Dermal fillers help to diminish facial lines and restore volume and fullness in the face. As we age, our faces naturally lose subcutaneous fat. The facial muscles are then working closer to the skin surface, so smile lines and crow's feet become more apparent.

The facial skin also stretches a bit, adding to this loss of facial volume. Other factors that affect the facial skin include sun exposure, heredity, and lifestyle.

Dermal fillers can be used to:

• Plump thin lips
• Enhance shallow contours
• Soften facial creases and wrinkles
• Improve the appearance of recessed scars

Dermal fillers can be very helpful in those with early signs of aging, or as a value-added part of facial rejuvenation surgery.

For some patients, surgery such as a facelift, brow lift, or eye lift may be the best approach. Non-surgical rejuvenation treatments, such as soft tissue fillers, cannot achieve the same results, but may help delay the time when consideration of a facelift becomes appropriate.

You may be a good candidate for dermal fillers if you:

• Are physically healthy
• Don't smoke
• Have a positive outlook and realistic goals in mind for the improvement of your appearance

There is no downtime with dermal fillers. You can resume most activities right away.

Your initial appearance after treatment with any dermal filler may include:

• An "over-filled" appearance to treated areas
• Mild swelling or bruising
• Temporary numbness or redness

These conditions can be alleviated with topical icing and will improve within a matter of hours or just a few days.

When your own fat is the injected filler, the healing process is longer and may take a few weeks.

The results of soft tissue augmentation using dermal fillers are apparent immediately.

The continued aging of your face and variables in the absorption of fillers will affect how long your results last.

There are several different types of dermal fillers.

Dermal fillers differ in chemical make-up, longevity, and have varying degrees of softness. Softer fillers are used in the lips, for example, while sturdier fillers might be desired to enhance cheekbones.

Your surgeon will determine with you the best type and volume of filler needed for your particular areas of concern.

For many people, the use of "off-the-shelf" fillers can be a simple office-based procedure that can nicely enhance their appearance. These dermal fillers are very predictable, and have relatively minimal risks and side effects.

Some patients may want to consider fat injections, which uses fat harvested from the patient's own body which can then be re-injected to enhance facial fullness, fill creases or build up shallow contours.

How fat injections are administered

Fat injection requires a more extensive procedure than "off-the-shelf" soft tissue fillers.

A "donor area" must be determined (such as the abdomen or buttocks) and liposuction is used to extract the fat. The suctioned fat can then be transferred to the face, as a graft.

The grafted fat then has to redevelop a blood supply in order to survive.

Fat injection results

In the face, most of the transferred fat usually survives, but the results can be a bit less predictable.

The use of fat transfer involves additional discomfort in the donor area. This is a minor surgical procedure that can be performed in the surgeon's treatment room or in an operating room.

The decision to use fillers is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks and potential complications of dermal fillers are acceptable.

Your plastic surgeon and/ or staff will explain, in detail, any risks.

You will be asked to sign consent forms to ensure that you fully understand the procedure, as well as the risks and potential complications.

Complications from dermal fillers are uncommon. Potential risks vary depending on the specific filler used and the relative permanence of the filler substance

Thes risks and others will be fully discussed prior to your consent.

It is important that you address all your questions directly with your plastic surgeon. Although good results are expected from your procedure, there is no guarantee.

In some situations, it may not be possible to achieve optimal results with a single procedure. Most fillers do dissipate over time. To maintain your correction, you will need to consider repeating the injection process at intervals.

During your dermal fillers consultation be prepared to discuss:

• Your goals
• Medical conditions, drug allergies, and medical treatments
• Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
• Any past treatment with soft tissue fillers, botulinum toxin therapy, laser or other non-surgical facial procedures, as well as any prior facial surgery

Your surgeon may also:

• Evaluate your general health status and any pre-existing health conditions or risk factors
• Discuss your available options
• Examine and measure your face
• Take photographs
• Recommend a course of treatment
• Discuss likely outcomes of using soft tissue fillers and any risks or potential complications

Your plastic surgeon will carefully explain:

• Your course of treatment
• The type of filler recommended in your case and why
• Expected results
• The longevity of the result

It's important you understand all aspects of dermal fillers. It's natural to feel some anxiety, whether it's excitement for your anticipated new look or a bit of pre-treatment stress. Don't be shy about discussing these feelings with your plastic surgeon.

• Am I a good candidate for this procedure?
• What will be expected of me to get the best results?
• Where and how will you perform my procedure?
• How long of a recovery period can I expect and what kind of help will I need during my recovery?
• What are the risks and complications associated with dermal fillers?
• How are complications handled?
• How can I expect my skin to look overtime?
• What are my options if I am dissatisfied with the cosmetic outcome of my procedure?
• Do you have before-and-after photos I can look at for each procedure and what results are reasonable for me?