Fat transfer versus Sculptra
Today, we have many choices for facial fillers. Sculptura was developed as a filler to treat overall facial wasting that occurs with age due to loss of fat and other supporting tissue and has just been approved by the FDA for cosmetic usage. It works well to improve contours of the cheeks and improve hollowing around the eyes. Unlike other fillers such as Juvederm made from hyaluronic acid which immediately plumps and fills, Sculptura, stimulates your own tissues to produce collagen so the results improve over several months. Typically 2-3 treatments spaced several weeks apart will provide the optimum improvement and results are thought to last up to 2 years.
Fat transfers can soften the lines around your mouth using your own fat from a different area of your body (typically your hips, buttocks, or abdomen). It can be used to plump lips, fill in cheeks and improve facial contours. Since it is your own fat you can't be allergic to it and last longer than other fillers- about 50% of the fat stays permanently where it was injected
For non-surgical volumizing of the face, I would certainly recommend Sculptra. After having used Sculptra in many patients, I have been impressed with it's volumizing abilities through the formation of collagen. Now, I tend to reserve fat grafting in the face for patients where I am already considering a separate surgical consideration such as eyelids or facelift.
Done properly, both fat grafting and Sculptra can be done with very natural looking results and without developing lumps or bumps.
Depending on the area in the face, there are a number of excellent options including fat transfer, sculptra, and voluma to replenish volume in the face. Each has its strengths and weaknesses. Without photos, the best recommendation is to consult with three experienced and expert board certified plastic surgeons.
Fat Transfer and Sculptra can work well, but both can cause problems
Fat transfer typically leads to partial long-term fill. Some of the fat get reasbsorbed by your body and some will survive. So there may not be a uniform contour by the time all is said and done. Sculptra can also lead to bumpiness, but i have found it to be much less than fat, particularly if the Sculptra is diluted and injected a bit deeper into the tissue.
Fat transfer versus injectable fillers
Sculptra can produce lumps and there is no consistent way to predict or prevent their occurence. Sculptra can be quite costly to achieve significant volume correction. It does offer convenience and that is its primary advantage.
Sculptra vs. Fat Transfer for volume on face
Truly rejuvenation of the face comes with re-inflating the balloon, i.e. our face. Replenishing volume that we used to have should be performed with fillers that will give you the most even result, with minimal bumps or lumps. Sculptra is made of PLLA (poly-L-lactic acid) requires typically 3 sessions, 4-6 weeks apart and works by stimulating your own collagen as PLLA gets reabsorbed almost completely in 2 weeks and gets replaced by your own collagen over time. In the early days of Sculptra where the dilution protocol was not uniform, lumps or bumps are more common. With the current dilution protocol with the FDA approval for cosmetic usage, lumps or bumps are exceedingly rare among experienced Sculptra physician injectors. There may be more versatility with Sculptra as there is always opportunity to make the subtlest augmentation adjustment in case there is any asymmetry. Fat transfer is a fine option; however, even in the best hands, there could be issues with lumpiness or uneven results as the fat transplant may not be evenly reabsorbed underneath the skin.
You may not have enough donor fat for fat injections if you are an athlete. Sculptra and Fat can leave lumps, but the lumps fro Sculptra are usually not visible. You will feel them when you touch the skin from the outside, or push your tongue against the cheek from the inside. Sculptra does take several sessions and it takes a while for your body to produce collagen as a response to the material. Radiesse is an immediate filler and can replace significant volume losses well but does disappear in about 10 months to a year or more.