Aging is a complex process resulting from both internal factors (soft tissue maturation, skeletal changes, and increased muscle activity) and external factors (gravity and sunlight). Consequently, the smooth, flowing continuity of the face is gradually replaced by sharp angles, superficial and deep lines, sudden depressions, and protrusions. A decrease in upper jaw height and an increase in eye socket volume cause the eyes to sink. The cheeks droop, the folds between the nose and the corner of the upper lip deepen, the upper lip appears fuller, and the tear trough, along with the lines around the mouth, becomes more prominent. As the ligaments holding the soft tissues and skin loosen, the lines and depressions on the face increase.

Soft tissue fillers are ideal for patients seeking short-term facial rejuvenation. While these substances are a good option for younger patients who do not require surgery, for older patients, they can be combined with surgery, fillers, and other surface treatments to achieve the best results. A wide variety of fillers are available. While the longevity of an ideal filler is a positive attribute, a substance that doesn’t age in direct proportion to the signs of aging on your face can have negative consequences. Therefore, reversibility is an important feature. Among the most commonly used fillers derived from the person’s own tissue are fat grafting, platelet-rich plasma (PRP), and cultured fibroblasts. Fat is harvested from the torso or thigh area using a cannula in a closed procedure under local or general anesthesia in an operating room, filtered, and injected into the area where the filler is to be applied. It shows permanence when it survives by being nourished by the surrounding blood vessels; however, it is known that some of it dissolves when it does not maintain this attachment. Thanks to the stem cells it contains, it also creates vitality and rejuvenation in the skin. It has been shown that stem cell-enriched fat injection increases the survival rate of the cells and reduces the absorption rate. Fat injection can be applied to any part of the body. When given in high volumes, it can also be used in breast and buttock augmentation. Platelet-rich plasma (PRP) is obtained by processing blood taken from the patient’s own vein in an outpatient setting for approximately 20 minutes, and then injected into the areas where the patient has wrinkles. It has been shown to increase collagen and dermal matrix formation over a three-week period and to improve wrinkles over approximately 20 months. It can be used for facial wrinkles and depressions, acne scar treatment, facial rejuvenation, and as an additional procedure before hair transplantation. Fibroblast therapy, which has become increasingly common recently, is effective in treating moderate to deep nasolabial folds (the line extending between the side of the nose and the corner of the lip). Fibroblasts obtained from a biopsy of the patient’s own skin behind the ear are cultured until enough cells for three injections are obtained and injected into the targeted area at intervals of 3-6 weeks. Among biological fillers derived from organic sources, hyaluronic acid is the most frequently used. This substance is found in the skin, cartilage, bone, and joint fluid of many living organisms. Hyaluronic acid has water-retaining properties and, even if it separates after injection, it continues to provide a fuller effect. Many hyaluronic acid-containing fillers are available on the market; however, not all of them have FDA (Food and Drug Administration) approval. Using a product without FDA approval should be avoided. The most commonly used FDA-approved products are Restylane, Elevess, Prevelle Silk, and Juvederm. Fillers can be safely used in lines at the bridge of the nose and forehead, forehead lines, eyebrows, tear troughs, nasolabial folds, cheek augmentation, lines under the corners of the lips, volumetric enlargement of the face, lips, nose reshaping, correction of scars and deformities, and hand rejuvenation. Since the procedure requires a detailed facial analysis, examination, and training, it is recommended that it be performed by a physician specializing in this area.