The Deflating Face

Evan Black, MD

Article by
Detroit Oculoplastic Surgeon

 We’ve all heard about Botox® and collagen type filler products for years. Public interest in these types of anti-aging treatments is at an all time high. What do these substances actually do, and how can they be used to treat problems associated with the aging face?

Facial deflation is the buzz word in the cosmetic surgery community. Thinning lips, deepening creases around the eyes and mouth, and hollowing cheeks all contribute to the appearance of aging. In other words, it is not just about wrinkles, it’s about fat atrophy and deflation. One example is that the “tear trough deformity” or deep groove under the eye can be inflated rather than removing the “fat bag” just above it with the traditional surgical approach. The surgical approach is still appropriate for many patients, but can create more hollowing or a sunken appearance if overdone. Fillers are less invasive, and usually provide excellent results. The good news is that on the rare occasion when the results are less than ideal, fillers are temporary!

Facial fillers such as Juvéderm™, Radiesse®, Restylane®, Sculptra®, and Perlane® are very useful for reinflating the face to create a more youthful appearance without surgery. Because of their versatility and the palate of product options, fillers can be used to treat frown lines/smile lines, deep wrinkles, declining lip volume, vertical lips lines, hollowed cheeks, and some types of acne scars.. The duration of effect of these products ranges from about 6-14 months, longer than their collagen based predecessors.

Botulinum toxin (Botox®) treats wrinkles by an entirely different mechanism. This substance acts by selective muscle denervation. The toxin irreversibly blocks the acetylcholine receptors at the neuromuscular junction, thereby disabling the muscle contraction. Simply put, if the muscles don’t contract, the face doesn’t wrinkle. This effect takes several days to maximize, and function returns to normal in about 3-4 months. Botox® works very well in the forehead/glabellar region, and the crow’s feet areas of the eyelids. It can be used cautiously for peri-oral lines, but temporary complications are more common here. Initial and regular use of Botox® can significantly reduce the appearance of dynamic type facial wrinkles.

As with all medical and surgical procedures, technique is the key to successful results with injectable cosmetic products. Depth of injection, needle placement, and quantity of product administered all make the difference between creating a more youthful appearance or a very unhappy patient! Most complications are temporary, but include bruising, pain, overcorrection (lumps, bumps and temporary facial paralysis) and asymmetry. More serious complications include vascular embolus, eyelid paralysis resulting in corneal damage, and lip paralysis with speech or eating difficulties. When these products are properly administered, and when Botox® is used in conjunction with fillers, the effects can be truly remarkable.