Facial fillers Juvederm Radiesse Restylane Perlane Sculptra Fat Injections

Facial fillers Juvederm Radiesse Restylane Perlane Sculptra Fat Injections

Facial fillers are fast becoming the most common procedure in cosmetic surgery.  The various types of fillers herein described vary in terms of mode of action, durability, safety profile, and anatomic suitability.

Fat injections are also appropriate for facial augmentation but are not a curative panacea for all facial volume loss.  Fat injections can be easily performed on an outpatient basis but there are specific indications for its use.

In your case, commercial facial fillers seem to have had an excellent safety profile and should be reconsidered since they provide adequate correction, although temporary.

Fat injections are considered by most doctors to have some permanent benefit.  In our practice, we have studied and presented another option which has given superior results, LiveFill.  Fat injection technique involves removal of fat cells from the body via liposuction.  The cells are then usually spun in a centrifuge.  They are then injected through a needle back into the face.  This process kills (depending on the study you read and the technique used for measuring viability) most to nearly all of the cells.  These dead cells cannot resurrect themselves.

LiveFill uses nontraumatized cells shaped into grafts which are then placed directly into hollow areas.  The percentage of dead cells is very low, 12% in our studies (vs. 75% dead cells for Coleman technique fat aspiration).  That means the number you are starting out with is higher, and your eventual success rate is higher as well.  We demonstrated this with 3-dimensional CT scans measuring volume, presented the results at ASAPS and ASPS meetings, and published the results in Plastic and Reconstructive Surgery.

So yes, LiveFill is an alternative to temporary fillers.

Having said that, in most 62-year-old patients, there are usually two primary problems going on:  loss of volume, and sagging of facial skin.  Sagging of the skin cannot be overcome with obtuse amounts of volume replacement, in my opinion.  Rather, a combination of a cleverly done facelift with volume restoration (with LiveFill grafts) gives the best long term results.

An old mentor of mine once said that if Plan A fails (i.e. temporary filler, temporary filler, temporary filler), make sure Plan B is not the same as Plan A (i.e. more temporary filler), but think of the problem differently.  In this case, consider whether a facelift is the most appropriate way to rejuvenate the face.

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Although fat transfer to the face (nasolabial folds) is not permanent, it does last longer than the injectable fillers such as Restylane, Juvederm,and Radiesse.

Approximately 80-90% of the fat will remain viable (alive) after one year.  It is possible that a patient may need a second or even third fat transfer throughout one's life to maintain the desired contour. Fat transfer seems to last longer in the cheek area as compared to the nasolabial fold area.

In the long run, compared to injectable fillers, fat transfer is more economical and has more longevity. It does however, involve a trip to the operating room to be performed,usually under local anesthesia with sedation.

Please consult with a board certified plastic surgeon prior to any fat transfer procedure.

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Dermal fillers do great for the nasolabial areas. Radiesse tends to last about 1 yr at a cost of $650-750 per syringe. Artefill lasts 4-5 yrs at a cost of $1000-1250 per syringe.  Other fillers such as Juvederm or Restylane last only 6-9 months at a cost of $550 per syringe. Regardless of which filler you use, you will need 2-3 syringes depending on how deep the grooves are. 

Fat injections have been very disappointing in lasting usually 6-12 months and getting bumpy as they resolve and the excess swelling and bruising for 2 weeks is bothersome to most patients as well as the shifting problem.  Fat doesn't stay well in the nasolabial area and may wind up in the jowls sooner or later or just pushed to either side of the NL grooves.

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