Although our choices of fillers in the United States are still far more limited than for most of the world, with the introduction of several new fillers during the past four years, we now have a variety of different products to meet our patients' needs.
The first step in choosing the correct filler is proper evaluation of the patient and understanding what the patient needs, wants, and also, can afford. The majority of patients who come for a consultation are interested in treatment of the nasolabial folds, treatment of the lateral oral commissural folds (marionette lines), adding volume to the lips, and treatment of the vertical upper and lower lip lines and glabellar frown lines. With increasing public awareness (or after pointing out the possibilities), patients may also be interested in treatment of tear-trough deformities, chin crease and lateral chin depressions, cheek and chin augmentation, and prejowl contours. Finally, some patients lack volume or have undergone age-related volume shifts that need to be addressed and corrected.
In my practice, the vast majority of patients have limited budgets and limited downtime. In general, those patients whose needs cannot be met by 1–2 cc of commercial filler (and/or BOTOX) choose to limit treatment to a limited cosmetic concern. Or, if they can afford it, they may opt for more definitive procedures with longer-lasting and relatively predictable results such as ablative resurfacing and lifts.