Historically, procedures for rejuvenating the face have entailed surgical treatments designed to remove excess fat or skin, and elevate or suspend descending tissues. In the last two decades, great strides have been made in non-surgical facial rejuvenation techniques. These advances were guided by our increasing understanding that facial aging involves not only gravitational descent, but also volume loss, muscular over activity, and skin changes. Non-surgical facial rejuvenation entails the use of injectable fillers, injectable muscle relaxing products, and medical lasers. In younger patients without significant skin sagging, non-surgical facial rejuvenation is an attractive alternative to facelift surgery. In older patients, non-surgical facial rejuvenation may not replace surgery, but it can still have a remarkable effect.

The three main components of non-surgical facial rejuvenation are: injectable muscle relaxers (Botox Cosmetic or Dysport), injectable fillers (Juvederm, Restylane, Radiesse, or Sculptra), and skin resurfacing lasers (Fraxel). Botox Cosmetic and Dysport help erase wrinkles in the forehead and the Crow’s feet. Injectable fillers restore volume to highlight the cheeks, plump the lips, rejuvenate the lower eyelids, and erase the naso-labial folds, the marionette lines, and the jowl folds. Resurfacing lasers restore tone, color, and elasticity to the skin.

The Allergan company has introduced a new injectible facial filler to the market that addresses the main area of concern for most patients: pain during injection. The new formulation of Juvederm has lidocaine (an anesthetic) mixed with the hyaluronic acid (the active molecule that gives the cosmetic benefit).

Hyaluronic acid products are currently the most widely used form of dermal injectibles used for treatment of lines, wrinkles, and depressions in the face. The addition of anesthetic makes filler injections more comfortable. The suffix “XC” indicates xylocaine (lidocaine). Both formulations of Juvederm (Juvederm Ultra, and JuvedermUltra Plus) are available in the XC formulation. Juvederm Ultra and Juvederm Ultra Plus last an average of six and nine months respectively.

Hyaluronic acid products and other dermal fillers can be used for non surgical facial rejuvenation in areas such as the nasolabial folds, frown lines, and depression below the eyes, and marionette lines. These fillers can also be used to augment the cheeks and the jaw, and to camouflage jowls. Dermal fillers can also be used for non surgical rhinoplasty.