52, male, premature aging. Filler/other options for fat loss/aged skin? HARMONY CA? (Photo)

Question

I am a 52 year old man. My skin has been prematurely aged through a medication. It is particularly evident on the right side of my face when I smile with dynamic crinkling under my eye and on my cheek. It is much less evident on the left side, possibly because of a slight palsy on this side of my face. I also experienced significant subcutaneous fat loss to my face on stopping the drug and more so in 2024. This again is more evident on the right side. I have been advised that Botox wouldn't be suitable for the dynamic crinkling to my cheeks and that resurfacing also wouldn't address it. During a recent consultation, two different fillers were recommended, the first being Ameela Rejuvenation and the second Harmony CA. The doctor said that the second would be the better option. He said that it was similar to Sculptra but safer re: potential complications. The reason for my posting is to ask the doctors on this site for their opinion regarding Harmony CA and whether they would recommend anything else. The doctor also said that fat transfer could be a longer term solution when asked. Could I also ask if Botox would help the under eye area and whether RF treatments like FaceTite or Morpheus8 could help my skin.

Nelson Lee Novick, MD · Answer

At least from the one photo provided, it would appear that the crinkles are accentuated with smiling Thus the use of a few microdroplets of Botox, a motion-induced wrinkle relaxer, would be a very simple and logical first step toward improvement . I expect is that this would likely prove quite helpful. 
For static wrinkling, i.e. those wrinkles that are already etched into the skin and remain when not smiling, the use of a low viscosity, malleable, cohesive HA filler properly oriented fanned under the wrinkles would provide the necessary infrastructure and support to diminish these.  It's an approach I have been using for many years for this issue with gratifying results So, in short, before going all out and the expense of  going all out, keep it simple. It's Occam's Razor. 
You would be wise to consult with an experienced, board certified cosmetic dermatologist injection expert.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing such detailed information and photos—it really helps to understand your situation. From what you’ve described, your main concerns are asymmetrical aging, volume loss (especially on the right side), and dynamic creasing under the eye and on the cheek due to both medication effects and natural aging.

Regarding the options you mentioned:

1. Harmony CA (or similar poly-L-lactic acid fillers like Sculptra):

Harmony CA works by stimulating collagen over time, which can improve both volume loss and some skin texture.

It’s generally a good option for gradual restoration of midface and cheek volume, especially if you’ve experienced fat loss.

The results take a few months to develop and tend to last longer than hyaluronic acid fillers.

Compared to direct fat transfer, fillers like Harmony CA are less invasive, lower risk, and don’t require a donor site, though fat transfer can offer a more natural and longer-lasting correction if volume loss is significant.

2. Ameela Rejuvenation:

This is typically a hyaluronic acid or similar filler that gives immediate volumization.

It’s useful for targeted areas but may not address overall volume loss as naturally or gradually as Harmony CA.

3. Fat transfer:

This can be a great long-term solution for facial fat loss.

The results can be very natural and lasting, but it is a more invasive procedure and may require multiple sessions to achieve optimal symmetry.

4. Botox under the eye / cheek:

Botox isn’t usually used directly under the eyes for volume loss.

It can help reduce dynamic wrinkling around the crow’s feet area, but for deep creasing from fat loss or skin laxity, it may not be sufficient.

Careful dosing is important near the eyes to avoid functional issues.

5. RF treatments (FaceTite, Morpheus8):

These treatments can help tighten the skin and improve texture and some laxity.

They won’t restore lost volume, but they can complement fillers or fat transfer by smoothing creases and improving skin quality.

Summary:

For your situation, a combination approach often works best: Harmony CA (or similar collagen-stimulating filler) for gradual volume restoration, possibly combined with RF treatments to improve skin texture.

Fat transfer is an option if you want a longer-term solution for more pronounced volume loss.

Botox may help selectively with dynamic wrinkles but won’t restore volume.

52, male, premature aging. Filler/other options for fat loss/aged skin? HARMONY CA? (Photo)

Answers (2)

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