Why volume replacement? The essentials.

Volume Replacement At A Glance

  • Best ResultsTreat all layers of the skin
  • Skin Texture ImprovementsLaser & peels
  • InjectablesHyaluronic acid, collagen stimulating injections
  • Skin TighteningHIFU, RF, PDO vectors

Why is volume replacement required for skin rejuvenation & what is the concept?

As one ages, facial fat reduces in volume. Additionally fat pads move downward with gravity, & the fibroseptal network (scaffolding of fat) becomes weaker. Volume replacement corrects the decline & descent of fat. Volume is an independent index, seperate from skin texture (quality) & skin tone. 


How do we replace volume?

Soft tissue fillers give predictable volume replacement. The two types of fillers we use are hyaluronic acid & collagen stimulating fillers. 

Dermal fillers are flexible in application, depending on the area of need or want. Fillers restore volume & stimulate collagen production.

I do use fat transfer to correct large volume deficits- typically more than 10-15 mls. The downside about fat transfer is the absorption rate that varies significantly between individuals.

Lasers do give marginal improvements in volume, typically 0.2 to 0.9 mm increase in dermal collagen production. Lasers do not replace fat or bone loss with age.

What contributes to volume loss?

Age, genetics, environment factors (UV) & metabolic rate all contribute to accelerated volume loss. A reduction in volume can be the result of one or all three of the following-

    1. Reduction in collagen. From your early 20s you lose 1% of collagen annually. In your late 40s, you have 30-35% less collagen than at your peak.
    2. Reduction of fat.
    3. Reduction in bone density & mass. Occurs in the 40s, especially in women approaching menopause.

How long do fillers last?

Longevity depends on the product, & your metabolic rate. It is widely accepted that fillers last longer than what is advertised. As a guide-

Location of fillers also play an important role- lip fillers 6-18 months, tear trough fillers 24 to 96+ months.


*High output cardio, defined as level 2 exercise for 40 minutes or longer 4 to 5 times a week may reduce dermal filler longevity. Genetics play an important role in how fast you break down filler.

Davin’s viewpoint on volume replacement

In my practice, volume replacement is the hardest concept for patients to understand. For balanced rejuvenation, volumetric defects must be addressed. This is independent of improving skin quality & tone or laxity.

The technology of dermal fillers has taken a huge step forward in the past 15 years as there are many good brands. My team and I hand pick particular properties from each brand to ensure patients are getting the best possible outcomes. The ideal filler depends on the amount of volume required, filler rheology, degree of skin laxity as well as a myriad of clinical features. 

The filler industry has expanded exponentially over the past decade with GPs, nurses, dentists, & even therapists  performing these procedures. With this comes the side effects & ‘bad jobs.’ The overfilled look really spoils it for everyone. Think of dermal fillers as artl, much like paint. In good hands, the result will look great, conversely in the wrong hands, it looks crap. 

We prefer to inject after addressing skin texture & laxity. Several reasons-

  1. Lasers can, in some patients, regenerate a significant amount of volume, in some cases the equivalent of 2-4 ml of filler. This change in volume can make a significant impact clinically. This means you require less dermal filler, & the collagen you generate should, in theory, last longer. 
  2. Accuracy of placement. Skin tightening before fillers means more accurate placement of product. This is especially important in the under eye area.
  3. Momentum of collagen regeneration is maintained with collagen stimulating hyaluronic acid biomodulators & stimulators such as PLLA & calcium hydroxylapatite fillers.


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