Any hope for those who metabolize fillers too quickly? I spent a few thousand dollars for restalyne and lasted only 4 months.

Question

First photo day of filler treatment 2 years ago. Second photo is current. I was happy with the results, but they only lasted 4 months. I was told it would last a year to 18 months. It was so expensive for it to not last longer.

Hung William Song, MD · Answer

If you are a non-smoker, the obvious answer is an autologous fat transfer. Taking fat from another area in your body and using it to add volume to your face will not only give you lasting results, you will be able to do a more complete correction. If you are doing more than 4 syringes of filler in a year, it makes complete sense both economically and results wise to use your own fat instead of fillers.

Elham Jafari, MD · Answer

Hi and thank you for your question! There are various types of Restylane fillers with varying duration of action, so depending on the exact type of Restylane you used (regular, Silk, Lyft, Refyne, Defyne, Kysse, Contour), the expected duration of the results will vary. This being said, 4 months appears to be too short and I highly recommend that you see your provider for a follow up and accurate assessment (preferably with picture comparison) so the changes can be evaluated objectively. You should also keep in mind that the aging process does not stop and quite often, the filler is still there but we have add additional volume loss naturally occurring that might make the filler look less effective.
If it is determined that you are indeed a quick filler metabolizer, then you can try other options (e.g. other brands such as Juvederm Voluma which is considered to be the longest-lasting hyaluronic acid filler) as well as non-hyaluronic acid fillers such as Radiesse, Sculptra and BellaFill which is currently the longest-lasting filler approved in the US. I hope it helps and good luck!

Marc Polacco, MD · Answer

Thank you for your question. It may be reasonable to try another filler. Some last longer than others based on their inherent properties. Radiesse, for example, tends to last longer than Restylane. However, typically longer lasting fillers are firmer. It's a good idea to discuss this with your physician and come to a treatment regiment that makes sense for you. I hope that's helpful, and I wish you all the best.
-Dr. P

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photos. There are many different products on the market which are used as fillers. An experienced injector who has multiple injectables in his practice will be able to figure out what is the best treatment  for you. See an experienced oculofacial surgeon for comprehensive evaluation and guidance. Good luck!

Nelson Lee Novick, MD · Answer

While there are individual differences in how long the results of any HA filler will last, there are a number of other factors that may play at least as important role in determining the durability of the treatment response. First, different fillers are produced with differing properties corresponding to the different regions of the face. As an example, more robust fillers, like Restylane Lyft or Juvederm Voluma XC, are intended for lifting and volumization of the cheeks.  If ordinary Restylane or plain Juvderm are used instead, or if fewer than the correct number of syringes of even the appropriate fillers are used to get the job done, the results are unlikely to last for very long. And even if the correct fillers are used, if a novice, inexperienced injector places them in the wrong location to get the job done, then the results are likely to be short-lived, if not unsatisfactory from the get-go. For example, experienced injectors have known for years that treating volume deficit in the cheeks with a robust HA filler will not only help the improve the shape and contour of the cheeks themselves, but secondarily improve smile lines and even to some extent marionette lines at the angles of the mouth. Inexperienced injectors are likely to "chase after wrinkles and folds" by injecting them directly, like injected smile lines directly with a filler, rather than addressing the root cause--i.e. the volume deficit in the cheeks responsible for the development of those lines. And, if this is done, the results will like not be terribly satisfactory nor last very long. To get the most bang for your buck, you would be wise to consult an experienced, board certified cosmetic dermatologist. Hope this helps going forward.

Jeffrey Lisiecki, MD · Answer

Great question--while there are some people that seem to metabolize filler quickly, it's pretty uncommon. Some more information about where the fillers are, and of course an in person examination would be most helpful to figure out what is going on, but the first photo shows you bruised and swollen (which is not abnormal for the first day after a big filler treatment), and the filler seeming to go away after a few months is probably more resolution of swelling and settling of the filler than anything. For you, I wouldn't expect fillers to go very far in reversing overall facial aging--they would be more for addressing very targeted concerns.
The reason is twofold. One, you have tissue laxity from facial aging that filler cannot reverse (which would take a facelift to reverse). Two, the amount of volume you would need is significant--a few thousand dollars of Restylane is only a few mL. In contrast, facial fat grafting (typically preformed in conjunction with a facelift) typically consists of 20 to 30 mL of volume added back to strategic areas.
Be seen in person by a plastic surgeon for a full evaluation and to come up with a plan, but to really address your facial aging a facelift with fat grafting would give you the best and most natural result, rather than continuing to try to use filler. Best of luck!

Dallas Walker, MBBCh · Answer

Hello there! Fillers are a wonderful volumising tool! Understanding there exact metabolism is quite variable and largely based on clinical judgment (guessing) and averages. In practice, a good high-quality dermal filler (like restylane) should integrate with your own tissue and become part of you. This aligns with more natural outcomes to both see and feel. Patients often may feel that they "Burn through filler" but this is not likely the case, largely when one can no longer feel a mass of filler, they believe it to be gone. But when we use tools such as ultrasound we can often identify the filler still residing in the tissues. Apologies for getting a little long winded and scientific. In your 1st photo day one post treatment, we can see a great deal of inflammation and bruise which adds to the volumized appearance, a photo 3-4 weeks post-treatment is a much better indication of the final outcome. Because after this amount of time inflammation will have settled and filler will have integrated. 
I would like to add that, form the photos, you have beautiful features to your face. I would recommend a consult with an aesthetic doctor focused on skin quality treatments first before re approaching dermal filler options. Skin tightening (morpheus8/facetite), retinol, Profhilo are all excellent options that improve skin quality and will emphasize your naturally beautiful bone structures etc. after skin quality treatments volume replacement for stubborned areas could then potentially be sought out...if needed.
hope that helps 
Dr Dallas Walker

Camille Cash, MD · Answer

There are a few options for you to consider.  The first would be trying a different HA product such as Voluma or Resylane Lyft.  Another option would be Sculptra which works differently than HA fillers.  I have included a video on that product that I hope you find helpful.  Yet another option would be fat grafting.  I encourage you to meet with a board certified plastic surgeon near you to discuss your concerns and learn more about these options.

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! Being a fast metabolizer of filler is definitely a challenge. Have you considered fat transfer? This procedure involves harvesting fat, typically from around the belly button, and processing it into smaller particles which can be placed within the face for volume. This procedure can be done in clinic and the results often last 5-10 years. The appearance is very natural. The face has to be overinflated by 30-50% as we expect some of the fat not to live upon transfer. The final results occur after 1-3 months. A facial plastic surgeon may be a great next step to see if this is an option for you!

Darryl J. Blinski, MD · Answer

Great question! Also even with posting 2 face photos you did not specify exact areas of fillers injected?/amounts in syringes?. In cases as yours, fast metabolizers of HA fillers, I recommend using a combination of Radeisse/Sculptra in 2-3 sessions every 3-6 weeks. Fees based on # of vials/syringes used. For example 10 vials/syringes fee $4,000, 20 of them fee $8,000. Another option is micro/nano fat grafting in 2 sessions, if you have any donor fat? (you appear facially very slender?). Fee $5,000/session.Best to virtual consult with.....

Any hope for those who metabolize fillers too quickly? I spent a few thousand dollars for restalyne and lasted only 4 months.

Answers (12)

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