New soft-tissue fillers for skin tightening, volume restoration in cheek area

Open any beauty magazine and it seems as though all the models have full, pronounced cheeks and a firm, tight jaw line. In contrast, aging causes a loss of volume across the middle of the face, resulting in a flattened or sunken cheek structure with sagging jowls that can make the face appear drawn, tired and old.

Now, armed with a deeper understanding of full facial contouring, dermatologists are using soft-tissue fillers to enhance and restore volume loss in the cheek area, thereby smoothing nasolabial folds (the wrinkles that form along the bottom of the nose to the corners of the mouth). In addition, newly introduced fractional radiofrequency technology to address skin laxity is showing promise by stimulating collagen contraction and reducing loose skin in the lower-face.

At the American Academy of Dermatology's Summer Academy Meeting 2010 in Chicago, dermatologist Marian E. Northington, MD, FAAD, assistant professor of dermatology at the University of Alabama in Birmingham, presented a new approach to achieving aesthetic balance to the aging face by combining soft tissue fillers and skin tightening techniques.

"Dermatologists no longer view the aging face as specific wrinkles or folds, but instead look at the face as a whole with what can be imagined as soft tissue scaffolding below the skin surface that supports the deep underlying fat," said Dr. Northington. "With this perspective, we now appreciate that cheek volume is a key component in re-establishing the facial balance and proportions most patients seek in a youthful appearance. What's more, volume loss of this deep cheek fat tends to create a more pronounced nasolabial fold, adding to a downward descent of the facial soft tissues."

As a first step, Dr. Northington noted that she asks her patients what bothers them about their face so together they can openly decide how best to address their age-related concerns. In the case of soft tissue fillers, Dr. Northington explained that while fillers were first used on targeted lines and creases, today deeper, thicker fillers - such as polylactic acid, calcium hydroxylapatite, polymethyl methacrylate, and hyaluronic acid - can be used in large areas to rebuild the lost volume in the cheek. In so doing, the added volume in the cheek lifts the face and diminishes the affected nasolabial folds.

"The more we learn about facial anatomy, particularly the different fat compartments of the cheek - or the superficial and deep areas of discrete fat extending toward the middle of the face - the greater precision we can bring to our ability to restore fullness, shape and contour the cheek and accomplish volumetric lifting," said Dr. Northington. "In fact, volumetric enhancement using thicker, deeper fillers is fast becoming the primary cornerstone of our facial rejuvenation approach for those who seek a youthful look without major surgery."

According to Dr. Northington, another new technology that shows promise for skin tightening and moderate lifting of the lower face employs fractionated bipolar radiofrequency (RF) energy.

The fractional RF device is designed with an array of micro-needle electrodes housed in a hand piece with an applicator tip. Heat energy is delivered to the dermis (the layer of skin beneath the top layer) in a non-uniform pattern of microscopic zones that are spaced in a grid, like water passing through a colander. The non-treated zones of uninjured surrounding tissues serve to promote safe and rapid healing. The thermal damage stimulates wound healing with the subsequent new collagen forming thicker, more elastic skin tissue. Through the wound healing process, tissue contraction and skin tightening are observed.

Dr. Northington noted that it appears from initial results that using fractionated bipolar radiofrequency technology allows the RF energy to be delivered in a more controlled manner, as the heat can be placed precisely in the deep dermis where it can produce significant impact with minimal disruption to the top layer of skin.

"The fractional treatment patterns and unique energy delivery system of this technology hold potential for improved skin tightening and skin texture," said Dr. Northington. "As the technology progresses and clinical results become more predictable, I expect fractional radiofrequency will play a significant role in our approach to cosmetic skin rejuvenation and offer dermatologists an effective complement to injectable fillers for restoring lost cheek volume in the aging face."

Dr. Northington advised those with concerns about aging skin to discuss the most appropriate preventative strategies with their dermatologist, such as the daily use of a broad-spectrum sunscreen with a Sun Protection Factor (SPF) 30 or higher, and the latest topical, non-surgical and surgical treatment options.