which treatment is the best and longest lasting for replacing volume in the face? I have had Sculptra in the past and didn't really notice a great improvement. I am contemplating fat transfer as a longer lasting remedy. I have also had Radiesse and do like the results but it gets costly for the amount of volume I need replaced. Any suggestions? Also, does fat transfer leave you bruised and swollen a lot more than say the Sculptra or Radiesse?
What is the Best Treatment for Fat Loss in the Face? (photo)
Doctor Answers (12)
Fat Transfer Most Cost Effective
Replacing lost facial volume Fat vs. Sculptra
This is certainly a hot topic in plastic surgery. Fat transfers offer the most noticeable volume but have a longer recovery. There is risk of having diminished uptake but with an experienced surgeon it should be fairly predictable. Sculptra has become very popular over the last few years. The onset is very gradual and you never have that "way too done" look. You do however have to have at least two injections. In looking at the photo you submitted, I would usually recommend 2 bottles on 2 occasions about a month apart. The product takes 6 months to peak and usually lasts a few years.
Restoring Facial Volume
Sculptra and fat injections are the two most common treatments for restoring facial volume. Both options have pros and cons. My preference is Sculptra/SculptraAesthetic (both are poly-L-lactic acid).
Depending on the age of the patient and the amount of volume loss, it may take 2-6 vials of Sculptra for optimal improvement which can last for two years or more. A treatment session is one vial (sometimes two). Injections are spaced 3-6 weeks apart. You will see minimal improvement after only one vial.
Thanks for your question and good luck!
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Best option for restoring facial volume
As others have mentioned, the amount of Sculptra and the # of treatments may have been sub-therapeutic, thus explaining your lack of noticeable improvement. When adequately treated, it does provide subtle but significant, and long-lasting volume correction.
Fat grafting is also a great long-term option, although it is "surgical" because fat must be harvested from your body (liposuction). Fat grafting does tend to leave you more bruised and swollen, and for a longer time, than any of the dermal fillers.
What is the Best Treatment for Fat Loss in the Face?
If you liked Radiesse injections than in my opinion fat grafting with PRP would give you great results that would last longer and allow more volume filling for the same $'s. Yes there can/could be ecchymosis after the multiple injections.
Treatment options for fat loss in face
All of the treatments you mentioned (Sculptra, Radiesse, fat transfer) would be options to replace volume in your face. Normally, the main reason you would not achieve improvement with Sculptra would be that not enough product was used or that you did not have enough treatments. The result with Sculptra should last two to four years, while the result with Radiesse would normally be gone by a year. Fat transfer results can vary and because it is more of a surgical procedure, I would say there definitely is more swelling and bruising than you would see with either Radiesse or Sculptra treatments.
Best treatment for facial volume loss
Sculptra is one of my favorite products for restoring a more youthful shape to the face. The older concept that “tighter is better” has been replaced by recognizing the importance of volume distribution as a defining characteristic of a more youthful face. You did not say how many vials of Sculptra were used in your treatment. In a recent study, patients having one to two Sculptra treatment sessions rated their correction as good to excellent 48% of the time. After three treatment sessions this percentage rose to 50%. After four treatment sessions this percentage rose to 67%. After five treatment sessions this percentage rose to 75%.
Replacing facial fat has multiple techniques, but unpredictable outcomes.
Your experience is very simular to those we have seen in consultation.
- Multiple products have been used
- Usually inadequate product has been used due to concern r.e. the costs
- Because not enough product was used, the longevity has been poor as has been even the early outcome.
- The patients bounce about between products which worsens the outcome.
The solutions are as follows:
- We avoid fat grafting in that at least in our hands it is the least predictable of the techniques
- We prefer Sculptra to enhance the cheeks and Radiesse for the naso-labia folds. Few patients need less than five ampules of Sculptra and two ampules Radiesse.
Patients who do not wish an injection techique are done with a special facelift that both repositions the existing facial fat and uses "dermal-fat grafts" that are placed under the skin flaps and are never injected. This is the most reliable of all techniques in our hands.
Fat Grafting to the Face
Yes, fat transfer to the face has become a relatively common procedure. The key is to have realistic expectations of what you desire. We like our patients to bring in pictures of when they were younger. This helps to identify the features that made them attractive such as full checks or an oval rather than rectangular face.
Some examples of Facial Rejuvenation patients that have undergone fat grafting to face at the time of their surgical procedure are in our photo library. This is rapidly becoming more of a standard in facelift surgery. May I suggest you seek out a member of the ASAPS familiar with fat grafting to the face for a consultation in your area. Best,
Gary R Culbertson, MD, FACS