Is beauty more than skin deep? We’ve all heard that beauty is only skin deep, which
may be philosophically valid, but as far as the perception of external appearance, beauty
actually goes far deeper and is at the bone structure. We intrinsically recognize a youthful
face for its fullness, volume, definition, and proportionality. These attractive attributes
are foundationally provided by your bone structure. Models, for example are often described as
having “great bone structure” or “high cheekbones”. As we get older, not only are
there changes in the outer skin quality, but there is also diminishing facial volume. In
fact, in my experience, loss of facial volume actually precedes having significant skin
laxity. Generally, facial volume deficiency is more pronounced with aging, however, many
people naturally have genetic bone structure deficiencies, which can be addressed when
their as young as in their 20’s. As far as aging is concerned, facial volume loss
includes the loss of facial fat, soft tissue, and skin thinning, but the most significant
facial volume loss is at the bone structure. I’m Dr. Amiya Prasad, I’m a Board-certified
cosmetic surgeon, and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve
been performing facial rejuvenation surgeries including facelifts and facial implants for
over 25 years in New York, and Long Island. I routinely perform a lot of non-surgical
procedures such as injectable filler treatments to address age-related facial volume loss
and laser skin rejuvenation.
When you understand that facial volume loss occurs mostly at the bone level, it’s logical
to focus on enhancing bone volume. In conventional practice, most doctors and other injectors,
don’t address bone volume, but rather put filler at the skin level, or just below the
skin at the fat and soft tissue level. Anatomically speaking, these spaces cannot retain the well-intended
shapes created by the practitioner. Simply stated, the space just under the skin can’t
hold that much filler volume in one area so, the fillers tend to migrate, resulting in
you looking bloated, soft, doughy, and obviously unnatural. This appearance has been made famous
by certain celebrities and media personalities establishing the term “pillowface”. This
of course, frightens a lot of people who are afraid of looking unnatural. Every day in
my practice, I educate my patients that the filler itself isn’t what leads to the “pillowface”
look, but rather the way the filler was placed. What I do in my practice to treat volumetric
bone loss by placing fillers at the bone level. Most practitioners do not do this, as bone
level placement requires specific technical knowledge and experience in my opinion. Although
this is a non-surgical procedure using injectable hyaluronic fillers, I feel that surgical knowledge
derived from experience with facelift and facial implant surgery, helps me to place
the filler at the bone level with a high level of accuracy. The bone structure is a solid,
foundational structure of the face at the deepest level. This foundational stability
allows for more filler material to be placed than is conventionally performed, to create
a defined and proportional appearance, which looks natural. This is somewhat counterintuitive
since it’s often assumed that people who look doughy have too much filler in their
faces. This is to a degree accurate in that they may have had less volume than I would
place at the bone level, but what they have is too much volume for the more superficial
space the filler is located in. I’m often asked, why the filler doesn’t spread out
with my approach like it does in other people who look “pillowy”. Essentially, I place
the filler at the bone level which has muscle structure on top of the bone. The muscle layer
over the bone appears to hold the filler in place and prevents the filler migration that
everyone is afraid of. Our patients often report that their friends and family say they
look great, but they can’t pinpoint exactly why. Since adding foundational volume restores
much of the lost support structure of the face, the skin gains back its support, resulting
in a lifting effect to the skin. We call this technique Structural Volumizing as the filler
volume is restoring facial structure. It can be considered a non-surgical facelift for
people in their 40s and 50’s who don’t have significant skin laxity. I must emphasize
that this is not a replacement for a surgical facelift but rather a technique to address
a problem that a facelift does not address. In fact, many of my patients have had previous
facelift are delighted to have Structural Volumizing rather than another facelift. For
Structural Volumizing, I use thicker hyaluronic acid fillers that can last 1-2 years. Hyaluronic
acid naturally occurs in the body, so these fillers are safely and gradually metabolized
with time. Hyaluronic acid fillers can also be dissolved with the injectable enzyme hyaluronidase,
should the need arise. If you are looking into facial rejuvenation, remember that a
youthful appearance is not just the skin, but the bone structure that supports the skin.
If we’ve learned anything from the past, overtightened skin is not youthful. In my
opinion, looking youthful can be better characterized as looking healthy and vibrant. You can achieve
this with the right balance of volume, proportion and definition. I hope this information from
my experience helped you. If you’re interested in recommendations for your individual situation,
you may contact us through our websites or call our offices to schedule a consultation.
Thank you.