Facial hollows and sag lines

FACIAL HOLLOWS

In absence of obesity, ageing is almost invariably associated with a recognisable pattern of *volume loss* that often goes undetected by patients themselves.

Observing themselves in a mirror, patients generally and reasonably identify frown lines, crows' feet and nasolabial lines as their chief concerns, but looking at the *front* of the face doesn't give us much idea of the *sides* and overall facial *shape*.

While diminishing *hollows* and improving overall facial *shape* will often deliver a younger and refreshed general *look* without anyone noticing.

Your friends, family and associates * do not know* to note facial hollows as signs of ageing, and they *do not know* to look for sudden improvements in these areas as evidence of treatment. 

And please note: no one here is talking about using so much filler as to make anyone look like they've gained weight. It is about delivering a *proportional* facial shape for a younger face of someone the patient's existing weight.

Facial hollows typically arise on the temples, under the cheekbones (zygomatic arches), in anterior cheeks, across the forehead. Boney volume loss can also arise at the angles of the jaw (gonial angle) and next to the nostrils (pyramidal fossae) (these are the main areas to watch for, but of course volume loss can occur elsewhere as well).

SAG LINES

Under influence of volume loss, gravity, and loss of skin collagen and elasticity, faces can develop lines that are visible at rest and do not change with movement. 

Typically, loss of volume and loss of elasticity have led to a downward shift in the skin, along with tension lines and fold lines consistent with that movement. 

This facial skin shift may create a redundancy of skin under the chin, or over the eyes, or around the mouth. 

The simplest and most straightforward way to reduce facial skin hollowing is with the injection of a dermal filler. Typically this will involve the use of a cannula or a single needle injection, meaning bruising is minimal if it occurs at all.

Improving a hollowing will often reduce associated sag lines into the bargain, but when further sag line improvement is needed the meticulous injection of filler along each line will deliver results.

That all said, other injection  strategies (that cannot here be named) can improve hollows by stimulating collagen development under the skin. We'd have to discuss these in consultation.

Some years ago we were offering *fat transfer* as an alternative to filler injection. This involved harvesting some fat cells from elsewhere on the body, typically the abdomen or hips, and injecting such (treated) cells into the face to provide natural fat augmentation. 

However, a couple of problems emerged.

Firstly, no doctor can guarantee exactly how many of such transferred fat cells will survive the process and thrive in the new location. Associated with this, some areas see more fat cells survive than other areas. Thus, the technique does not deliver adequate *reliability* of a smooth outcome neither underfilled nor overfilled.

Secondly, it turns out that regular dermal fillers often last under the skin far longer than was ever foreseen in the early days. Therefore, the ostensible comparative advantage of fat, i.e., that it lasts much longer, is lost.

Thirdly, should fat ever be injected incorrectly, or in excess, or should it find itself where it ought not be, e.g., in an artery, fat is not easily removed and certainly not quickly removed, whereas filler can be rabidly dissolved with an enzyme we all stock in our clinics. Thus, fat injections are simply *not as safe* as filler injections, and we no longer offer this fat-transfer procedure at Peach.

Getting back to hollowing and sag lines: our suite of treatments applicable to the tightening of skin and restoration of skin elasticity are all applicable to the reduction of sag lines and the improvement of skin quality over facial hollows.

Every face is different.

Every face requires an individualised plan and approach.

So call us.