Solution for Gaunt Face? Filler, Fat Grafting. (photos)

Question

Prior to fat-grafting, I'd like to try a reversible filler first. My face is extremely gaunt - particularly around my mouth, below my cheekbones, & my temples. I'm 48 and have been the same weight for about 10 years but every year my face gets thinner. I'd hoping for advice on 1) what areas of my face should be the first focus (temples, below eyes, mouth, etc), 2) what particular fillers (reversible) are best, and 3) whether fat grafting will be appropriate for these areas in the future.

Mark Been, MD · Answer

The use of reversible filler is a sound decision if you have never had any facial filler injections in the past. The only caution for someone with a gaunt face is that the amount of volume required to achieve the desired effect may result in a high expense based on the number of filler syringes you will need. For the cheeks and submalar region I think Voluma is an excellent choice. It also lasts longer than most of the other fillers. Juvederm is a versatile filler that I frequently use for the temples, the folds around the mouth and the prejowl region of the jaw. Below the eyes where the skin is thin I find Belotero to work well (low risk of bumps, persistent swelling, and Tyndall effect). I also like this filler for the fine lines around the mouth. When you are ready for a fat transfer, the procedure can be performed to all these regions. I think focusing on your cheeks, lower eyelid hollows, and temples will really help. A small amount of fat can also be injected into the hollows above your upper eyelid to help create a more youthful appearance. Be sure to consult with an experienced facial plastic/plastic surgeon who performs this procedure regularly. Good luck!

Elliot M. Heller, MD · Answer

THE DIFFERENCE BETWEEN FAT TRANSFER AND FILLERS ARE FILLER ARE LESS INVASIVE AND CAN LAST 6-9 MONTHS SOMETIMES UP TO A YEAR DEPENDING ON WHICH ONES. FAT TRANSFERS ARE USUALLY SURGICALLY DONE WITH LIPO AND TRANSFERRED TO ANOTHER AREA OF THE BODY. A FAT TRANSFER CAN ALSO BE DONE THROUGH A LOCAL AFTER SURGERY FOR A REPEAT FAT INJECTION. FAT INJECTIONS OR TRANSFERS ARE USUALLY MORE PERMANENT. THIS IS SOMETHING THAT YOU MAY WANT TO SPEAK TO YOUR DOCTOR ABOUT IN A CONSULTATION AND SEE WHAT YOUR OPTIONS ARE.

John Michael Thomassen, MD · Answer

I would recommend fat grafting over other fillers.  It has a very natural result and the volume is not limited, unless you have very little fat in your body.  I would recommend grafting to your lower lids, lips, submalar area, and temples and brows.

Zoran Potparic, MD · Answer

Multiple fillers are available on the market for this purpose. You would, most likely, benefit from augmentation of deep fat compartments in the face first, since they are most deflated in patients like you. Voluma, Sculptra may be your first choice to evaluate what result you may expect with more permanent option, fat grafting. In your case, it is just waste of time and money; fat grafting should be your first choice.You should consult an experienced plastic surgeon for detailed evaluation and discussion about your options. Good luck.

Lawrence Kass, MD · Answer

If you are looking for reversible fillers, I would recommend either Juvederm Voluma or Restylane Lyft to achieve the goals you are seeking.  Both of these can be used to fill the areas you are looking for and both are reversible.  If you are happy with the results, you might consider Radiesse, Sculptra or fat grafting in the future.

Michael M. Omidi, MD, FACS · Answer

Both fillers and fat transfer are excellent options to add volume. If you are not confident with a permanent option it is best to start with something like Radiesse Juvaderm or Sculptra. Best of luck. Dr. Michael Omidi

An in-person exam with a
board-certified plastic surgeon is the best way to assess your needs and
provide true medical advice.

An in-person exam with a
board-certified plastic surgeon is the best way to assess your needs and
provide true medical advice.

Michael Law, MD · Answer

I wonder why you desire a temporary filler prior to fat grafting? There are some areas of the face where no other filler could possibly provide the same results fat grafting can provide.  I would encourage you to have a consultation with a plastic surgeon with extensive experience and expertise in fat grafting who also has busy, experienced and expertly trained nurse injectors offering temporary filler.  My guess is you are concerned about an unnatural appearance that doesn't look like you. I often suggest that patients bring in photos from their youth. Together we can examine the changes that have taken place. The goal is not to make a person look exactly like they did in their teens. Most people tell me that after fat grafting the way they look matches the way they feel. It is important to do a lot of research, including looking at a lot of photos of fat grafting before and after photos to determine that a plastic surgeon has the expertise you require, but that you also have a similar aesthetic ideal.

Mats Hagstrom, MD (license on probation) · Answer

You're thinking and game plan is right on.I highly recommend you do a test run with temporary filler's prior to attempting a permanent treatment.First and foremost please understand that fat grafting is very different than using fillers.Is not nearly as predictable and technically more difficult.   All of the hyuloronic acid fillers are reversible.These include Restylane, juvaderm, voluma and boletero. Of these Voluma is significantly more expensive.In order to achieve a full facial of volume restoration you will need a lot of filler.Perhaps 10 or more cc.  This is a substantial investment and something that is temporary.   It may cost as much as having fat transfer.  still, having temporary fillers prior to attempting a permanent solution is a good idea.It will give you and your plastic surgeon an idea of how much volume to place in different areas.Also, if you're not happy with the results you have the ability to change providers prior to attempting something permanent. Fat grafting has many pitfalls.One of them is the predictability of how much fat survives.There are many factors that determine the success of fat transfer.One important component is the amount of tissue available to graft into. In order for fat to survive after being drafted it has to be surrounded by live vascular tissue. Each particle of grafted fat has to be surrounded by live tissue able to give nutrients and bring a new blood supply to the grafted tissue.  If too much tissue is grafted in a single area the percentage of fat that survives is decreased.Fat that becomes nonviable because it does not establish a new blood supply will become necrotic.  Scar tissue and lumps conform.This is particularly true around the lower eyelid area where tissues are quite thin between the skin and skeleton. As a general rule of thumb it's better to have conservative amounts of fat grafted planning on multiple sessions than trying to get everything achieved in a single operation. The success of this procedure has much to do with technique and aesthetic judgment. Choosing the right plastic surgeon cannot be under emphasized. If you're pleased with the results of temporary fillers and ready to move forward with the fat grafting then the above stated fillers can be completely reversed using hylouronidaze. One treatment option that I have used locational he is injecting Celine to demonstrate what facial volume can achieve.The saline injections will only last minutes but can allow the patient to get an assessment of facial volume restoration with no cost for materials. Your next job is to find the right surgeon to help you along the path.Best,Mats Hagstrom M.D.

Tarick K. Smiley, MD - Account Suspended · Answer

I commend you for having a plan.  For patients who want the conservative route, the general rule of thumb is to use hyaluronic acid fillers such as Restylane and Juvederm whose effects can be reversed by an injectable substance called hyaluronidase should they are not happy with the results or bumps/lumps occur. These traditional fillers also gradually dissipate within the course of a few months. For more long-lasting results, I suggest fat grafting.  However, it involves a more complex procedure to achieve predictable outcome and high survival rate of fat. Go to an experienced injector who can assess what areas of the face that will need contouring.  Regardless of the volumizers used, it is important to create discrete layers of fat/dermal filler to support the new contour and avoid the pillow face appearance. Good luck and best wishes. Dr. Tarick SmailiCalifornia Surgical Institute

Jon A. Perlman, MD (retired) · Answer

Although I do usually recommend initial use of a reversible filler, the expense involved for the use of multiple syringes of Juvederm is such that considering the very likelihood that you will like the results I would recommend that you skip that step and proceed with either radiesse or a series of Sculptra injections.  Discuss your options with a Bd Certified plastic surgeon (ABPS) and depending upon your budget make a careful choice.Good luck and look forward to the improvement that I think you will receive.

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