Structural fillers of the face

The popularity of dermal fillers and the introduction of higher viscosity products have expanded their indication beyond wrinkles and creases to sculptural techniques that have the ability reshape the face. As the comfort and experience with dermal fillers has grown, their use has expanded to cheek augmentation, rhinoplasty, chin augmentation, asymmetry correction, facial shape alteration, forehead reshaping, and the creation of the perception of a narrower face. Complications such as skin necrosis, blindness, and embolism have been reported in the literature, and these studies emphasize the importance of a thorough understanding of the vascular anatomy and proper injection technique to decrease the incidence of complications. The focus of this chapter is on fillers that can create sculptural change in facial shape. These are the high viscosity fillers such as hyaluronic acid (Restylane, Perlane, Voluma, and Juvederm), calcium hydroxylapatite (Radiesse), and poly L-lactic acid (Sculptra).