For nasolabial folds which filler has the longest duration and is also the most effective Perlane or Radiesse? Does the actual Fractional CO2 Laser used for facial resurfacing make a difference in the healing process, for example is the laser Lumenis Ultra Plus a superior Laser in comparison to other Fractional CO2 Lasers?
Is Structura Fat Grafting As Effective As Using Perlane or Radiesse for Under Eyes, Infraorbital Rims,cheeks and Jawline?
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Fat Grafting Under the eyes
The loss of soft tissue volume with aging occurs in a predictable pattern in most patients. Most people experience some deflation of the cheek fat pad in their thirties, and lip volume may also begin to thin around this time. Nasolabial folds begin to deepen. In their forties most people experience some loss of fatty fullness in the temples and along the jawline, particularly in the area just lateral to the chin. All of these areas are effectively 'reinflated' and thus rejuvenated by means of structural fat grafting. In many cases patients in their thirties and forties can be treated by fat grafting only, and do not require any incisional surgical procedure to remove or 'tighten' skin.
For patients in my practice undergoing major facial rejuvenation surgery such as facelifts, structural fat grafting is one of the most important parts of the procedure and it is what I perform first. All areas of facial hollowness are restored to a more youthful fullness before any incision is made to address skin laxity and the need for some 'redraping' of the skin and deeper soft tissues. The eye area is filled out and the temples are restored to fullness before blepharoplasty or browlift is performed. The result is a patient that looks like a younger version of themselves, not like a person who has obviously just had a facelift.
I have also treated a number of patients who have experienced facial fat atrophy as a result of procedures which can heat the facial deep soft tissues excessively such as IPL or Thermage. Most of these patients come to my practice not only with areas of fat atrophy, but also with the frustration that their facial skin in the affected areas has lost its youthful quality. Remarkably, structural fat grafting has provided these patients not only with a correction of the soft tissue contour problem, but also with an improvement in the quality of the overlying skin.
Choosing the right under sys filler and laser intervention
As far as lasers, the only true fractional lasers are the erbium laser based products such as Scitons Erbium profractional. CO2 lasers cause etoo much coagulative damage to be truly fractional and I would recommend staying way from them. Structural fat grafting if done correctly is hands down the best filler and lasts the longest. Radiesse will likely destroy fat in your face, cause granulomas and cause facial aging-stay away! Perlane Juvederm and other hyaluronic acid based fillers are safe and can provide corrections for about one year. I hopee this helps!
All the best,
Rian A. Maercks M.D.
Under eye fillers
It will be interesting to see the varied responses to this question. I feel strongly that fat under the eye can be a nightmare if not done exceptionally well. This is the thinnest skin in the body and minor contour irregularities are clearly obvious. For this reason I prefer the thinner hyaluronic acid fillers such as restylane. Perlane is thick and best used in the nasolabial folds. Hyaluronic acids are also particularly valuable in this area because they can be dissolved if you are unhappy with the appearance. you do not have this luxury with radiesse or fat.
Fractional Co2 lasers today are fantastic but they must be tunable which means your surgeon can set the parameters to customize your treatment to your specific needs. I prefer the DOT laser as this can be a fine no downtime experience or a completely ablative resurfacing. The bottom line is the experience of the provider is more important than the specific device used.
Seek out a board certified plastic surgeon to help you with these decisions. I hope this was helpful.
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Fat grafting, in experienced hands can achieve very natural long lasting results, whereas the fillers need to be redone from time to time. The volume created by fat is more natural appearing as well. Special care needs to be taken around the infraorbital rims as the skin in this region is quite thin.
Laser can be done at the same time.
Fat grafting versus injectable fillers
In my opinion, fat grafting produces better, more natural correction for treatment of under eye hollowing, cheek augmentation and jawline improvement compared to injectable fillers. More volume can be used and the results are long lasting.
For injectable fillers, I prefer Radiesse for the nasolabial folds as it seems to provide more lift and collagen stimulation in the area. But more than the product used, the determining factor is the skill of the physician treating you.
-Dr. Jamil Asaria
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