FACT: By age 50, most of us have lost about 20% of our facial volume. This causes our faces to look tired, hollow, sagging or generally less youthful or engaging. Reflation can help with this!

THEORY: If our faces are deflating, then to look natural we must restore lost volume.

MYTH: Skin creams alone can restore a youthful face. True, taking care of your skin is important, what happens under the skin is even more critical.

THE EXPERTS: “When it comes to aging, the main culprit is deflation,” so says Beverly Hills dermatologist Ava Shamban in a recent W magazine column Under your Skin.“By age 50 to 60, most of us have lost up to 20% of our facial volume – both fat and bone. This results in our faces sagging and looking gaunt – not unlike a pillowcase over a shrunken cushion.” This volume loss is responsible for the bags and sags, the hollows and dark circles. The fullness and highlights, the heart-shaped roundness is replaced by flatness and wrinkles, with squaring or lengthening to the face. Rather than using little makeup to highlight, now more contrast is needed to suggest curves and highlights that are no longer there. With progressive volume loss, the face very subtly loses its softness. Even the most expertly done facelift will not look “natural” if the lost facial volume is not restored.

OPTIONS: Facial volume can be restored with injectable fillers or your own fat. Unlike peels and superficial fillers for skin lines, reflation is a procedure that uses filler or fat deeper in the face to prop up the skin and recreate lost contours. Hyaluronic acid fillers of different concentrations (Restylane, Perlane, Juvederm) or Radiesse (calcium hydroxylapatite) are commercially prepared FDA-approved products that can be injected into different deflated facial areas to correct volume loss. These fillers will last about 9-12 months. Depending on the area and degree of deflation, usually one to three syringes are needed. Like applying make-up, injecting fillers requires an artistic vision. Not every hollow or crease needs filling.

BEWARE: Filler injections may be temporary but filler complications can last forever. Injections improperly done can cause irreversible  complications including skin loss, infection, facial distortion or blindness; more important than which filler is used is the expertise of the injector.

“OFF-LABEL”: What does off-label mean? Off-label means that an experienced physician injector is using the filler in an advanced application, not yet approved by the FDA. Most all fillers have only been FDA approved “for correction of facial wrinkles and folds” (such as nasolabial folds.) Reflation is an off-label use of these fillers where the filler is injected at a deeper level. This more advanced procedure should only be performed by a very experienced board-certified plastic surgeon. Only blunt needles should be used to minimize the risk of skin injury or blindness.

NATURAL FILLING: Perhaps the “ideal” option to restore lost volume is to use your own fat as micro-fat grafts. A small amount of your own fat is removed with a cannula or tube, similar to liposuction, but instead of discarding the fat, the fat is re-injected in small seed size injections into specific areas where the face has deflated. Fat is a natural filler. Different from commercial fillers, fat is finer and softer and can be used deep or just under the skin. Between 50-80% of the injected fat will survive; once healed, the results are permanent. There is abundant supply and there is no rejection. Fat also has the unique ability to improve the quality of aging skin. No cream, peel or laser can restore the lost skin elements like fat grafting. Because the fat is sensitive to weight changes, you want to be at a stable weight before doing this procedure. Again, this “advanced procedure” must be performed only by a plastic surgeon who is very experienced in this technique.