We all know the lip enthusiasts who go for really large lips even in faces which might do better with a smaller lip. A similar trend can be seen with the total face. Here if colleagues are too enthusiastic the final result after a filler treatment can be a ball, an apple or even a pear face. However, a round or bottom heavy face is, in most cultures, not considered to be the most desirable facial shape.

But how do we come to inject too much?! There are a couple of reasons for that. First the availability of new filler products: we have now filler products which are intended for volume augmentation and others for very superficial injections. So we are using them! We often inject large amounts of volume and we also inject large amounts of superficial fillers subdermal in one session (not always because of us but also because some patients want us to do as much as possible in one session). In case of elastosis there is little that can hold these masses so the face gets larger and heavier. Second the additional encouragement for both behaviors by the filler companies: companies of course want to sell as much product as possible (which is quite okay) and give us a rebate if we inject large amounts their fillers (which is okay, too).

19th century ivory head on an ebony walking stick (collection of B. Rzany)

So what to do?! The most important thing is to understand (and also to communicate to our patients!) that the aging process cannot be reversed in one or two sessions even if we inject a lot of material. It needs multiple sessions and, of course, other interventions than fillers, too. Nota bene: to increase dermal strength the mere injection of superficial fillers is not enough – other interventions, such as, for example, fractionated laser treatment need to be included into the treatment plan. Last but not least: what else is most important! We have to understand better what defines aging and how age related signs and symptoms can be reversed. In my opinion, small steps, e.g. filler injections of not more than 2-3 ml per session in addition to other treatments will certainly lead to more natural and better results in case of volume loss and increased elastosis.

And when we have better results we will get more patients to treat and make also the companies happy as they will be able to sell more of their products.