer cheek can lead to lifting of the descended cheek pad that in turn diminishes both the fold that extends from the nose to the corner of the mouth and the jowls.

Nose to Corner of the Mouth Folds (nasolabial folds) and Jowls:
Dr. Heher prefers Juvederm™ or Restylane®

Many of us will note a deepening of the fold that extends from the nose to the corner of the mouth. This is caused by the drooping of the cheek as it is pulled down by gravity. Filler is used to bridge the fold and smooth the contour creating a softening of the fold.

Many of us will also develop fullness extending downward from the corners of the mouth and this is referred to as jowls. While some are good candidates for a facelift procedure to improve this area, many can gain improvement by camouflaging this aging change with filler. In addition to jowls, many will also develop a downturning of the corners of the mouth that creates a sad appearance. Fillers can now be used to replace volume that in turn lifts the corner of the mouth, restoring them to a more youthful position.

Lips: Dr. Heher prefers Restylane Silk® or Juvederm™

Many of us will note thinning of our lips and the development of fine lines as our lips lose volume over time. Fillers can be used to replace the lost volume and to inflate the vermillion border where the red edge of your lip meets the skin. Replacement of volume can lift the upper lip, and fine vertical lip lines can be smoothed on both the upper and lower lips. Most of us with age lose the gentle anterior projection of the lips, and care must be taken to replace this while maintaining a natural appearance. Where many of us are fearful that our lips will look overdone and too large, the treatment is designed to achieve a subtle more youthful effect.

Fine Facial Wrinkles: Dr. Heher prefers Restylane Silk® or Belotero®

As we age more and more fine lines become slowly etched into our smooth facial skin. Some of these are formed from facial expressions and others from sleeping. Belotero® and Restylane Silk® are especially designed to soften and smooth these lines, discreetly blending them like no other fillers.
© Katrinka L. Heher, MD | 617.426.0082 | 185 Devonshire Street, Suite #350 | Boston, MA 02110 | Site Map