SOFT TISSUE AUGMENTATION - Treatment of Wrinkles with Injection of Fillers

Soft tissue augmentation involves injecting a substance into the skin to correct wrinkles, depressions and scarring.  Its goal is the recreate or restore youthful contours & texture.  Dr Thomas Chu has been performing soft tissue augmentation since 1990.

Beauty & Youth

Beauty & youth are perceptions that are inextricably linked in modern culture.  Though some ideas of beauty are culture-specific, some characteristics of the face are universal:  symmetry, proportion & contours associated with youth.


Though no human face is truly symmetric the appearance of symmetry is crucial to the  perception of beauty.


The classic proportions of the face are as follows:  the top 1/3 of the face should extend from the frontal hairline to the top of the eyebrows;  the mid 1/3 should extend from the top of the eyebrows to the bottom of the nose;  the bottom 1/3 should extend from the bottom of the nose to the bottom of the chin.


Contours of the Youthful Face

The contours of the youthful face form the so-called "triangle of youth" in which the high well defined cheekbones & plump upper cheeks & adjacent full lower eyelids represent the base of the triangle and the well defined jawline & chin intimate the apex.  As we age several inevitable changes occur:  bone resorption takes place, loss of collagen in our skin & soft tissues leads to loss of volume, and sun damage & gravity lead to sagging of our skin.  The sum of these effects lead to many telltale visible changes in our face:  hollowing of our temples, deepened tear troughs(eye hollows), flattened cheekbones, deepened meilo-labial folds(mid-cheek folds), the formation of "marionette lines"(grooves leading from the corners of our mouth to our jawline),and heavy jowling which obscures our once straight well-defined jawline.  These unfortunate but inevitable changes result in the inversion of the "triangle of youth " into what some term the "pyramid of age".


Injection of Fillers in Soft Tissue Augmentation 

Dr Chu has been injecting fillers since 1990.  Initially only collagen of animal sources were available.  Their injection frequently lead to complications and the correction achieved was short- lived.  These animal derived collagen products were replaced by human collagen of autologous & heterologous sources. The injection of these collagens were relatively free of complications but their duration was also also short-lived.  Dr Chu also performed autologous fat transplantation in the early 1990's but these procedures proved to be problematic and their results unpredictable and, therefore unacceptable.The current generation of fillers were approved by the FDA in the early 2000's and have proven to be essentially free of complications when administered by an experienced physician injector as they were designed.  Below are listed the current families of fillers routinely employed by Dr Chu for soft tissue augmentation. 


 All fillers used by Dr Chu are FDA approved and either contain lidocaine or are approved to have lidocaine added to them to make their injection less uncomfortable.


What conditions can soft tissue augmentation improve or correct?

improving wrinkles & smoker's lines

-acne scars & traumatic scars

-lip enhancement 

enhancing fullness & definition of cheekbones 

-softening hollows under eyes, cheek hollows, meilo-labial folds, & marionette lines

improving definition of jawline 

chin augmentation

Which filler is best for me?

Each filler product has its own unique properties based on its particle size and formulation.These properties determine which level of the skin it is designed to be injected into and, therefore, which defects it best corrects.

During your consultation with Dr Chu he will conduct a thorough examination of the skin & soft tissue of your face and engage you in a thorough discussion of your expectations.  Only then will he make suggestions as to which filler or combination of fillers will best suit your uniquely individual needs and desires.

How many treatments will I need initially & how frequently will I need to repeat them?

Usually only one treatment is required for correction with most fillers although supplemental "touch-ups" may be required to achieve your ideal correction.  The frequency of maintenance treatments will be determined by several factors one of the most important is the location of correction.  For example, fillers injected into the cheekbones & upper cheeks can last 9-12 months or longer because these are relatively static areas as far as muscle movement.  Fillers injected into more dynamic areas of muscle movement such as the mid cheek, lips and marionette lines may only last 6 months. Another determining factor is the "softness" of the filler.  Softer fillers are designed to be injected more superficially than others for wrinkle correction & lip augmentation and are less likely to form "lumps" but are degraded faster.

If I begin filler injections and decide to discontinue them will the treated areas sag & look worse than before starting treatment?

No.  Contrary to false internet rumors this does not occur.  In fact, the opposite is probably true. Most, if not all, of the current filler products used by Dr Chu have been proven histologically to stimulate collagen synthesis that should lead to long-term improvement in the volume of the treated skin.

What should I expect after treatment?

Some swelling will occur and last for 2-4 days.  Because small caliber needles are use for injecting, some minor bruising may occur but if the patient bruises easily moderate bruising may occur and last 4-7 days.  To minimize bruising patients should discontinue or abstain from taking NSAID's & supplements which thin the blood for 7-10 days before the procedure.  Ice pack should be applied directly after the procedure & the night after until bedtime.

What are the possible complications?

Dr Chu has been injecting fillers since 1990 and sees very few problems after filler injections when performed by an experienced physician injector.  However, he regularly sees patients who are unhappy and sometimes disfigured by inexperienced or nonprofessional injectors.  Such problems include:  overfilling of the lower cheek resulting in a "chipmunk cheek" appearance, overfilling the border of the upper lip leading to "duck lips", overfilling of the tear troughs causing bulging lower lids, and injecting too superficially resulting in nodules & raised linear clumps of filler with a blue hue.  Fortunately, many of these problems can be corrected within days but many cannot be corrected.

It is of vital importance that a patient seek out a physician injector who has the knowledge of facial anatomy, training, judgement, and experience to whom she/he can trust her/his face. Dr Chu's philosophy of cosmetic procedures is that they should enhance one's unique features to produce a more youthful "you". One actress's lips or another's cheekbones may not complement your features in a harmonious way and may even detract from one's natural beauty.