INTRODUCTION
There has been significant growth in both patient interest
and physician use of soft tissue augmentation in recent
years, especially among younger patients. Patients’
motivation behind this increased interest is complex. Studies
using digitally enhanced photographs1 and those conducted
using botulinum toxin type A injections2 have shown that improvement
in facial appearance increases overall attractiveness,
reduces perceived age by up to 5 years,2,3 and promotes a
positive effect on mood4 and self-esteem.5
A 2006 Harris Interactive Survey involving nearly 800 women
aged 35 to 69 years, conducted on behalf of the American Society
of Plastic Surgeons, found that the reasons women consider
cosmetic interventions include: looking younger, improving
intimate relationships, and increasing their confidence.6 Sixty-
three percent of the respondents reported that they would
much rather have a facial injectable treatment than a surgical
treatment. The facial signs of aging that women are most likely
to be very concerned or extremely concerned about are wrinkles
(44%) and sagging skin (41%).6
Recently, the first ever American Society for Dermatologic Surgery
(ASDS) Consumer Survey on Cosmetic Dermatologic
Procedures solicited feedback from over 6,300 consumers.7
While 6.4% of those surveyed had previously had a cosmetic
treatment, 53% said they were considering injectable fillers in the
future.7,8 Consumers gave the highest overall satisfaction ratings
to injectable filler treatments (92%), including poly-L-lactic acid
(PLLA), and injectable wrinkle relaxers (92%),9 with injectable
fillers receiving the highest “extremely satisfied†rating (45%).7
Another study conducted by the ASDS found that among women
considering using medical anti-aging treatments, 89% and 75%
would prefer gradual results lasting 2 years, compared with immediate
results lasting 6 months or 1 year, respectively (Figure
1).10 It is interesting to note that long-lasting effects were more
important than cost as a factor in treatment decisions, particularly
among women who had already used an injectable product.10
To optimize outcomes, cosmetic treatment must be tailored for
each patient; communication is thus paramount. Clinicians need
to understand their patients’ treatment goals, including areas for
correction and the desired timeframe for cosmetic benefit.11 The
cosmetic deficits of patients considered for PLLA should match
its benefit profile of increased soft tissue volume. If PLLA is
agreed upon, patients should be educated on the nature of their
underlying deficits (eg, volume depletion), the gradual onset of
cosmetic improvement, the need for multiple sessions, and the
long-lasting benefits of the approach.11 Clinicians should also
take measures to minimize the occurrence of adverse events,
such as nodule formation, through the implementation of the
latest recommendations on methodological approaches.11,12
There is a growing trend in the use of injectable dermal fillers
for soft tissue augmentation in patients 35 to 50 years of age
(Figure 2)11; in fact, in 2012, about 75% of respondents receiving
