I am very nervous & anxious about fillers. Is it best for a plastic surgeon or dermatologist to perform the procedure. I hear positive results but also hear so many horror stories. Exactly how safe & effective is it?
Does Anyone Have Any Information on Fat Transfer Vs Juvederm for Nasal Folds & Around the Mouth?
Doctor Answers (21)
Fat transfer or Juvederm for nasolabial folds and round the mouth?
One great aspect ofJuvederm is that it is reversable with an enzyme. Also it is not a surgical operation. I inject Juvederm Ultra Plus in the lips virtually every day. My patients are routinely thrilled with the injections. My tendency is to be conservative at first to assure the patient is happy. Then at a later date, we can add to it if necessary. Also I recommend using a DermaSculpt cannula to avoid bruising and bleeding rather than a needle. Bleeding and swelling makes symmetry very difficult.
Regarding fat grafting, this is a wonderful procedure, especially for the perioral area, but not particularly in the lips themselves. However, my latest technique is concentrating stem cells from the fat liposuctionied to the fat that is to be grafted. This gives the advantage of a better "take" for the grafts and thus better longevity. Fat is particularly good for the cheeks, midface, under the eyes, temporal areals, around the chin and jaw line. Volumizing the cheeks will actually reduce the nasolabial lines. Fat grafting can last a decade or longer. It is an operation, however, and there is some recovery time involved. But many people appreciate the simultaneous liposuction.
Routinely, I injects Juvederm UP in the nasolabial lines. You can have it done in a few minutes and be on your way. And it will last about a year.
The future of volumizing the face, however, is in fat grafting, in my opinion.
Fat Grafting vs Juvederm for Nasal Labial Folds and around the mouth?
I have found fat grafting works best for volume in areas like cheeks, temples and sub-malar areas. It has not worked as well for areas with a lot of movement such as nasal labial folds or fine lines around the mouth. I have found dermal fillers work better in those lines. Who should perform the injections depends on training and expertise. Both Dermatologists and Plastic Surgeons, and some nurses with advanced aesthetic training should be able to perform injections safely for you. Fat grafting involves a surgical procedure to harvest the fat so that would need to be done by a surgeon with the proper aesthetic training and experience.
Hyaluronic Acid-Based Volumizers and Fillers Have Advantages Over Fat Transfer
I have more than three decades of experience with the use of all kinds of fillers and volumizing fillers beginning with the use of the original Zyderm collagen product back in 1982. During that time, I have seen many fillers come and go--have their day in the sun and then fade from the scene. And it's been quite a number of years--about seventeen to be exact--since I stopped using fat for filling.
On the surface, fat transfer would seem to have certain advantages. For one thing, the material is your own, so there is no concern for allergies. And, at least initially, there was much talk about it lasting so much longer (or permanently) as compared to the existing fillers.
Well, unfortunately, it turns out that in most cases, the high hopes for the fat lasting so much longer have not panned out for a variety of reasons, particularly when treating areas subject to a great deal of movment, such as around the mouth and the smile lines. In addition, retrieving the fat from the buttocks, thighs or abdomen requires a minimally invasive procedure (i.e. a second wound to heal in addition to the treatment sites themselves). And fat is a uniformly thick material that requires larger cannulas to remove and to deliver and because of its relative bulkiness lacks the versatility to be used in locations requiring materials of lesser bulk. Finally, once injected, if there are any undesirable lumps and bumps, it can become a difficult and frustrating problem to fix.
Here's why I believe that hyaluronic acid fillers and volumizers have eclipsed fat for use in filling and volumizing. Hyaluronic acid, like fat, is a natural product and is found throughout the skin and other tissues of the body. Allergy to the commercially made hyaluronic acid products has proven rare, to say the least, given the milllions of people who annually are treated with these products worldwide. They can be easily dissolved with a natural enzyme, hyaluronidase, should that be so desired. They can be pulled off the shelf and used immediately, without the need for what amounts to a separate operation on another area of the body in order to retrieve them and process them. They come in a whole variety of particle sizes to so that their use can be tailored to very fine wrinkles and crinkles, such as lipstick bleedling ("smoker's lines") around the mouth or deep folds. They can be easily combined with another natural material, Radiesse, a calcium based volumizer to perform a Nonsurgical 3D Vectoring Facelift, which can very favorably improve smile lines and marionette lines ("Howdy Doody" lines) around the mouth and whose results may last up to two years. More recently, they have been shown to stimulate new, native collagen synthesis, which may ultimately contribute to longer-lasting results and the need for less involved touch-ups going forward. And finally, they are relatively inexpensive.
Of course, consultation with an experienced board certified aesthetic physician with extensive experience in the uses of all kinds of fillers and volumizers is a must, so that a treatment plan can be tailored to the specific needs of the individual.
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Fat or fillers for facial folds
As others have stated, fat is a wonderful filler for larger volume such as cheeks, and, especially in younger individuals, can be very long lasting. In the nasolabial folds Juvederm, Restylane or Radiesse are excellent choices, usually lasting around nine months. If injected with a cannula, side effects are few and the safety is excellent.
Fat transfer or fillers
Fat transfer and fillers such as Juvederm are both great for volume restoration. However, I find that for areas, such as the nasolabial folds and around the mouth are a little less reliable with fat transfer. Fat is great for general volume restoration, especially when larger volumes are needed in the cheek, midface and around the eyes area. Fat grafting provides a more long term result than fillers which usually last between 6 months to 1 year. Fillers, such as Juvederm, Restylane and Perlane are reversible if results are not desireable, and will disappear over a period of 6-9 months on average. This makes them a desirable choice for your first injection. Juvederm is made of hyaluronic acid which is a material that we have in our bodies and there is minimal risk of having an allergy or reaction to it. Physicians such as a facial plastic surgeon, plastic surgeon, dermatologists, and oculoplastic surgeons are the most qualified to perform these injections. There are many medispas offering injectable fillers but your injectors experience level can vary in these types of spa environments.
THere are many well qualified specialist that can perform fat transfer and fillers: plastic surgeons, facial plastic surgeons, oculofacial plastic surgeons [oculoplastics], and dermatologist.
I would recommend finding a specialist that is experienced in BOTH techniques, since they are more objective about what each procedure can offer.
In general, fat grafting is a better long term solution for more natural results, with the downside being a higher upfront cost. In addition, technique is extremely important, especially around the eyes.
Fillers achieve very nice results as well, and are less expensive in the short term, and are easily reversible if you are unhappy with the results, or if you want a minor revision.
Each person is different and I may give different recommendations [fat vs fillers] based on a patient's anatomy and goals.
Both fillers and fat work well for perioral and facial rejuvenation. I would recommend you try the fillers which absorb first to see if you like the results
Fat vs. Fillers for Folds
There is no right or wrong answer. Both of the products will work. However, I always recommend for my patients to start with something temporary, like Juvederm first. This way you can see if you're comfortable and like the look. I am big proponent of fat grafting and it works beautifully. It is a more involved procedure and lasts significantly longer than fillers.
Juvederm versus Fat transfer
Juvederm is much simpler but may not last as long in some cases. However many of the fat transfer cases I see dont last very long either. Juvederm is much simpler and probably less expensive.
Fat Grafts vs. Fillers for the Nasolabial Folds
Thank you for the question. Either treatment option can be a fantastic treatment for the nasolabial folds (sometime called the "parentheses"). The benefit of fillers is that they are temporary -- if you like it, you can repeat the treatment, and if you don't, it will go away over time. Fat grafting is more involved, generally more expensive, and can be permanent -- though, in a small percentage of patients, the grafts won't "take" and minimal results are seen. For my patients, I suggest that we start with a temporary filler, like Juvederm or Perlane, to "try out" the effect. If they really like it, then we discuss longer-lasting options (like Radiesse or fat grafts). Identifying your goals and comfort level, as well as finding a trained expert, will help you make the right decision. Best of luck!