How, and Where, Do Fillers Work?

fillers-face-mapConsider the following question…”Would you rather have wrinkles on your face, or would you rather have sagging skin?”

Unanimously we would agree that wrinkles would be preferred. Why then, when trying to combat the signs of facial aging, do we preferentially treat wrinkling, and address any facial skin thinning, or sagging, secondarily?

As commonly as Botox and other wrinkle relaxers are used, fillers should play an equally large role in facial rejuvenation. Most individuals unfamiliar with fillers are unaware that both treatments are administered identically, have similar recovery times, and are used to treat different signs of aging. When wrinkle relaxers and fillers are used in combination, dramatic and long-lasting results can be obtained.

So, how exactly do fillers work?

The most commonly used fillers today are comprised of hyaluronic acid, or HA, a naturally occurring substance found in the connective, skin, nervous, and extracellular matrix (ECM) tissues of the body. It is HA’s role in the ECM that provides most of its cosmetic benefits. The ECM is a gel-like fluid found in the spaces between our cells, providing tissue support, increasing tissue volume, and preventing tissue compression. Fillers place HA into the ECM, restoring and augmenting its properties.

In an earlier post we discussed how fillers improve the appearance of “static” wrinkles. These are wrinkles present in our skin even when we are not moving the underlying muscle, but fillers help address a number of the signs of aging:

Nasolabial Folds – These are the “laugh lines” or “parentheses” around our mouths that can deepen into noticeable lines. Fillers add volume and smooth the transition from the lips to the cheeks.

Upper and Lower Lips – Fillers plump thin lips, improve lip asymmetries, and enhance full lips. Fillers also help lift the corners of the mouth.

Marionette / Chin Lines – These are facial creases that run from the corners of the mouth towards the chin. Fillers add volume to the creases, minimizing their depth.

Jowling / Jawline – Fillers mask the shallow contour of jowling, while recreating the straight jawline of youth. Fillers can also be used in males to augment the back of the jaw, creating a more masculine, squared-off profile.

Cheeks – As we age our cheeks thin, flatten, and droop. Fillers reposition our cheeks into a higher, more youthful position, creating a more heart-shaped appearance to the face.

Lower Eyelids – The lower eyelids develop hollowing and darkening due to tissue atrophy and skin thinning. Fillers restore this volume and thicken the tissues.

Temples – Thinning of our temples is a hallmark sign of reaching our forties. Fillers replace this volume, improving an under-appreciated facial contour.

Others – Fillers are used to correct chin dimpling and clefting, subtle nasal asymmetries, low eyebrows, and recessed scars.

As an Emory, Harvard, and University of Pittsburgh-trained, board-certified plastic surgeon, Dr. Castillo leverages his training and experience to achieve natural, but noticeable facial rejuvenation results. Dr. Castillo performs all injections himself, supplying patients the same level of care that he would give his friends and family.

If there is a topic that you would like discussed on our blog, leave us a comment, or write us at

Leave a Reply

Your email address will not be published. Required fields are marked *