Treatment of facial aging with fillers should be aimed at compensating for "normal" changes occurring with age, and not trying to dissimulate them, which will always end in creating an "abnormal" anatomy.

History of our treatments shows that, starting from tightening the skin, we are now into restoring volumes. To achieve this aim, we have to know how and where these volumes losses occur.

There are two main zones for fat in the face: a superficial layer, immediately sub dermal, which is the third layer of the skin, the hypodermal fat. This layer is present everywhere in the body, apart from under the eyelid skin. Contrary to what is commonly thought (as many things in the medical field) this layer does not change with age, as proven by a recent publication, but with weight changes. (1)

This is physiologically understandable, as it is the layer where the metabolisms for skin integrity occur, and major changes would result in major impairments in the protection of the body.

Volume losses occur in the bones, in the fat compartments and in the muscles.

What is easily attainable is injecting to the bone level, pre periosteal plane, to compensate for bone losses (mainly forehead, malar, chin, mandible) and for fat compartments.

Injecting superficially within the hypodermal plane would only result in creating the equivalent of a localized obesity, with the "ball" and unsightly appearance so dramatically visible in far too many women, victims of wrong teaching.

So please, let us keep volumizing injections for the precise areas where needed, and not, as still too often, just subcutaneously.

1 - Mertens 1., Foyatier J.L., Mojallal A. Quantitative analysis of midface fat compartments mass with ageing and body mass index, anatomical study (inEnglish) Annales de Chirurgie Plastique Esthétique, Volume 61, Issue 6, Pages 798-805