The difference between a young face and an old face is the absence or the presence of jowls. Saggy cheeks are the most ageing feature in a person’s face. For this reason we need to look at how the face moves and where the face has lost volume. Most people who develop jowls at an early age have strong muscles around the chin and neck area. By relaxing those muscles, similar to what you would do with the frown lines, we can get a great lift and even more important prevent sagginess of the face in future. The next step is to replace the naturally reducing facial volume.

Why should we think about replacing facial volume?

Our patients come to us for mainly one reason:They want to look younger, fresher and of course more attractive. Most people are very happy with their looks and they don’t want to change them. By replacing some of the missing facial volume, mainly around the mid face, cheeks and temple area you can get a great lifting effect even to the jaw line. This will also reduce the dreaded tired look around eyes and restores some of the youthful facial proportions, which are a fuller upper face and cheek region and narrower around the chin and jaw. Remember: The difference between a young face and an old face is the loss of volume.

1. Can you give us a short overview on what fillers are and what they can do for you.

Most commonly used dermal fillers contain a synthetic form of Hyaluronic Acid (HA), naturally found in the skin’s collagen layer. HA in our skin gradually decreases over time. In fact, 50-year-olds are estimated to have less than half the amount of HA they had in their youth. By the age of 30, signs start to show—skin starts to lose its elasticity and volume as fine lines and wrinkles appear. Visible ageing of the skin is to 90% loss of collagen. By replacing the missing collagen the skin can appear plumper and more hydrated but also smooth and more elastic. Injected into the deeper layers of the skin, fillers can be used to contour and shape the face.

2. So, the areas of the face that can benefit and why and what age does Dr Prager feel fillers should be used - from 30 onwards and why?

Most of the ageing of the face is due to the loss of facial volume. This starts in the mid face region below the eyes either side of the nose. As a result we tend to see the Naso Labial Folds deepening as a first sign of ageing. In the old days people had those lines injected regulrarly. The side effect was a slightly I hardly inject those now as first line treatment. It is the reduction in facial volume, fat actually that makes the lines appear as the cheeks sag. Therefore it is much more natural to replace this volume and lift the cheeks back up again. Facial proportions play a major role in how we perceive beauty. Replacing facial volume is therefore a very effective way to improve facial proportions and to make a face look naturally younger. Loss of volume takes place as early as our mid twenties. Look at an endurance athlete or a very lean person. The fat that gives the face its youthful shape is burned off and the athlete’s face can look much older prematurely.  In a normal person hollowing and loss of volume in the cheeks can start to become visible at around 30. Especially in people who diet or exercise a lot. Replacing the missing volume in the face is preventative and maintains youthful facial proportions. At 20 dimples are cute and at 40 they can be deep lines. Dermal fillers prevent this from happening.

3. Loss of volume in cheeks and lips and so on

After treatment with hyaluronic acid based dermal fillers the lines on your face should appear minimized and softer. Facial volume replacement has almost taken over from Botulinum Toxin Injections.  For example, young people with thin lips are estimated to be older than their age peers, simply because thinning lips are something that happens with age. Our understanding of youth is linked to a fuller upper face and a chiselled jaw line. As people age they lose volume from the upper face and gain it under the chin and neck. Heart shaped faces are often used by cartoon artist to portray the likeable beauty such as Pocahontas. The Shrek character has the complete opposite facial volume distribution, narrow on top, heavy and square around the jaw. As we age we turn from Pocahontas to Shrek…

4. Dr Prager, what kind of Dermal Fillers do you use in your practice, what do they consist of and why do you like to use them
 
In my office I use dermal fillers containing Hyaluronic Acid (HA). Modern HA fillers are much smoother and absorb completely compared to the first generation products. HA is present throughout our bodies, with 50% of it located in the skin. It occurs naturally in the deeper layers of our skin (the dermis), where it helps to keep skin smooth and ‘plump’ through its amazing ability to hold up to 1,000 times its weight in water. Dermal fillers based on HA are used to replace facial volume, smooth the lines and restore skin elasticity, the most visible effects of skin ageing. Dermal fillers can restore skin tone and texture and even prevent future ageing. HA dermal fillers can also contain local anaesthetic which reduces the discomfort during injection greatly.  This way it possible to use small amounts and treat more often just like one would with Botulinum injections.

5. How would you explain the procedure, any downtime and the cost and how long do the effects last?
  

As a naturally based biological material, hyaluronic acid (HA) is similar to your body’s natural HA. In fact, it’s so similar you won’t need a skin test prior to treatment.The procedure involves small series of injections under the skin, either to fill lines or to increase facial volume, where the deeper layers of the skin are injected.Immediately after treatment it’s perfectly normal to experience temporary minor stinging, sometimes moderate redness and swelling. Bruising can happen. Recovery may take a few hours to a few days, depending on the area treated and the type of filler used. Most people find that they can return to work or go about their normal activities immediately after the procedure. Generally we would say the products last between 12 to 18 months, in some cases however 2 to 3 years is not at all unusual. The cost for one syringe starts from £390.

6. Next, what are the tell-tale signs of having too much filler? You see quite a few celebs with chipmunk cheeks!

Tell tale signs are patients in their 40ties and 50ties who’s cheeks and facial proportions are more Pocahontas now then they were in their twenties. Large amounts of even the safest dermal fillers can result in a strange look but is reversible.  The more permanent products such as Silicone can cause permanent damage. Heather Locklear or Mickey Rourke for instance are examples for fillers gone wrong. Unfortunately any promising procedure that delivers amazing results is prone to be hijacked by the cosmetic junkies who will find a practitioner to supply them with even larger amounts of the stuff that makes them happy. In the end they are unable to see themselves, after all beauty is addictive. It is not the product or the procedure that makes people look funny, it is their need for more that eventually makes faces look pumped.

Finally, information on Dr Prager's Clinic – Website

Phone: 020 7323 3660

25 Wimpole Street

W1 London

www.drmichaelprager.com