Does having fillers before serious volume loss prevent the sagging upside down triangle?

I'm aware that starting botox early prevents lines and wrinkles associated with movement, does having dermal fillers offer similar benefits. I'm already having botox done and using retin A. I'm in my late 20s and smoked for over a decade and being of Irish descent the damage was already done. Does having fillers before serious volume loss prevent the sagging upside down triangle. Also does botox improve very fine static lines with long-term use. Still have them in eye area after 2 years of botox

Doctor Answers 4

Modalities to Prevent Aging..

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Thanks ciaren for the really great question. Aging can come about as a result of intrinsic (eg, genetic) and extrinsic (eg, environmental) factors, resulting in deterioration of skin (spots, fine lines and wrinkles), deflation  (volume loss from diminishing collagen and elastin) and descent (gravitational forces) of tissue. Over time, this causes the youthful upside down triangle to become an upright sagging triangle.

A great rejuvenation and preventative aging program best attacks all these aspects of aging to help transform one's appearance:

1) a. Lasers (fractional, ablative or nonablative) and IPL (Intense Pulse Light) can improve fine static lines, pores and color (reds, browns) aberrations.

    b. Neurotoxin  (eg BOTOX) can help mitigate dynamic wrinkles which can slowly etch into the skin. You are correct..the sooner you are able to stop the movement, the easier you are able to soften those etched lines. Stubborn lines can be improved with lasers.

2) Loss of volume can be addressed with fillers. A less viscous product can be used for nasolabial folds, while a heavier product can help volumize cheeks. A product with lifting ability, such as Voluma, can improve sagging tissue while volumizing.

3) Modalities to further improve descent of tissues include devices which slowly help the body build collagen such as radiofrquency (Thermage, Profound, Sublime) or ultrasound (Ultherapy).

All this combined with an improvement in your life style  (stopping smoking, exercising) as well as nutrition will surely hit a home run for you!

Best of luck!

Dr. K

Los Angeles Ophthalmologist

Fillers and Botox to prevent Aging

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Fillers and Botox will definitely prevent aging.  Sculptra and Voluma will add volume and needed collagen to the skin and improve the wrinkles and damage that you did.  Please consult an expert for the best cosmetic results.  Best, Dr. Green

Managing age related changes in the face

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It sounds like what you may be looking for is to replace lost collagen and to delay/reduce future loss of collagen. The fine static lines you describe are collagen loss, and as you have seen botox is not helping the area much. Our fibroblasts "know" how to make collagen, they just are not generally doing so unless an injury has occurred or they are getting the right chemical signals. So, consider the combination of a home skin care program that has been proven to stimulate new collagen production (some examples: Alastin SkinCare, or Skin Better). Retin A is fine but its effect on collagen is fairly minimal because it remains extracellular. It's primary strength is increasing cell turnover so your dead skin cell layer does not get thick. Retinol is the form of topical vitamin A that goes intracellular and has the true anti aging benefits. Beware that thousands of OTC skin care products state they contain retinol but in fact have so little of it and of such a poor quality that it will do NOTHING- just a marketing scam. Alastin has a high grade retinol, ZO Skin Health has a high grade retinol (Retamax for example), and the Skin Better line has an entirely new retinol which is very effective, very potent and causes almost no irritation even for sensitive skin (AlphaRet Intensive overnight cream). Now, for procedures- what you are looking for is collagen induction procedures- these procedures create a therapeutic "injury" which triggers your skin cells to make new collagen. Examples: Medical microneedling, Medical microneedling with platelet rich plasma- the so called Vampire Facial, or energy based treatments such as fractionated laser or radiofrequency skin resurfacing, Ultherapy smoothing treatment (microfocused ultrasound), and many more. A good plan for microneedling would be to do 3 or 4 sessions a month apart, then maintenance of 1 session every 3 month. This combined with a high quality skin care regimen is very potent. 

Volume loss will occur with age and can be replaced with dermal filler as it occurs, not preventatively. 


Lisa Vuich, MD

Lisa Vuich, MD
Nashua Physician
4.7 out of 5 stars 11 reviews

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Fillers used as prevention of sagging?

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Fillers will not prevent volume loss. You body will still age and the fat, muscle, and bone loss will still occur. If you keep up with the volume loss using fillers, the skin will not sag as much. There are still skin changes associated with aging. Retin A helps with this, as you are doing. Other measures to help the sagging process are RF (Infini), laser resurfacing (Fraxel), and chemical peels. Some docs have coined the term "PREJUVENATION" and it fits in this case.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.