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    Facial rejuvenation efforts may need to go no more than skin deep

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    Dr. Fagien
    Diluting HA fillers and preparing customized mixed filler treatments for patients is one of the next frontiers in facial rejuvenation, says Steven Fagien, M.D., Aesthetic Eyelid Plastic Surgery, Boca Raton, Fla. One of the areas that has been ignored in facial rejuvenation treatments is the skin itself, he says.

    "Once collagen went away, we stopped injecting the skin because all of the products currently available are subcutaneous or deep dermal fillers at best, and we kind of left the skin because we did not have an adequate skin filler," he explains.

    "If you really want to fortify and rejuvenate the skin, I do not believe that you can do it consistently with energy-based devices universally. I also believe that most of our currently available fillers are not as appropriate for applications to the skin (dermis). I think we have ignored the fact that there are ways that you can manipulate existing products, particularly Juvéderm (Allergan), and make them skin fillers," Dr. Fagien says.

    ANALYZING THE AGING FACE "Every filler has its place, and a synthetic filler is chosen according to the target region in the face and the aesthetic correction and result you are trying to achieve. However, performing a true facial rejuvenation using fillers can be done best by addressing the individual components of the aging face," Dr. Fagien says.

    According to Dr. Fagien, some of the main components of the aging face include volume loss of fat; soft tissue descent due to lack of integrity of the retaining ligaments and other structures that hold the soft tissue to the skeleton; and the thinning and loss of elasticity of skin with its ongoing depletion of native dermal components.

    "For volume augmentation such as those performed in the jawline, chin and cheeks, the fillers that have the most capability of projection are going to be the preferred fillers, as one can achieve more result with less filler product," Dr. Fagien says.

    Due to its greater viscosity, Juvéderm Voluma (Allergan) is one of the better fillers for voluminization, Dr. Fagien says. However, it is not available in the United States. Of the more robust fillers with a greater G prime that have Food and Drug Administration approval, Dr. Fagien says he often chooses Perlane (Medicis), Restylane (Medicis), and Radiesse (Merz) for volumizing purposes.

    For softer results in areas where less projection and firmness is desired, such as in the lips or the nasolabial folds, Dr. Fagien says Juvéderm works very well.

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