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Injectables and Fillers

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Smith and Nesi’s Ophthalmic Plastic and Reconstructive Surgery

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Abstract

Facial aging involves volumetric change, alteration of tissue quality, and the effects of long-standing facial muscular animation [1]. These factors lead to soft tissue ptosis and static and dynamic rhytids [1]. The traditional concept of beauty involves the “triangle of beauty” with high cheekbones and a defined jaw whereas the “reverse triangle” or pyramid with flattened cheeks, drooping eyes, and jowling is considered unattractive [2]. Facial rhytids can be classified as dynamic or static. Dynamic rhytids occur with muscle action and are best treated by specifically targeting facial muscles with botulinum toxin [2]. Facial expression not only contributes to the development of facial lines but also influences atrophy of soft tissue and malposition [3]. More facially animated individuals typically demonstrate increased lines and furrows relative to their less-animated counterparts [3]. Static rhytids result from the natural aging process with collagen loss and photodamage [4]. They are visible at rest and are addressed with volume replacement or combination therapy. Sun exposure and smoking additionally contribute to facial aging [3]. The trend in facial rejuvenation has increasingly emphasized the three-dimensional aspects of facial aging [5]. The three critical components of facial augmentation involve control of movement, improvement of contour, and restoration of volume [5]. The volume loss in the aging face involves atrophy of subcutaneous fat, which is variable between race and gender [5]. Bone loss plays a minor role as well [5]. Characteristics of the aesthetic ideal differ between men and women and need to be considered when developing a treatment plan [5].

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Allure Facial Laser Center and Medispa, University of Washington, Kirkland, WA, USA

    Audrey E. Ahuero M.D.

  2. Department of Ophthalmic Plastic Surgery, Allure Cosmetic Surgery, University of Washington, Kirkland, WA, USA

    Bryan S. Sires M.D., Ph.D.

Authors
  1. Audrey E. Ahuero M.D.
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  2. Bryan S. Sires M.D., Ph.D.
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Corresponding author

Correspondence to Bryan S. Sires M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Department of Ophthalmology, Associate Professor of Ophthalmology Wayne State University School of Med, Detroit, Michigan, USA

    Evan H. Black

  2. Oakland University William Beaumont, Clinical Professor of Ophthalmology Director, Oculoplastic Surgery, Southfield, Michigan, USA

    Frank A. Nesi

  3. Department of Ophthalmology, University of Central Florida, Orlando, USA

    Christopher J. Calvano

  4. William Beaumont School of Medicine, Clinical Professor of Ophthalmology Co-Director, Oculoplastic Surgery, Detroit, Michigan, USA

    Geoffrey J. Gladstone

  5. Former Chief of Ophthalmology, Emeritus Clinical Prof of Ophthalmology Case Western Reserve University, South Euclid, USA

    Mark R. Levine

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Ahuero, A.E., Sires, B.S. (2012). Injectables and Fillers. In: Black, E., Nesi, F., Calvano, C., Gladstone, G., Levine, M. (eds) Smith and Nesi’s Ophthalmic Plastic and Reconstructive Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-0971-7_31

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