Facial Reflation and Contouring: Clinical Pearls


B. Kent Remington, MD

Dr Remington provides key takeaway points:

  • With time we all sink – sag and wrinkle. The focus for facial fillers is to improve facial deflation the sinking part of the aging process. Injectable collagen [Zyderm] became available in 1981 and most us were taught to be line chasers with horizontal injections –serial puncture – radial techniques and fanning and ferning – all retrograde methods. None of these techniques are very effective to restoring facial deflation.
  • Inflation is an injectable vertical technique to lift by mostly antegrade methods the deflated facial zones with contouring up to the level of a more youthful appearance.
  • This is not to be confused with Inflation –where the areas injected are injected far beyond what the patient once had. Reflation restores the patients normal volume loss and not beyond.
  • In our female aging patient with areas of deflation, “Facial Reflation” and Contouring re-creates feminine natural smooth facial curves and softness.
  • In Men, Facial Reflation and Contouring re-creates masculine structure and strength.
  • To Create great results with facial fillers it is important to have “Double Vision” The 1st Vision is to be able to see in 3rd dimension what the face needs and be able to demonstrate this to your patient. The 2nd Vision is to be able to “See the end result” before you start.
  • It is not possible to have facial shadows without light and it is also not possible to have Youthful Facial Highlights without shadows. Youthful faces have light and shadows all in the right places.
  • In restoring the youthful cheek both in volume and in shape with the apex mathematically just right involves understanding the phi and math of the face. Reflating and contouring the cheek shadows caused by aging and not injecting and filling the youthful “cheek form shadow” is a delicate balance.
  • The Yin and Yang of facial light and shadows are not opposing forces they are complementary. Faces have both Yin & Yang aspects – Shadows and Light for Balance and Harmony. To see the aging face clearly, do not just look at the facial highlights, but also focus on the important shadows of deflation.
  • Converting your pre-treatment facial photographs to black/white makes determining the shadows that need reflation much easier. Also a “Split Face” study of the current photo and a youthful one helps show the shadows of youth to leave untreated and the shadows of deflation you need to focus on.