Injectable Soft Tissue Fillers and Their Use in Facial Rejuvenation

Minimally invasive and nonsurgical procedures for facial rejuvenation have increased exponentially in the last decade. The main reasons for the above are the consumer’s demand for reduced downtime and accessibility of cosmetic treatments, as well as the increased awareness with emphasis on self-improvement. That is why in particular dermal fillers and neuromodulators have been increasingly performed not just by surgeons but also physicians across all specialties as well as mid-level practitioners at medical spas. This is not surprising as dermal fillers have become the gateway treatment in aesthetic medicine and have become a household name in our society globally. Keeping up to date with the accelerated evolution of injectables is challenging for many practitioners and demands continuous education and knowledge update. With the increasing popularity of social media, the above trend has increased exponentially as the “selfie culture” has made us more aware and observant of our facial features than ever before. This coupled with the race to compete with the aesthetic norms and constant comparison with our peers and beauty idols has created what is today known as “Zoom dysmorphia.” The latter, classically known as body dysmorphic syndrome, has been reported in the literature to comprise roughly 7–10% of patients walking into an aesthetic practice. Today, dermal filler treatments have increased by 174%, with an average of 3,410,730 fillers injected. This is despite the decreased access to cosmetic procedures from 2019 to 2020 due to the COVID-19 pandemic (Plastic Surgery Statistics Report, 2020). Despite the above trend, there has been a paradigm shift in the way we utilize facial fillers in aesthetic medicine today. Traditionally, fillers were utilized to counter the gravitational effects of the aging process, which is initiated by the increased laxity of the dermal as well as the deeper SMAS (superficial musculoaponeurotic system). This occurs because of the downregulation of collagen and elastin production of our soft tissues in combination with bone atrophy, and the net result is ptosis and transposition of the facial soft tissues. In recent years, we have learned that this is not possible without over-volumization and distortion of the facial features, which has created a rather unaesthetic appearance and proper interference with the mobility of the facial soft tissues during animation. As a result, it has changed our present view and approach in the utilization of dermal fillers in facial rejuvenation and is now mainly recommended for the correction of absolute deficits, hollowness, and the enhancement of wanted facial features. The specialized training of oral and maxillofacial surgeons gives us the advantage of a comprehensive understanding of facial anatomy and aesthetics. This is important as only the proper diagnosis can lead to the proper choice of any therapeutic treatment. In-depth knowledge of facial anatomy and physiology is also important since, by definition, any injection into the human body is considered an invasive procedure and can lead to potential adverse effects like tissue necrosis, emboli, blindness as a result of intravascular injection, or occlusion. In addition, the proper management of patient expectations warrants precise physician-patient communication, patient counseling, and informed consent that includes the knowledge of and ability to manage possible complications and adverse effects associated with injectables.