The third dimension in facial rejuvenation: a review

Facial rejuvenation has long been dominated by surgical techniques that act on only two dimensions of the face, ignoring the third dimension (facial volume); therefore, a truly youthful look remains elusive.

This paper aims to define the various surgical procedures employed by cosmetic surgeons that can be combined with alloplastic implants or injectable devices in order to restore lost facial volume.

A search of the literature was performed.

Alloplastic augmentation and implants provide permanent restoration of facial volume, but require invasive surgery. Soft-tissue fillers include autologous fat, calcium hydroxylapatite, and a variety of polymers. Devices based on collagen and hyaluronic acids provide correction of superficial lines and folds, but cannot offer long-lasting restoration of facial volume. The only fillers that have been proven to augment facial volume are autologous fat, calcium hydroxylapatite, poly-L-lactic acid, polyacrylamide, poly-alkyl-imide, and methylpolysiloxane.

For optimal facial rejuvenation, the accepted surgical techniques of skin lifting and tightening could be combined with volumizing devices, thereby addressing ptosis, lines, folds, and volume loss.