Historically, plastic surgery was a specialty designed to treat war injuries, burns, accident victims and cancer reconstructions, etc.

One of the first famous people to actually request cosmetic surgery was Hedy Lamarr, a famous actress in the 1930s. In an attempt to look younger, Hedy sought out a plastic surgeon and basically demanded skin tightening and some type of filler.

At that time, the only fillers available was wax, industrial silicone, and who knows what else, which apparently the doctor injected into her face. The result was so disfiguring that Hedy, once known as one of the most beautiful women in the world, became a recluse and would not let anyone see her, including her children.

As cosmetic surgery emerged from movie stars to the general public, facelifts that tightened the skin become more commonplace. However, skin tightening alone frequently did not give a more youthful, softer, natural-looking appearance. There was also a need for a filler to revolumize the face.

The first medical grade soft filler was collagen, named Zyderm and Zyplast. This was used for small wrinkles but not for adding volume to faces. Collagen was successful for diminishing fine wrinkles, but – as faces lose volume with age – it only lasted a few months.

Thus, the advent of longer lasting fillers with different “P” factors, the ability to lift the area or spread out into surrounding areas. An advantage of hyaluronic acid products is that they are reversible with injections of an enzyme that dissolves the product.

Longer lasting fillers injected into different areas are now commonplace. The hyaluronic acid fillers, such as Restylane and Juvederm products, as well as Sculptra can last from 10 months to two years, according to the product used.

Originally, the most common place for a filler was the smile lines between the corner of the mouth and the nose. These deepen with age due to loss of volume in the cheeks and even temples, allowing the skin to fall forward and downward, accentuating the lines and wrinkles, as well as creating jowls. So, for the best result, the patient must be skillfully assessed to see where the actual volume loss is.

A much longer lasting product is Bellafill, which lasts five or more years. It cannot be injected into the area under the lower eyelids or in the lips, and a skin test must be performed prior to its use for possible allergic reaction to the collagen in the product.

Bellafill is used for smile lines, cheeks, the chin area, temple depression, above the brow, jaw line, and even the nose for non-surgical rhinoplasties.

However, because of its longevity, only experienced physicians or skilled injectors are qualified to inject Bellafill.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com