Introduction

Many options are available to the individual wishing to ameliorate such facial signs of aging as rhytids (fine lines, creases, and wrinkles). In response to ongoing demand, research is focusing on new and better ways to do so. In consultation with the dermatologist or cosmetic surgeon, the patient can explore these options in detail and arrive at an individualized plan. In some instances, combining procedures may be an excellent choice.

Over time, senescence of the skin, elastosis, decreased collagen, and lipoatrophy lead to the loss of the face’s youthful turgor and tightness, resulting in the appearance of radiating vertical lines around the lips and mouth, deepening and furrowing of the nasolabial folds, and the development of a longer and flatter upper lip leading to a thinner lip vermilion border. These changes begin to appear in a person’s late 20s or early 30s, and they may become a growing concern for individuals in their 30s, 40s, and 50s [1]. People are living longer and want to achieve their best appearance for their entire life, and soft tissue augmentation is one of the few cosmetic procedures that can be used in all skin types (Fitzpatrick I–VI) [2, 3]. Figures 6.1a,b and 6.2a–d are before-and-after photos that demonstrate the results from soft tissue augmentation. This section focuses on procedures and products to ameliorate the fine lines, creases, and wrinkles associated with age and exposure to the elements as well as the process of revolumizing the face.
For the individual desiring to rejuvenate his or her face by treating perioral signs of aging, there are many options available, including use of botulinum toxin, injectable fillers, microimplants, and combination therapy. These include soft tissue fillers that may be synthetic, animalderived, human-derived, or autologous–the latter harvested from the patient’s own vein or fat. The primary action of these products and techniques is to induce collagen formation and/or occupy volume and space. The dermatologist or cosmetic surgeon can assess the patient’s needs and desires and propose a course of treatment from among available products and techniques.

Fillers are categorized as permanent, semipermanent, and temporary. The majority of injectable fillers are temporary, lasting from several weeks to several months, although some reportedly last 9–12 months. Many of these processes require ongoing treatment to maintain the desired appearance. Injectable microimplants are, for the most part, semipermanent, although some newer products containing microspheres are temporary. Synthetic implants are permanent, remaining in place unless removed surgically; human-derived or cadaverderived implants, while long lasting, do not appear to last indefinitely. Finally, autologous implants and injectables vary in their longevity.


Each type of soft tissue filler or implant has its own advantages and disadvantages. Candidates for treatment must consider factors such as product availability, treatment complexity (number of required serial treatment sessions), necessity for local anesthesia, longevity of augmentation, contraindications, allergy testing, potential complications, cost, and technical expertise required of clinicians.

General contraindications include any active disease (including diabetes) that may affect risk or outcome; disorders involving collagen, scarring, or connective tissue; lupus (dependent on type of treatment); recent treatment with isotretinoin; and clotting problems. Each type of treatment may have additional contraindications, and these are discussed in the appropriate section below.

New products and techniques are being developed at a rapid pace in numerous countries. Clinical trials are in progress for many products. Product availability varies widely, and a variety of products are being used off-label. Dermatologists and cosmetic surgeons should regularly review treatment options to provide the best care possible for patients.