Aesthetic Plastic Surgery

, Volume 37, Issue 2, pp 266–276 | Cite as

A Novel Approach to Structural Facial Volume Replacement

  • Neil S. SadickEmail author
  • Suveena Manhas-Bhutani
  • Nils Krueger
Review Aesthetic


Improved understanding of the anatomy and physiology of the aging face has laid the foundation for adopting an earlier and more comprehensive approach to facial rejuvenation, shifting the focus from individual wrinkle treatment and lift procedures to a holistic paradigm that considers the entire face and its structural framework. This article presents an overview of a comprehensive method to address facial aging. The key components to the reported strategy for improving facial cosmesis include, in addition to augmentation of volume loss, protection with sunscreens and antioxidants; promotion of epidermal cell turnover with techniques such as superficial chemical peels; microlaser peels and microdermabrasion; collagen stimulation and remodeling via light, ultrasound, or radiofrequency (RF)-based methods; and muscle control with botulinum toxin. For the treatment of wrinkles and for the augmentation of pan-facial dermal lipoatrophy, several types of fillers and volumizers including hyaluronic acid (HA), autologous fat, and calcium hydroxylapatite (CaHA) or injectable poly-l-lactic acid (PLLA) are available. A novel bimodal, trivector technique to restore structural facial volume loss that combines supraperiosteal depot injections of volume-depleted fat pads and dermal/subcutaneous injections for panfacial lipoatrophy with PLLA is presented. The combination of treatments with fillers; toxins; light-, sound-, and RF-based technologies; and surgical procedures may help to forestall the facial aging process and provide more natural results than are possible with any of these techniques alone.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Cosmetic techniques Face Poly-l-lactic acid Rejuvenation Skin aging 



Editorial support for this article was provided by Peloton Advantage, LLC, funded by Sanofi–Aventis U.S. LLC, a Sanofi company. The authors were fully responsible for the content, editorial decisions, and opinions expressed in the current article. No author received an honorarium related to the development of this manuscript.


Neil Sadick is involved in workshops and serves as an injector trainer for Sanofi–Aventis U.S. S. Manhas-Bhutani has no competing financial interests or pertinent disclosures or known conflicts of interest to declare. N. Krueger has no competing financial interests or pertinent disclosures or known conflicts of interest to declare.


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Copyright information

© Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2013

Authors and Affiliations

  • Neil S. Sadick
    • 1
    Email author
  • Suveena Manhas-Bhutani
    • 2
  • Nils Krueger
    • 3
  1. 1.Department of DermatologyWeill Cornell Medical College, Cornell UniversityNew YorkUSA
  2. 2.Sadick Research GroupNew YorkUSA
  3. 3.Division of Cosmetic ScienceUniversity of HamburgHamburgGermany

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