title: Anatomic and mechanical considerations in restoring volume of the face with use of hyaluronic acid fillers with a novel layered technique.
abstract: BACKGROUND
  Facial fillers have revolutionized the field of cosmetic facial rejuvenation as it has become the prime sought - after rejuvenation procedure offering youthful, 3-dimensional look with minimal invasiveness. Fillers are expensive and need to be redone periodically hence a sound understanding of structural basis on which they are laid is important in reducing the quantity of filler required in each sitting as well as increasing the longevity of results.
  
  
  OBJECTIVE
  The aim of the following study is to analyse a novel method of facial filling "The pillars pyramids and tie beams (PPT)" technique and its advantages over the conventional methods.
  
  
  METHODS
  A novel technique of injecting the facial fillers was employed on 67 patients visiting our clinic. These patients were followed-up for a period of 3 years.
  
  
  RESULTS
  We observed that the amount of filler material required in initial sitting remains the same, however the frequency of touch up visits is decreased and so is the amount of filler material required for follow-up injections.
  
  
  CONCLUSIONS
  Facial contour remodelling is being revolutionised by the new filler materials for volume augmentation and no uniform consensus has been reached on the techniques currently used in clinical practice. We advocate this novel PPT technique of facial filling in facial rejuvenation to restore a youthful look as a primary goal.
authors.affiliation: Department of Cosmetic Surgery, Cosmetic Surgery Institute, Mumbai, Maharashtra, India.
authors.forename: Mohan K
authors.initials: MK
authors.lastname: Thomas
authors.affiliation: Department of Cosmetic Surgery, Cosmetic Surgery Institute, Mumbai, Maharashtra, India.
authors.forename: James A
authors.initials: JA
authors.lastname: Dsilva
authors.affiliation: Department of Cosmetic Surgery, Cosmetic Surgery Institute, Mumbai, Maharashtra, India.
authors.forename: Ateesh J
authors.initials: AJ
authors.lastname: Borole
authors.affiliation: Department of Facial Plastics, Cosmetic Surgery Institute, Mumbai, Maharashtra, India.
authors.forename: Sudhir M
authors.initials: SM
authors.lastname: Naik
authors.affiliation: Department of Cosmetic Dermatology, Cosmetic Surgery Institute, Mumbai, Maharashtra, India.
authors.forename: Soma G
authors.initials: SG
authors.lastname: Sarkar
keywords: Aging face; facial fillers; facial rejuvenation; hyaluronic acid