You have been doing Botox and fillers for many years, but now you are not getting the same results you used to, and wonder what is next.

This is a familiar question on the lips of many people, especially when they are not ready for cosmetic surgery. It is important to understand the aging process.

Aging is a continuum of processes that involve genetics, environmental factors, sun exposure, skin health and care, smoking, nutrition, and other factors.

Aging is a three-dimensional process. Under the influence of the factors mentioned above and with repeated facial muscle movements, lines start to initially appear during facial gestures. These are called dynamic lines, as they appear only during muscle movement.

About the same time, static (“permanent”) lines start to appear as the skin loses moisture constantly under the effect of the sun. As we get older, our turnover of collagen (the difference between new collagen being formed and old ones being absorbed) turns to negative balance. The loss of collagen results in skin losing elasticity, and the whole face sagging. This is due to loss of tension in the collagen scaffold that holds the skin up against the face, as most of the face is not supported against gravity.

All this while the facial bones and fat cells which support and give fullness to the face start to shrink from middle age.

These fat cells are not in a uniform layer but rather in “compartments”. These compartments shrink at a different rate, creating the hollows and bumps (convexities and concavities) seen with aging. As mentioned above, aging is a three-dimensional process.

The result of these changes may include length, like a more-prominent forehead with wrinkles, brow droop, nose-to-mouth lines, cheek and chin droop, and jowling.

Breadth changes result in inversion of the so-called triangle of beauty with cheek bones becoming narrower while the chin and jaw widen.

Depth changes include the various hollows and dips that appear in the temples, under the eyes, and in the cheeks and chin.

Botox and dermal fillers are among the most popular aesthetic treatments. Botox is ideal for dynamic lines as it relaxes the muscle causing them, while dermal fillers are good for replacing volume.

Both of these may not be enough, especially when the signs of aging are brought on by severe loss of collagen and drooping of the facial scaffold. This is when lifting will be required, which is why a surgical facelift is often seen as the ultimate in shaving many years off. However, not everyone is ready, nor wants surgery.

The appearance of various treatments such as skin tightening, biostimulatory fillers, Instalift and fat transfer has created the opportunity to bridge the gap between Botox and fillers on one side and surgical facelift on the other.

Biostimulatory fillers strongly induce the production of collagen, thereby restoring strength and volume to your skin.

Instalift is a thread that lifts and anchors the skin giving support against sagging.

These treatments can be combined with Botox and fillers to create a more individualized rejuvenation plan for you.