Fillers, the Liquid facelift and “Puffy Face” Syndrome

Everything evolves. When cosmetic fillers were first used, we applied them to the problems of wrinkles – and they worked pretty well. Then we used them to enhance lips, and then to enhance cheekbones, and to smooth out jawlines…and the list of uses kept on growing.

This ever-increasing use of fillers has directly led to the concept of the “liquid facelift”, which is simply the use of a significant volume of injectable filler agents to add volume to the face. When done appropriately, and done well – the technique can look good, restoring the lost contours of youth, at least for a time, until the costly products are absorbed by the body. But like anything, it can be overdone. And quite expensive.

Hype alert: the liquid facelift technique is not really “just like a regular facelift”, despite the marketing hype of some websites. The two methods work totally differently. Let’s review some of the basic differences:

– In a surgical facelift, you remove excess neck and cheek skin. Not possible with the liquid facelift technique, which works by inflation.

– In a surgical facelift, you can tighten the neck muscles and re-suspend the SMAS layer (the fibro-fatty anatomic layer between the skin and the muscles). Not possible with the liquid technique.

– Traditional facelifts (with the exception of those that use fat grafting techniques) work by tightening tissue planes. This can sometimes cause a flattening effect on soft-tissue facial curvature.

– The liquid techniques work by inflation or “re-volumizing”, and can add fullness to areas that would otherwise be difficult to correct. Traditional facelifts can sometimes shift soft tissue fullness by re-distributing or lifting tissues, but they don’t add new volume.

– Surgical facelifts typically have an effect of 8 to 10 years, on average. Injectable products, even the newer, longer-lasting ones, last 1-2 years at most.

So, the two procedures are not directly comparable. Don’t be fooled – choose the right procedure for your particular needs. If you have a lot of lax skin, get a surgical facelift. If you have loss of facial volume issues with minimal skin laxity, then you might be a candidate for re-volumizing with fillers. Your plastic surgeon can advise you.

I’m also starting to see patients who have been over-treated with the facial fillers. It used to be just the lip area – but now it’s the entire face that is involved. Since there isn’t an official name for this, I’ll call it “puffy-face syndrome”. Features of “Puffy face syndrome” that I’ve seen include:
– generalized swollen or bloated look to the face, due to the over-injection of filler agents, which is out of keeping with the pre-procedure appearance;
– excessive fullness in some or all of the injected areas: brow, cheekbones, paranasal and perioral areas;
– obliteration of normal naso-labial creases.

Interestingly, many of the patients that I feel are over-injected seem to be somewhat addicted to their filler treatments. When I tell them “no, you really don’t need any more volume” – they react with shock and disbelief!

So, while I think that facial fillers are useful, they are but one option among many for the treatment of facial aging. Too much filler can lead to Puffy Face Syndrome! This is another example of how aesthetic judgement is important.

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