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.

Tarick K. Smiley, MD · 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

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.

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

Answers (10)

Answer: Fat grafting

Answer: Fat grafting

Answer: Voluma replacement in a gaunt face

Answer: Voluma replacement in a gaunt face

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

Answers (10)

Answer: Fat grafting

Answer: Fat grafting

Answer: Voluma replacement in a gaunt face

Answer: Voluma replacement in a gaunt face

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Recommended reading

Everything you need to know about Facial Fat Transfer

Our mission is to create a world where every investment in modern beauty is Worth It.