The role of autologous fat and alternative fillers in the aging face

Soft-tissue fillers can be used successfully to restore volume loss caused by facial aging. Injectable fillers can be used in isolation or in conjunction with other facial rejuvenation procedures. To achieve a superior aesthetic result the plastic surgeon must understand the key components of facial aging: soft-tissue atrophy, gravitational descent, and loss of skin tone. An accurate assessment of the relationship of these factors will determine the role of soft-tissue augmentation through the use of fillers. Because the majority of facial volume loss through aging is attributable to fat loss, the authors believe that autologous fat represents the ideal soft-tissue replacement. The authors describe the appropriate use of autologous fat and improvements in technique that have enhanced the predictability of facial fat grafting. When autologous fat is not an option, alternative facial fillers including calcium hydroxylapatite and hyaluronic acid may provide excellent results. The authors' algorithm for filler selection is based on relative morbidity, recipient-site characteristics, and the physical characteristics of each filler. This algorithm is discussed in the following anatomical regions: the nasolabial folds, glabellar crease, malar region, naso-jugal groove, and lips. When used appropriately, soft-tissue fillers can contribute significantly to overall facial rejuvenation.