“I just want to look less tired.” “People say I look angry.” “I am not interested in surgery. What other options do I have for my face?” These comments and questions are heard almost daily from my patients.

Facial aging takes place in layers. Skin thins due to loss of collagen, which is the most abundant protein in the body. This reduces the skin’s ability to retain moisture, and it becomes less elastic. Fat and bone loss is a normal part of aging. As a result, the face experiences greater viability of lines and wrinkles, hollowing of the mid-portion of the face and widening of the lower face as jowls form.

Soft tissue fillers are injected below the skin to reshape the face. This is performed in a clinic setting often with topical numbing cream. Surgery is not required. The most popular facial fillers, such as Juvederm, Restylane and Voluma, are made of hyaluronic acid. Hyaluronic acid is naturally found in the skin. As a result, one does not have to worry about local reactions. Fillers are not permanent since the product is naturally broken down by the body. Fillers typically last from six months to two years depending on the type used and where they are placed.

Where can fillers be placed in the face? Due to social media, the best known area is the lips. Unfortunately, these injections are often overdone. If performed properly, lip injections should lessen lines around the mouth and add subtle volume. One should not look like a duck. In the lower face, injections can camouflage mild jowling, increase the projection of the chin (if needed) and diminish lines that form from the corner of the mouth to the jaw (marionette lines). Filler is a great way to turn up the corners of the mouth. In the mid-face, fillers can be used in the tear trough (below the eye), to reduce the lines between the nose and the corners of the mouth (nasolabial folds) and to restore the youthful appearance of the cheek. Injections in the upper third of the face have significant risk. Practitioners have reported a small subset of patients who have experienced blindness.

One of the greatest benefits of having fillers (rather than surgery) is the minimal downtime. Mild swelling and small bruises are common. These can easily be covered up with make-up. Injections, if performed properly, should give a person a refreshed appearance.

As with any aesthetic procedure, investigate the qualifications and experience of the person holding the syringe. Texas law allows a wide variety of individuals to perform facial soft tissue filler injections.