Juvederm vs. own fat for lip augmentation?

Question

Hello! I have been researching the pros and cons of various lip fillers, and while fat grafting theoretically seems like the optimal solution (even with some degree of reabsorption), it appears that temporary fillers such as juvederm are generally favored. The data on effectiveness of one vs. the other I was able to access do not seem unequivocal at this point. I would appreciate some information on current trends. Thank you!

Robert M. Tornambe, MD · Answer

Boston4569.    It is nice to have options.  The advantage of fillers is that they can achieve your desired size with minimal down time during a short office visit.  The disadvantage is they don't last.  However, that is not such a terrible thing, especially if you don't like the look.  Fat is an excellent long term option when performed by an experienced injector.  It is a somewhat longer (one hour), and more complicated procedure, but still can be done in the office under local anesthesia.   I recommend that you try a filler like, Juvederm Ultra plus first and see how you like the appearance of your lips.  If you like the look, then go for fat transfer.  Be sure to consult with a board certified plastic surgeon. Good luck!

Elliot M. Heller, MD · Answer

You should start out with 1cc of juvederm filler or restylane filler and go from there. You do not want to overdo too much filler in the lips. It also depends on the look you are going for too. You can always add more filler to the lips if needed. Just remember if you are going to do your lips and you do not want to bruise you should not take any aspirins or anything that will thin the blood since brusing can occur. One syringe is typically $500.

Jeffrey H. Spiegel, MD · Answer

Temporary fillers are reversible typically and you can determine if you like the results. However, in experienced hands fat grafting can be done effectively and safely.  The difference is really how willing you are to come back every year for a touch up.  For many people there is a permanent solution involving a lip lift and augmentation however.  That's worth looking in to.

Richard W. Westreich, MD · Answer

I personally avoid fat injection to lips. Once done it is nearly impossible to undo  there is a possibility of lumpiness that can result. While not common, it is an outcome to avoid. Hyaluronic acid fillers are safe and reversible, thus making them the industry standard.

Nelson Castillo, MD · Answer

Thank you for sharing your question.  There are pros and cons to both Juvederm and fat grafting with the most obvious difference being anticipated duration.  The fat that remains after grafting will be permanent while at best you can anticipate 1.5 years with Juvederm products.  Juvederm is easily reversible whereas fat grafting is not, and Juvederm allows for adjustments over time.  Remember that with fat grafting the size will fluctuate as you gain and lose weight so it is important to stay as weight stable as possible.  See an ASPS board certified plastic surgeon in consultation, they can offer you the best advice.

Kouros Azar, MD · Answer

While both fillers and fat grafting can deliver excellent results in the lips, fillers are more predictable. I also like the fact that they can be reversed if the patient doesn't like the result. Personally, I use Vollure, Volbella and Juvéderm for the lips.

Richard E. Moore, MD · Answer

Thank you for your question. Until recently, I preferred dermal fillers such as Restylane or Juvederm over fat transfer to the lips. However, there is a relatively new procedure called ALMI that combines a small amount of your fat which has been micronized and added to PRP. This strips out the mature fat cells which were not going to survive and results in a long lasting result without the intense swelling seen with fillers or fat transfer. Unlike traditional fat transfer procedures, the end result is very predictable. This office based procedure can be performed in less than one hour without any downtime. I hope this was helpful - Dr. Moore

Steven Wallach, MD · Answer

Absorbable fillers are very reliable but have to be one regularly. Fat grafting is permanant and usually requires multiple treatments to get to the desired volume long term.

Val Lambros, MD, FACS (retired) · Answer

fillers like juvederm are predictable and can be reversed if necessary. Fat is not predictable, one doesn't have the same control over shape and it can grow if you gain weight, get pregnant, or even just grow on its own. It's a problem to remove. I prefer fillers

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures using dermal fillers, facial silastic implants, liposuction and facelifts for over 30 years.  In my experience and despite its recent increase in popularity, fat transfer (fat injection) offers "far" less of a reliable and predictable volume for facial shaping than an off the shelf dermal filler or silastic facial implant (lip implant, cheek implant, chin implant).  For that reason, I do not use fat to shape the cheeks, chin, lips or jaw line.  Tissue physiology is quite simple.  Tissue requires a blood supply in and out as well as lymphatic connections to remain viable and alive.  Once fat is removed from the body all of these things have been disrupted.  Just because the removed fat is mixed with PRP or something else doesn't make the blood and lymphatics magically re-appear.  The fat at that point is not living tissue which means that it's prone to being dissolved by the body (most likely in an uneven and unpredictable manner).  Injecting fat back into the face does not create the required elements to make the fat living tissue once again.  So the argument that fat is alive and viable in the face once it's been removed and re-injected makes no sense to me as a physician and surgeon.
 The other issue that I have with fat transfer is the lack of precision.  Fat is thick by nature which means it's not the same consistency as an off the shelf dermal filler.  Fat injections use an increased volume injected in an attempt to compensate for the volume loss that "will" happen.  This means a lack of specific shape and volume that simply can not begin to compare with the specificity of using a silastic facial implant of a "known" shape and volume.  In that regard fat offers too much of an unknown to make it a reliable and predictable method for facial shaping.  There's a significant difference between a 3mm and 5mm thick cheek implant.  You can imagine the magnitude of difference there is between retaining 60% of 25cc's of fat versus 35%.  In my humble opinion, I just don’t see how fat could possibly be used to precisely shape facial features?
 I have performed many lip augmentation procedures using dermal fillers or lip implants for over 30 years. From the photos, your upper lip is small compared to your lower. Following my beauty principles, the lips should be full with upper lip should be approximately 75 % the size of the lower lip for the lips to appear balanced. The lips can be augmented using a dermal filler or a Permalip implant.
Dermal filers and lip implants offer a much more reliable volume for augmentation of the lips than permanent fillers or fat injections which are associated with increased, unwanted, side effects.
Hope this helps

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