Alternative to fillers ?

I have tried fillers in the lips, above and below mouth and in cheeks and love the results but they never last more than 3-4 months. What are my other options ? Is there someone you could recommend in the ft. Worth tx area?

Doctor Answers 1

If you love the results of fillers, but they don't last too long, you can opt for longer lasting fillers for the cheeks

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Thank you for your question. You submitted a question without a photo, so I’ll still give you some conceptual ideas about what you’re asking. You state you get injectable fillers in your lips above and below your mouth, as well as in the cheeks, and you love the results, but you are a little frustrated by the longevity as they only last 3-4 months, so you’re asking about other options.

I can give you some guidance as to how I can counsel my patients about situations like yours. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years, and injectable fillers are a very significant part of my practice. I can help you understand the thought process a lot of doctors use, myself included, and I think I can also offer you an option that still involves fillers as a strategy that might be of benefit for long-term results.

For your frustration with 3-4 month longevity, likely that type of longevity are for soft tissue fillers such as Restylane or Juvederm Ultra placed at the more superficial levels of tissue. When you place these types of fillers you want a correction, improvement, and to avoid lumpiness, so these fillers are designed in a way to minimize lumpiness, and they can be placed relatively superficially. When people say I want a longer lasting filler, very often that longer lasting filler tends to be thicker. The problem with putting a thicker filler in a superficial area is that it has the tendency to look more lumpy and be problematic. When it comes to the lips in terms of volume correction, I think you are potentially committed to a certain level of filler before it becomes problematic with irregularities or lumpiness. You may want to try an alternative option from a different company, and discuss this with your doctor, and see which one may last for a little longer.

When it comes to the cheek area as well as the jawline, I think there’s something worth considering when you describe below the mouth. There is a concept for filler placement we apply to our patients called structural volumizing. When people want volume in their cheek area, jawline, and chin, the challenge is getting the correction to look good and to give you a really good youthful appearance. So there’s a distinction I always make - if you put a soft tissue filler more superficial or into the fatty layer of the skin, you can only place so much, and it doesn’t necessarily give you angularity even if it gives you a little of volume. If you go above a certain amount it tends to become too rounded, or softly flatten out in a way that doesn’t give you definition.

Structural volumizing is a concept where we’re placing the filler at the bone structure level, which most doctors don’t do. There is a very specific method to doing this. When we place this at the bone level, the cheekbones looks really nice and well defined. When it comes to longevity, the results can last a lot longer. When you use for example a Juvederm Ultra Plus or a Juvederm Voluma, we can get a longevity in the cheek area for 1 to 2 years, as opposed to 3 to 4 months you might be experiencing now. The placement at that level may be a way to balance out what you’re looking for. When I talk to my patients about this type of procedure, the same applies at the jawline and the chin where I’m placing it at a deeper level, and typically it tends to last longer.

The more superficial the placement, you just have to accept a certain amount of maintenance as part of the process . It’s really a combination of factors, and also understand when you place these soft tissue fillers, often the body does create some degree of collagen as a response to that placement, and you may get some correction that’s a little longer term. Sometimes my patients have said that it’s starting to last a little longer which does actually occur. Everyone is an individual, so  we have to always customize to their needs.  

The other option you could also consider is facial implants. Often, people are used to having fillers, so they are not always crazy of the idea of having facial implant placed. Fillers have improved so much over time. Facial implants do still have a very important role as a surgeon, as  I still  use a lot of facial implants,but I can say on the day-to-day desires of most people who want minimal downtime and quick correction, fillers have become very versatile. It’s the placement of those fillers, and the level and the artistry of placement that really makes a big difference.

I think the take home message here is learn more about structural volumizing for areas where the fillers can last longer, and maybe even give you a better result than what you may be getting currently. Maybe explore some alternative fillers in the same category to see if one type of filler lasts longer than another. Hopefully you understand the direct relationship between the thickness of the filler, the level it can be placed, and its longevity. I hope that was helpful, I wish you the best of luck ,and thank you for your question.

New York Oculoplastic Surgeon
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