As i age my cheeks are getting sunken in and my wrinkles are deepening. would sculptra be my best choice? or should i look at fat injection or cheek implants?
Sculptra for Deep Wrinkles and Sunken Cheeks - Best Choice?
Doctor Answers 7
The best filler is all Natural - your fat
Sculptra is a material injected into the tissue and causes a local inflammation and swelling. It is the swelling that creates the volume.
1-Comes from a vial.
2-Easy to do.
1-Unnatural, comes from a vial.
2-Requires frequent treatments.
5-The response or volume correction occurs days or weeks after the injections, making it hard to be precise as to the amount of filler to use.
The best large volume filler is fat. In the past, fat got a bad name for being unreliable. That is because people took dead fat from the liposuction machines or treated it in a cnetrifuge that killed most of the fat. Lipose Corporation has a new technique called Viafill that will provide 500% more live cells, and thus will have better survival when injected.
When live cells are injected with good technique the results should be wonderful and durability should be much longer than any alternatives. The downside is that you need to have unwanted fat somewhere else on your body for harvesting. Some patients are too thin to make this a practical technique.
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Sculptra vs Fat grafting
Fat in the face ages by melting away, accumulating inconventiently and descending inappropriately. While I would prefer to fat graft a face which is gaunt, some patients don't want surgery or the downtime required. Sculptra is one solution for these volume depleted faces, although it doesn't make fat. It is multiple repeating units of Lactic acid, which is derived from corn. Mixed with sterile water and local anesthetic, it is ideally injected as a single layer, deep to the skin, where it causes inflammation with the net result of collagen formation.
This process does require time, so we photograph all patients at each visit, so they can document their progress. We also advise them not to panic when the volume seems to be lost, 24 hours after treatment. It definitely doesn't belong in certain zones, i.e the lips, around the eyelids, neck. My experience is limited to cheeks and temples and the incidence of lumps has decreased as the amount of fluid added to Sculptra has increased.
It has historically been expensive, however that may change, as its manufacturer Dermik seeks a larger user base. If a patient realizes how much Hyaluronic acid filler is required to fill deflated cheeks, Sculptra is quite cost effective. Another difference is that once the HAs are dosed, the body starts to break it down. By contrast, Sculptra causes an inflammatory response, which thickens skin progressively with time. The earliest group of non HIV patients are 2-3 years out, without having further treatments, after getting to their desired goal.
I consider it another option in the war against facial aging.
Fillers for wrinkles
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All may be good options for volumizing the cheeks. Fat is an excellent choice, but some patients may not be good candidates for this and this may be why Sculptra may be a better option. I recommend that you see a board certified plastic surgeon to review your options.
The materials and techniques you mention are all appropriate. There are advantages and disadvantages of each depending on your specific needs. More important than the filler used is the technician (surgeon) doing the work. Carefully choose a physician skilled in these procedures.
Sculptra for Sunken Cheeks
Sculptra is one of many options to improve volume deficits of the cheeks. There are many other manufactured injectable fillers that can achieve a comparable result (i.e., Radiesse, Perlane, Juvederm Ultra Plus etc.). In our hands, Sculptra does appear to last longer than the others (about 2 years or more). Interestingly, I found that it works better in patients who have reasonable volume present and want to add. If the face is very thin and deflated, the volume gain appears less.
Alternatively, cheek implants (i.e. malar or submalar) or facial fat grafting should be considered. Recovery is significantly longer (10 days plus / minus).
Implants will provide a very predictable enhancement but appear to frighten some patients. (And comfort with the procedure should be present) They will provide the most long-lasting enhancement, though.
Fat injections are probably closest to the perfect filler: it is your own, there is (usually) enough available, it provides natural feeling results. Sometimes additional treatments are requested for further enhancement. In average, we use 25 to 40 cc of purified fat.
Sunken in cheeks-avoid off the shelf permanent products and implants!
I would recommend you avoid cheek implants and sculptra as both have long term risks and can cause facial fat atrophy and premature aging. By weary of amazing claims like 'this product makes collagen' it is really an elegant way of saying it induces a firm scar ball deep in your face where no such structure should be! Fat grafting is the gold standard but has to be applied by a practitioner that understands the delicate nature of adipocytes. High G-force centrifugation ruptures adipocytes, removes stem cells and growth factors yeilding less take and temporary results. Using careful harvest, minimal processing and thoughtful placement fat can deliver incomperable results that last. I hope this helps!
All the best,
Rian A. Maercks M.D.