Last time we figured out where attractive young people have their volume. If all we were doing with filler was injecting thin-faced young people, we could stop here (good news- If you are a thin faced young person you only need to find an injector who has thought it through this far). But young people with thin faces are generally not the people who are calling our office asking about fillers (which is really too bad- it would make my job alot easier). Unfortunately for most of us, it’s those of us that have started aging who are interested in fillers. So how do we make these people look young and attractive? We need to answer that pesky third question in order to figure this out (for those of you not paying attention the pesky third question was “what is it that happens to volume as we age that causes us to look older”). Now, I’m still patiently waiting for my invitation to join Mensa, I am definitely not in Albert Einstein’s IQ league, and I am not really sure why calculus is called math- but it seems to me if we’re going to add volume to people who are losing volume and want them to look younger and more attractive, we have to figure out why the loss of volume is causing them to look older and less attractive. You may not know this, but I spend a lot of time looking at faces. While this may come as a surprise to you, I have spent a lot of this time trying to figure out what is it that is happening to volume as we age that makes us look older and less attractive (see pesky question #3- amazing coincidence, I know). After looking at many thousands of faces, here is what I see with regards to aging, volume, and filler (we will start from the top and work down because that’s how my brain works best):
Area above eyelids and below browbone
Forehead- Young people have volume over their brow bone, just underneath their eyebrows and just above their upper eyelids. Light hitting the face causes this area of volume to shine. This light reflex just beneath the eyebrow gives this area a very young and attractive appearance (you probably already know this- many of the women reading this apply a light colored makeup to this area to try and create this same effect). One of the earliest signs of aging is that the eyebrows start to fall while the volume beneath it goes away. When this happens, the eyebrows now sit over the top of the brow bone, causing this light reflex to disappear. The result? You look older and less attractive.
Volume in the temples and space below the eyes
Temples- As we age, we lose volume over the temples. This happens especially in thin people. This loss of volume causes an older, slightly unhealthy appearance.
Lower Eyelids- As we age, the upper part of the lower eyelids has too much volume (the “bag”) while the lower part has too little (the groove). This also causes the lower eyelid to lengthen, making us look older and less attractive.
Volume in the cheeks and middle portion of the face
Cheeks- As we age, the tissue in the cheeks fall. This changes the face from an oval shape to more of a square shape (oval= young and attractive, square= old and unattractive).
Nasolabial Folds (often referred to as the “smile lines” around the mouth)- As we age, the falling cheek tissue builds up along these folds, causing the creases to become deeper. The problem here is not a lack of volume in the crease, but the fact that there is too much volume pushing up against the fold (this is where we have injected most of our filler over the years and what do you know, it’s really not where we want it).
Volume in the lower part of the face, volume in the lips, and the smooth smile lines, or nasolabial folds around the mouth
Lower Face- As we age, the falling cheek tissue adds too much volume to the lower part of the face, making the overall contour of the face bottom heavy, causes jowls to appear, makes the jaw-line indistinct, and blends the face and the neck into one structure (ughhhh). Once again, this is not where we want to be injecting our filler (and where we have injected gallons of the stuff over the years).
Lips- As we age, the lips start to thin (making them almost disappear when we smile), the edges of the lips flatten and lose definition (we lose the “pucker”), and the philtrum (the 2 pillars going from the nose to the middle of the upper lip) disappears (making the area between the nose and lip look long, flat, and you guessed it- old). Also, the loss of volume underneath the corners of the mouth causes the corners to fall, creating a somewhat sad appearance.
Neck- As we age, our neck seems to take on more fat, extra skin and wrinkles. Oh, and by the way, volume in our neck does not make us look young or attractive.
And there you have it. We need to add back volume. We need to add the volume to the places that make young people look attractive. Finally, we need to add the volume back to those places we have lost it as we have aged. Put all of this together and we really can use fillers to make those of us that are aging (meaning anyone over the age of 30) look younger and more attractive. And (ready for it) here is how we do it. Before we spell it out, remember that these are just guidelines. Every person is unique. If there is something that really, really bothers you that doesn’t follow the rules I am about to lay out, you can break these rules if that is what it will take to make you happy. As a general rule though, if we inject outside of these recommendations, it should be a small injection that is done in addition to injections that are following the rules.
Guess what?! We are finally spelling it out now. This is how we should be thinking about the use of fillers.
- Don’t fill wrinkles (young, attractive people have wrinkles).
- Don’t fill the nasolabial folds, commonly referred to as the smile lines around the mouth (it’s a cheek problem).
- Don’t fill the bottom part of the face (you guessed it- it’s a cheek problem).
- Fill the cheeks. It will make the nasolabial folds and the bottom part of the face look better. If you are on a limited budget, the cheeks are likely where you will get the biggest bang for your buck.
- Don’t forget about the lower eyelids. Filling the groove connects the “bag” to the cheek, making the cheek look higher, and therefore making the lower eyelid look shorter.
- A small amount of filler in the lips makes a big difference (not talking about big, overblown, sausage-like, Goldie Hawn in The First Wives Club lips, but well defined, appropriately full lips with the corners of the mouth no longer turned down).
- In really thin faces (in case you’re wondering I am primarily talking to my really fit women runners) filling the temples makes a really big difference.
- A very small amount of filler just beneath the eyebrows opens the eyes and makes them “pop”.
This is how we do it. It’s our magic potion. It’s our secret sauce. It’s not the way everyone does it. In fact it’s not the way most others do it. But it works really well. And because of that, we’ll keep doing it this way. What I mean to say is that we’ll keep doing it that way until we find another way that works better. I can’t tell you when that will happen, but I can promise you that in the meantime we’ll keep looking at faces… and we’ll keep thinking.