Rethinking filler strategy for the aging face

Filler injections have seen considerable growth in the United States as social media increases awareness and educates the masses on the role they play in facial rejuvenation. To optimize facial rejuvenation using fillers, an understanding of predictable aging patterns of the face is essential. Facial aging is significantly influenced by volume loss, and knowledge of the facial fat compartments guides volume restoration. This manuscript is conceptually based on the senior author’s expertise and 25-year experience and current philosophy in using fat and filler for facial volumization and rejuvenation. A standardized, top-down approach to rejuvenating the aged face with filler is described. Moreover, an algorithm has been provided to prioritize treatment of the highest impact facial areas in terms of human perception and rejuvenation with pure volume enhancement. The top-down sequence also allows for stepwise evaluation of downstream rejuvenation effects and judicious use of the product.