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  • Soft-tissue fillers are used for multiple cosmetic and therapeutic indications.

  • A wide variety of injectable soft-tissue fillers are available for clinical use, including biodegradable products such as hyaluronic acid, collagen, calcium hydroxylapatite, and poly-l-lactic acid; products that remain indefinitely in tissue, such as polymethylmethacrylate microspheres, hydrogel polymers, and silicone; and viable autologous fat.

  • Adequate clinician training in the use of these agents is essential for the prevention of adverse events.

As we age, lines, grooves, and creases become more apparent. Superficial rhytides are largely caused by solar damage, characterized by the loss of collagen at the epidermal–dermal junction and an increased elastosis in the reticular dermis. Repetitive facial movement over the years produces pronounced rhytides in the most active areas of the face, such as the forehead, glabella, periorbital and perioral areas, and nasolabial folds. Rhytides tend to appear deeper in the nasolabial and melolabial creases with the compounding feature of soft-tissue atrophy.1

Facial rejuvenation comes in many forms; its primary stake being replacement of soft-tissue volume by an assortment of augmentation techniques. Two major categories are subcutaneous volumizers and dermal fillers. Although subcutaneous volumizers tend to provide more long-lasting results, with improvements in dermal fillers over the past several years, these products have become increasingly popular and are now widely used. When deciding which technique(s) to use in the correction of facial soft-tissue atrophy, an accurate diagnosis of the level(s) of volume loss must be made. In younger patients, dermal fillers may be adequate for treatment, while in a more advanced aging face, a combination of the two above categories may be necessary to obtain optimal results. 1


Dermal filler use began in the mid 1980s and has since become the cornerstone of facial filling in the office setting.1 There are several dermal fillers approved for use in the United States (Table 215-1). Soft-tissue fillers (Table 215-2) are either injected through a sharp needle or blunt cannula. The level of injection into the skin and the length of the needle chosen depend on the type of filler injected, the properties of the filler, the area injected, and the desired result. Threading is a technique in which the needle is inserted into the skin and the filler is deposited in a linear fashion along the track of the needle as it is being withdrawn. Fanning is a type of threading in which, instead of inserting the needle into a new area each time, the needle is just withdrawn so that a new track can be made radially adjacent to the last. In the “push-ahead” technique, an injection is made in an anterograde direction, so that the injectable material flows from the tip of the needle and hydrodissects the tissues as it flows. This technique is often used in areas where bruising is more likely to ...

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