Surgeon Discusses the Art of Skin-Deep Facial Rejuvenation

Can dermal fillers be used to rejuvenate the surface appearance of the skin? At least one surgeon thinks so. Diluting hyaluronic acid fillers and preparing customized filler treatments may represent a new frontier in facial rejuvenation, according to Dr. Steven Fagien.

“Once collagen went away, we stopped injecting the skin because all of the products currently available are subcutaneous or deep dermal fillers at best, and we kind of left the skin because we did not have an adequate skin filler,” he recently told the Cosmetic Surgery Times.

Soft tissue fillers like Juvederm, Restylane, and Perlane have become increasingly popular in recent years as nonsurgical alternatives to facelift surgery. Dermal fillers are sometimes combined with Botox to achieve optimal results.

“If you really want to fortify and rejuvenate the skin, I do not believe that you can do it consistently with energy-based devices universally…. I think we have ignored the fact that there are ways that you can manipulate existing products, particularly Juvederm, and make them skin fillers.”

The secret, he says, is making sure to use the appropriate fillers in different parts of the face. Different fillers are suitable for treating different signs of aging, including volume loss of fat, soft tissue dissent, and the thinning of the skin.

Another technique that Dr. Fagien supports is altering the concentrations of existing fillers, as well as mixing and matching different fillers for different target areas. Diluted concentrations can be injected closer to the surface of the skin, unlike regular dermal fillers, which are typically injected deep into the dermis.

“Altering the concentrations of the existing compositions in order to optimize certain fillers has become a great passion of mine,” he told the Times. “Mixing different fillers with varying concentrations allows you to be somewhat more creative in applying these mixed fillers in the face by improving formulations that you get in a packaged syringe. You can more appropriately treat specific facial regions and create custom filler treatments individualized for each patient.”

Dr. Fagien’s results are set to be published in an upcoming article in the Journal of Plastic and Reconstructive Surgery.