Unlike the lines (Rhytides) on the upper half of the face caused primarily by dynamical muscle action, those on the lower half are caused mainly by the effects of gravity. I like to call these "static lines" and they manifest themselves as a deepening of the groove between the nostril and the lateral portion of the lip (laugh lines), lines at the corners of the mouth (smoker's lines) and thinning of the upper and lower lips.

Correction of these static lines with one of the many available filler materials have a significant rejuvenating effect. The question which often arises is "Which filler ?". It is important to realize at the outset that most fillers are not permanent. They usually last up to six months and require top ups to maintain their effect. The oldest filler, is of course fat, which may be transferred from the buttock or abdoment via small syringes into the treatment areas of the face. Fat transfer has undergone considerable refinement over the years to improve the graft "take" with the hope of permanence. In my experience at best it lasts from six to eight months, however there have been patients who have retained the graft for years. The downside is that it needs to be done in the Hospital, and is painful under local anesthetic. The introduction of bovine collagen some years ago gained great acceptance due to its simplicity and results. Collagen is injected into the furrows after application of a local anaesthetic cream to the face, and is quite tolerable. It does however require a test dose into to forearm, which needs to be watched for four weeks prior to injection into the face. This is inconvenient to a number of patients, but is necessary as some people have had allergic reactions to collagen. Recently the introduction of Hyaluronic acid (one of the basic building blocks of the skin) synthetically produced has become popular. It does not require a test dose and lasts as long as collagen. Many companies produce this under various names eg "Hylaform" or "Restylane".

Whatever procedure one chooses to do, it is important to discuss in detail with your plastic surgeon about the advantages and potential side effects of any procedure. In order to have a satisfying result, communication of ones expectations and the surgical ability to achieve it must be at the same level.