All About Fillers

Dr. Menachof, MD, FACS has performed thousands of facial plastic surgery procedures in over 20 years of experience. He has been recognized as a Fellow by multiple academies, named one of America’s Top Facial Plastic Surgeons continually since 2003 and is featured in multiple national publications.

Filler isn’t what it sounds like – it isn’t a “line lifter” or a “hole filler” – it’s volume. This non-surgical procedure results in a full, smooth, more youthful looking appearance, and has little recovery time and immediate results. Every face is different and requires different filler placement – the goal of fillers is to bring a smile to your face every time you look in the mirror. Speak to an experienced surgeon about your aesthetic goals and determine if fillers are the right solutions for you.

The History of Fillers

Things seem to change so much in the “filler world.” I use quotes here because most people who talk about fillers are simply reciting what the filler companies have told them to say, as opposed to what I am about to tell you about my experience.

For many years, surgeons used filler to make skin look smoother. They injected it to lift skin, muscles and fat. They injected it under the lines around the mouth, under deep nasolabial folds (the lines from the nose to the corner of mouth), and into very thin lips. The result was that people looked smoother, but they didn’t look better, and they definitely didn’t look younger. Almost no patient looked in the mirror on a regular basis after their injections and smiled. In before and after photos, the depth of facial lines were less noticeable, but while the patient’s lines looked better, the person did not.

Throughout my career, I have worked to find the answers to the following questions – since filler is volume, how can we use volume to make us look better? How does volume make us look attractive? How does volume make young people look young? What is it that happens to volume as we age that causes us to look older?

All about facial fillersFacial Volume

Not all young faces look young – typically, the more fat in a person’s face, the younger they look, no matter their age. Therefore, facial volume equates to a younger appearance.

While volume plays a big role in appearance, it is not the entire answer – there has to be an attractive component as well. When we are injecting filler, our goal is not that you simply look young, but that you look young and attractive. Since we know that volume is one of the keys, but not the only key, we next need to figure out how volume makes us look attractive.

The Aging Face

Filler patients are typically individuals who have started aging. How do we make these people look young and attractive? Here are some areas of the face that indicate aging.

  • Eyebrows – Young people have volume over their brow bone just underneath their eyebrows and just above their upper eyelids. Light hitting the face causes this area of volume to shine. This light reflects just beneath the eyebrow and gives this area a very young and attractive appearance (many women apply a light-colored makeup to this area to try and create this same effect). One of the earliest signs of aging is that the eyebrows start to fall while the volume beneath it goes away. When this happens, the eyebrows now sit over the top of the brow bone causing this light to disappear. The result? You look older and less attractive.
  • Temples – As we age, we lose volume over the temples. This happens especially in thin people. This loss of volume causes an older, slightly unhealthy appearance.
  • Lower Eyelids – As we age, the upper part of the lower eyelids has too much volume (the “bag”) while the lower part has too little (the groove). This also causes the lower eyelid to lengthen, making us look older and less attractive.
  • Cheeks – As we age the tissue in the cheeks falls, changing the shape of the face from an oval to more of a square (oval = young and attractive, square = old an unattractive).
  • Nasolabial Folds -The falling cheek tissue builds up along the fold causing it to become deeper. The problem here is not a lack of volume in the crease, but the fact that there is too much volume pushing up against the fold (this is where surgeons have injected most filler over the years).
  • Lower Face -The falling cheek tissue adds too much volume to the lower part of the face, making the overall contour of the face bottom heavy, causes jowls to appear, makes the jaw-line indistinct, and blends the face and the neck into one structure. Once again, this is not where we want to be injecting our filler.
  • Lips -As we age, the lips start to thin (making them almost disappear when we smile), the edges of the lips flatten and lose definition (we lose the “pucker”), and the philtrum (the two pillars going from the nose to the middle of the upper lip) disappears (making the area between the nose and lip look long, flat, and old). Also, the loss of volume underneath the corners of the mouth causes the corners to fall, creating a somewhat sad appearance.
  • Neck -Volume in our neck does not make us look young or attractive.


We need to add back volume to the places that make young people look attractive, and back to the places we have lost as we have aged. Put all of this together and we can use fillers to make those of us that are aging (meaning anyone over the age of 30) look younger and more attractive.

All about facial fillersThe Filler Solution

Every person is unique – these are general guidelines to fillers. If there is something that bothers you that doesn’t align with these rules, have a conversation with your surgeon about your facial needs.

  • Don’t fill wrinkles (young, attractive people have wrinkles).
  • Don’t fill the nasolabial folds (it’s a cheek issue).
  • Don’t fill the bottom part of the face (it’s a cheek issue).
  • Fill the cheeks. It will make the nasolabial folds and the bottom part of the face look better. If you are on a limited budget, the cheeks are likely where you will get the biggest bang for your buck.
  • Don’t forget about the lower eyelids. Filling the groove connects the “bag” to the cheek, making the cheek look higher, and therefore making the lower eyelid look shorter.
  • A small amount of filler in the lips makes a big difference (well defined, appropriately full lips with the corners of the mouth no longer turned down).
  • In really thin faces, filling the temples makes a really big difference.
  • A very small amount of filler just beneath the eyebrows opens the eyes and makes them “pop”.


At the Facial Surgery & Aesthetics Center, this is how we do it. These guidelines work really well for our patients. As a general rule, however, if we inject outside of these recommendations, it should be a small injection that is performed in addition to injections that are following the rules. If you have any questions about fillers or about your specific filler needs, don’t hesitate to reach out.

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