My question concerns plastic surgery for the face. Will repeated dermal hyaluronic collagen fillers cause more sagging of the skin when the injections cease? Would it be better to leave the skin alone? And will repeated injections over the years as it is required every 9 months cause the patient to eventually require face lifts? If the patient does not like non invasive procedures would you recommend that the face be left alone? Lastly, do yoga exercises for facial suppleness really work? They promise to decrease nasal labial lines. Is this true or a gimmick? Thanks.

When we age, our skin tends to sag normally due to gravity. Dermal fillers (such as hyaluronic acid) can help prevent wrinkling of the skin but do little to improve the sagging. In fact, some physicians suggest that dermal fillers may actually increase the rate of sagging by increasing the mass of the skin (if ever so slightly).

There are few proven methods to prevent facial sagging and these include botox injections as well as face/eye lifts. Facial exercises, such as facial yoga may exercise specific facial muscles not normally used but you should only expect minimal results.

It is important to note that one of the only proven non-surgical methods of decreasing facial lines/wrinkles are vitamin A derivatives. Tretinoin (all-trans-retinoic acid), also known as Retin-A, is currently the only topical agent FDA-approved for the treating of wrinkles and furrows caused by prolonged sun damage. Retinol and Tazarotene are also vitamin A derivatives becoming more widely used in topical creams and studies have shown they can also decrease wrinkles in the skin.

Therefoer, one of the best treatment for wrinkles is any cream containing a vitamin A derivative (tretinoin, retinol, or tazarotene) – available commercially in most department stores.