Fill vs. Lift in Facial Cosmetic Enhancement

This article is a corollary to my other article called the “Two-Finger Rule”. In the article on the “Two-Finger Rule”, I argued that taking two fingers and gently pulling up on the skin would not be achievable with any type of cosmetic procedure since it cannot be exactly reproduced by any lifting or filling technique. Similarly, when a patient asks me whether filling a part of the face in will help to lift that structure up I respond simply, “No.” The two are not the same thing. Filling a part of the face will not lift it and if it is reasonably filled up also should not make it heavier to create any sagging.

The most common question is if I fill the cheek in will that lift the smile line.  The answer is emphatically no.  It won’t.  Sometimes just filling the cheek in can cast a greater shadow on the fold and at times make it appear deeper but not substantially so.  It seems intuitive that if you enlarge something that it would stretch out the areas around it to lift it but this simply is not the case.  I had also a question on my forum that if an injectable filler could be placed near the bone so that it would provide more structure as compared with placing it close to the skin where it would add more weight.  I countered this by explaining that a filler placed deeply should not provide better structure and one placed close to the skin should not provide greater weight.

The optical illusion that is created is that something filled in changes the way that light reflexes on it making it look lifted just by virtue that there is now more light and less shadow on the structure.   But there is no net lifting effect.  In summary, this article is intended to dispel a misconception and to provide a better understanding for a prospective patient that filling fills and lifting lifts but one does not help the other.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. Call (972) 312-8188 to schedule a consultation or to ask Dr Lam a question about facial rejuvenation procedures please visit his plastic surgery forums.

Leveraging the Hardness of Products in Cosmetic Injectable Fillers

How hard an injectable product is can be a very good thing or a not so good thing.  In any case, I try to use products based on its hardness factors for differing effects on the face.  One of the softest materials that I use is fat.  When injected it provides the most universally soft and natural facial rejuvenation.  However, because it is so soft it tends to work poorly to lift scars, lines, and folds.  That is why I undersell it to a patient who is having a fat transfer because I want him or her to understand that fat grafting simply will not fix the lips and folds around the mouth or eyes.  Silicone is the next hardest material but it tends to stay soft in the lips when placed a little at a time.  Interestingly, it tends to fill in acne scars very well despite this limited hardness factor but it tends not to fill in folds as well.  Restylane and Artefill (and other injectable fillers) are firmer and work much better for targeted facial filling of folds or other specific defects.  That is why even someone who has had a fat transfer still may benefit from some targeted facial fillers in the folds or lines of the face.  Understanding how to use facial fillers based on their hardness is important when counseling a patient on areas of the face for facial enhancement/augmentation.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s plastic surgery procedures please call (972) 312-8188 to schedule a consultation. If you would like to ask Dr Lam a question please visit our plastic surgery forum.