Fillers or Fat Transfer Pros and Cons

Question

Which method is the safest and easiest to manipulate? I am not ready for a facelift (mid 40s) but would like the same effect. I have a pretty think face. I need volume in cheeks and temples. Maybe under the eyes but I understand this is difficult. I like the idea of fat transfer because it a natural filler as I am worried about the rejection rate of fillers.

Larry S. Nichter, MD, MS, FACS · Answer

Without an exam or even photos I cannot give you an accurate answer. That being said among the fillers available I personally prefer fat transfer. However, the key to success is going to a plastic surgeon with extensive experience as the results are technique and experienced bases.

	However please note that you age by three factors - sagging (through gravity and time), loss of volume (counteracted by fillers), and skin texture (determined by environmental and genetic factors). Your fillers should enhance your effect of the lifting if placed appropriately by addressing one of the causes of aging..Most often one of these factors are more out of balance than another and therefore your procedures should customize for what is most needed. Often fillers alone can "stall" the inevitable as they only correct one aspect of aging.
	Facelift and Skin resurfacing procedures (laser, Ulthera or Thermage ) and fillers are synergistic so as long as you wait until the Sculptra injection site is soft you should do fine. Not a problem and there is no problem with the timing for a facelift. Sculptra, Radiesse, Jeuvederm, Restylane, your own fat (fat transfer) and other fillers address volume issues, resurfacing procedures corrects surface flaws associated with aging and face lifting addresses the sagging loose skin. Resurfacing procedures address skin texture, color variation (e.g. sun spots)- so all three are synergistic and complementary. It is very common in my practice to do all three approaches to rejuvenation at the same time

Ron Shelton, MD · Answer

It is important when answering your question to be evaluated in person. There is a three dimensionality that must be evaluated as well as the condition of the skin and dermis, the roundness of the face, and adjacent areas that may have dropped. If there are focal areas such as smile folds or small indents, then the fillers such as Restylane, Perlane, Juvederm, Radiesse can be used. When more volume is needed, or deeper placement, then Radiesse, Fat Injections and Sculptra can be done. Fat injections may involve a series of treatments and not all of the fat lives; it's not that the fat is being rejected, it's just that the some of the cells die before they develop enough circulation in the new neighborhood to live. It is a thicker product then some ready-to-use fillers. The fillers don't have a rejection possibility, they continue to dissolve after the first day they're placed but their longevity is different in different situations.

Otto Joseph Placik, MD · Answer

The rejection rate of fillers is not a common problem. The techniques for injection and the cost may be greater concerns. The advantage is that Hyaluronic based fillers have the advantage of adjustability and actual reversibility with off label use of hyaluronidase. This is an over simplificaiton and after a thourough evaluation and consultation, a better recommendation could be offered. Following the use of fillers and if you appreciate the appearance achieved, you could consider the use of fat grafting which may involve greater potential risk, cost, and recovery.

David Whiteman, MD · Answer

Both fat transfer injections and facial filler injections can be used to rejuvenate a patient’s face by plumping up areas of lost volume and improving the facial contour. If a higher volume is required then, then fat transfer may be preferable, as re-injected fat tends to spread throughout the face in a broader manner. Certain patients, especially those who are allergic or sensitive to certain products, may prefer to go with fat transfer injections for facial rejuvenation. The best way to be sure of which cosmetic injection method will be the best option for your specific needs is to consult with a medical professional.

Jason Litner, MD · Answer

There are pros and cons to injectable fillers and facial fat transfers. The best procedure for you will depend on your individual concerns and facial anatomy. In general, my partner and I prefer facial fat transfers as the patient's own body fat will provide the most natural, voluminous results that are long-lasting and compatible. Injectable fillers do not always provide the best results and because they only last between 4 months to a year and a half, the cost of maintenance adds up.

Michael Law, MD · Answer

One guiding principle of reconstructive plastic surgery is short and simple: "Replace like with like." Specifically, where tissue is missing, restore the defect with the same tissue whenever possible. If bone is missing, use a bone graft. If muscle is missing, use a muscle flap. So if fat is missing, the ideal solution is obvious.

	Whether the goal is to restore volume to the lips or cheeks or temples, or to fill in a crease or depression such as the nasolabial folds or marionette lines (or all of the above), the ideal material is quite clearly the material that one wishes were there in greater abundance in the first place: your own fat. To be the ideal filler material it must also make sense from a cost perspective, which it does. The fat supply, from the standpoint of the volumes required for facial enhancement, is essentially limitless. A multi-area facial enhancement by fat grafting costs about the same as several syringes of ArteFill, Radiesse or Sculptra. And fat has the distinct advantages of not inciting an immune response, producing a more natural soft tissue consistency, and being well tolerated immediately below the skin (even within the deep dermis itself). So in my practice, there really is no place for the 'semi-permanent' soft tissue fillers.

	The process is actually quite straightforward: fat is harvested from the abdomen, thighs, hips or buttocks using specially-designed instruments and a specialized technique, processed (by centrifugation, which eliminates all components of the harvested material which are not viable fat), and meticulously introduced into the facial areas to be enhanced using a second, smaller set of fat transfer cannulas. This procedure does not require an operating room and deep sedation or anesthesia - it can be performed in the office procedure room under local anesthesia and oral sedation.

	A number of terms are currently used to describe varying techniques for harvesting and delivering fat in small quantities to produce long-lasting soft tissue augmentation: structural fat grafting, microfat grafting, lipostructure, orbital pearl fat grafting, etc. These terms all describe techniques for harvesting living fatty tissue with minimal trauma, refining the fat (in most cases) in some manner such as by centrifugation, and meticulously introducing the fat into the recipient area a small amount at a time to produce new soft tissue structure.

	In patients who have developed deep 'tear troughs' at the junction of the lower lid and cheek, adjacent to the side of the nose, the meticulous grafting of fat harvested from the patient's abdomen, hips or thighs can build this area back up and nicely restore a more youthful contour. In some blepharoplasty patients this depression or 'hollow' extends horizontally across the entire junction of the lower lid and cheek, and this must be corrected to obtain the ideal postoperative result.

Rafael C. Cabrera, MD · Answer

you missed the point of fillers. they are not lifters. they are volumizers. Sculptra is the most similar in effect to fat while the other fillers are more "fold" and "line " treatments. the main adv of fat is the price per cc of material. you have a large surplus and especially for facial fill there is usually more than enough. Fat also can be used just about anywhere on the body. fat is potentially permanent and "stem"cells may be benficial but the science just isn't there yet. the main disadv's of fat is lack of reliability in "take", swelling and length of recovery, potential for asymmetry. general rule i tell my pts: if you are having another procedure at the same time, do fat. otherwise don't waste 2 weeks of recovery after fat grafting when fillers can do the job with little risk, minimal downtime, and ability to add or subtract (if hyaluronic acid used) from the result as needed. finally, I would trust my doctor to help me make an informed decision. It would be nice if they could offer all options so that you don't worry they only offer what they can do. good luck

Anurag Agarwal, MD · Answer

While an in-person consultation would be required, I think that fat transfer to the cheeks, temples, and under the eyes is a great procedure.  I tell my patients that about 30-40% of the injected fat lasts long term, requiring overcorrection initially.  I think that for broad areas that need volume augmentation, fat is great.  You could use several vials of injectable synthetic fillers, but often large quantities are needed, and I believe they resorb faster than your own fat.  I agree with other physicians who have suggested looking at photos of yourself from 10 or 20 years ago, to see how much volume you had to begin with.

Samir Shureih, MD · Answer

If your problem is loss of fat (Deflation) then the treatment is fat transfer.

	If there is aging, deep nasolabial fold, jowles, etc then you need a face lift. Some people will benifit from both. It all depend on analyzing your face and the aging process.

	Look at pictures of you 10 years ago and 20 years ago. That will give you an idea of how, where you are aging.

	See a BOARD CERTIFIED PLASTIC SURGEON(AMERICAN BOARD OF PLASTIC SURGERY), To help you with the analysis and achieving your goals.

Richard P. Rand, MD, FACS (retired) · Answer

As Dr. Placik has said, you might try a round of temporary fillers and if you like the effect, you could continue to do these and adjust the areas needed as you age.  Avoid permanent fillers at all costs as they have potential uncorrectable complications.  Know that fat grafts don't always take and sometimes too much takes so this is not as easy as it sounds.

	Also, no filler regimen will give you "the same effect" as a facelift.  Just not possible.  I have seen patients who needed a facelift but tried to get by with fillers and these fell short.  In fact, I just this morning did a facelift on a patient whom another doctor had filled with Radiesse a few months ago.

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